The Role of Physician-targeted Drug Marketing in Opioid Overdose Deaths

A recent study published in JAMA Network Open identified a correlation between drug marketing targeting physicians and an increase in opioid prescribing and overdose deaths.

The researchers evaluated data on all counties in the United States pertaining to overdoses from Aug. 1, 2014, to Dec. 31, 2016, and its connection with marketing data from Aug. 1, 2013, to Dec. 31, 2015. They queried the Centers for Medicare & Medicaid Services Open Payments database and the Centers for Disease Control and Prevention for the information.

A total of $39.7 million was spent on opioid marketing not related to research that reached 67,507 physicians spanning 2,208 counties. An uptick in opioid overdose deaths was observed with each 1-SD increase in marketing value in dollars per capita (adjusted relative risk [aRR], 1.09; 95% CI, 1.05-1.12), number of payments to physicians per capita (aRR, 1.18; 95% CI, 1.14-1.21), and number of physicians receiving marketing per capita (aRR, 1.12; 95% CI, 1.08-1.16), according to the authors. There was also an upward trend associated with opioid prescribing rates and marketing.

“Today, opioid-related overdoses in the United States increasingly involve heroin, illicitly manufactured fentanyl, and numerous other substances such as alcohol, benzodiazepines, and cocaine,” the researchers wrote. “Nonetheless, the United States continues to vastly exceed the rest of the developed world in opioid prescribing, and many individuals with opioid use disorder are first introduced to opioids through a prescription. Our findings suggest that direct-to-physician opioid marketing may counter current national efforts to reduce the number of opioids prescribed and that policymakers might consider limits on these activities as part of a robust, evidence-based response to the opioid overdose epidemic in the United States.”

Because opioid overdoses often involve other drugs, targeting the problem requires a multi-faceted approach, said Jordan Trecki, PhD, Drug & Chemical Evaluation Section, Diversion Control Division, Drug Enforcement Administration, in an accompanying editorial.

“The combination of pharmaceutical marketing in combination with excessive inappropriate prescribing by physicians could be viewed as one of the root causes of the current opioid epidemic,” Trecki wrote, adding, “It is clear that a variety of approaches will be necessary to control this epidemic.”

“Prescription opioids contribute to more than 17,000 overdose deaths annually in the U.S. Our findings suggest an urgent need to examine the role the pharmaceutical industry marketing plays in the national opioid crisis,” said senior study author Magdalena Cerdá, DrPH, associate professor of Population Health and director of the Center for Opioid Epidemiology and Policy, NYU School of Medicine, in a press release. “Data suggest that when physicians are targeted in opioid marketing, they prescribe more opioids. This, consequently, impacts on opioid overdose deaths.”

Researchers had previously been focused on more upscale interactions between pharmaceutical companies and doctors, but often the gestures are small, according to lead author Scott Hadland, MD, MPH, MS.

“We’ve had our eyes on these drug companies making large dollar payments—often tens or hundreds of thousands of dollars—to these doctors, yet the public health problem appears to be driven by the subtle acts and the very widespread meals affecting a very large number of doctors,” Hadland, who works in the pediatrics department at Boston University School of Medicine, Boston, Massachusetts, told Reuters.

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Source: JAMA Network Open