It’s been an infuriating week on the opioid news front. Just days ago, the New York Times reported on court documents revealing how the Sackler family, which owns the company that makes OxyContin, pushed doctors to prescribe more and more dangerous opioids, urging “that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid painkiller because it was the most profitable.” Today, a study published in JAMA Network Open reveals exactly how that kind of pressure works—and how well it works.
As the New York Times’ reported, the study found that “for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher.” Over two years, the study said, “$39.7 million in opioid marketing was targeted to 67 507 physicians across 2208 US counties,” with 434,754 total payments made. One of the counties with high levels of physician payments and opioid deaths was Cabell County, West Virginia, which the Times said has “one of the highest overdose death rates in the nation,” though its overdose totals dropped 40 percent in 2018, according to the Herald-Dispatch. Still, the 95,000-person county was seeing “an average of three emergency calls a day” for overdoses, the paper reported.
The data on these payments comes from the Open Payments database and includes things like “meals, travel costs, speaking fees, honoraria, consulting fees, or educational costs.” These kinds of payments are commonplace in the medical business (and it is a business, unfortunately): A 2017 study found that about half of doctors received payments from pharmaceutical companies. And these companies spend more on marketing than they do on research and development, despite critics’ claims that Medicare for All would kill pharmaceutical “innovation.”
These payments, as you’d expect, affect prescribing habits, meaning doctors might end up prescribing a drug that isn’t best for their patient or that costs more than an equally-effective alternative. A smaller-scale study from Boston Medical Center’s Grayken Center for Addiction in March 2018 found that doctors who received meals from pharma companies prescribed 9 percent more opioids. Another study found that meals with a rep from Pfizer increased prescriptions of their two cholesterol drugs, Lipitor and Crestor, by 73 percent. Yet another study, from 2016, found that doctors were “up to two times as likely to prescribe the promoted brand-name drugs as physicians who received no meals.” Brand-name drugs are much more expensive than generic drugs—and those drugs are how big pharma makes its massive profits.
Meanwhile, a JAMA study last year found that one in five young people who died in 2016 died from an opioid overdose, and the National Safety Council said this week that the odds of dying of an opioid overdose are now higher than the odds of dying in a road accident.
The Times noted that both opioid prescriptions and payments to doctors are falling, thanks in part to more public scrutiny of these companies’ actions. And it’s important to remember that 80 percent of opioid users were not prescribed the drugs themselves, instead obtaining them from others—though often from those with prescriptions.
The study is an indictment of America’s sick healthcare system more broadly. It’s appalling to think that these companies, with billions in sales each year, spend millions on pushing doctors to prescribe dangerous drugs. And it’s appalling to think about the position this practice in general puts patients in: not knowing whether their doctor is only thinking of what’s best for them medically or who bought them their last steak dinner. There’s no reason to allow pharmaceutical payments to doctors to continue, and today’s study makes clear: banning these payments could save lives.