A new study conducted by researchers at Boston Medical Center has found that one in 12 doctors has received money or other compensation from drug companies that market prescription opioid medications. Researchers discovered that, between 2013 and 2015, these companies made more than $46 million in payments to over 68,000 doctors.
The researchers combed databases from the Centers for Medicare and Medicaid Services for details about the payments. This information is available thanks to the Physician Payments Sunshine Act, which is included in the Affordable Care Act and mandates that medical product makers report payments or offerings of value made to doctors and teaching hospitals.
Author Scott Hadland, a pediatrician and researcher, said the next step would be to examine how the payments might be tied to “prescribing practices and overdose deaths.” After all, these deaths are on the rise: over 52,000 people died of drug overdoses in 2015, and that number rose dramatically during the first nine months of 2016, according to the National Centers for Health Statistics. Increases in opioid deaths, particularly from heroin and fentanyl, were primarily to blame for this rise. “It’s very common that the first opioid they’re ever exposed to is from a prescription,” Hadland noted.
The study also found that doctors were paid most for the promotion of fentanyl, an extremely powerful synthetic drug. Typically, fentanyl is used in hospitals to treat cancer patients, post-surgical pain, and in end-of-life situations. The fentanyl that has been involved in increased fatalities, however, is typically manufactured overseas and cut into heroin— but the study also found that companies were not aggressively marketing the tamper-proof versions of pills created to address the opioid crisis.
Hadland explains, “…opioids are being really heavily marketed for pain.” Additionally, family physicians received the highest number of payments from companies marketing opioids, despite opioids typically being acknowledged as a more aggressive way to treat pain. Meanwhile, other methods of pain relief— for example, NSAIDs like ibuprofen— were not marketed as aggressively as opioids, meaning that patients are potentially being prescribed opioids over medications better suited to their condition.
The potential link between doctors and opioid abuse has been explored before. A 2016 study of US states that started monitoring pain prescriptions and the doctors writing them found a 30 percent drop in prescriptions for controlled substances. Yuhua Bao and colleagues at Weill Cornell Medical College said, “This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward.”
The researchers had many theories as to why monitoring programs might reduce opioid prescriptions: “It is possible that the implementation of a prescription drug monitoring program by itself substantially raised awareness among prescribers about controlled substance misuse and abuse and made them more cautious when prescribing pain medications with a great potential for abuse and dependency.” However, they also noted that the feeling of being “watched” might have also deterred some doctors from prescribing opioids.
The Centers for Disease Control says doctors are partially to blame for the increase in opioid deaths, both due to overprescribing the drugs, and enabling people with dependency issues who “doctor-shop.” Additionally, the CDC notes, doctors prescribe opioids to too many patients, often at unnecessarily high doses, and for unnecessary lengths of time.
Michael Botticelli, former director of the White House Office of National Drug Control Policy who is now executive director of the Grayken Center for Addiction Medicine at the Boston Medical Center, notes of the opioid epidemic: “one of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications.” Botticelli suggests, “Education on addiction really needs to happen as part of a core medical school curriculum, core dental school curriculum and nursing school curriculum.”
Whether the payments doctors receive from drug companies marketing opioids influence the rate at which doctors prescribe those drugs remains to be seen. However, there does seem to be some correlation. While companies gave money to doctors from all over the country, many states that recorded the most payments— such as Indiana, Ohio and New Jersey— are also those hit hardest by the opioid crisis. Limiting payouts to doctors, along with monitoring programs and increased education, may prove to be the best way to combat the overprescription of opioids and keep patients healthy.
Fox, Maggie. “Many Doctors Get Goodies From Opioid Makers.” NBC News 10 August 2017.
Fox, Maggie. “To Cut Opioid Abuse, Watch Doctors, Study Says.” NBC News 6 June 2016.
Zezima, Katie. “Study: Doctors Received More Than $46 Million From Drug Companies Marketing Opioids.” The Washington Post 9 August 2017.