Dollar amount of marketing to physicians less important than number of interactions
By Elizabeth Hlavinka, Staff Writer, MedPage Today
Doctors more frequently prescribed opioids in counties with more direct-to-physician marketing of opioids, according to a population-based, cross-sectional study.
Across over 2,000 U.S. counties, prescribing rates were tied to opioid marketing across three measures — the number of total payments, the total dollar amount spent, and the number of doctors receiving payments per capita. The latter showed the strongest association, with prescribing rates increasing with every 1-SD increase (adjusted relative risk [aRR] 13.59, 95% CI 11.48-15.71), reported Scott Hadland, MD, MPH, MS, of the Boston Medical Center, and colleagues.
The number of overdose mortalities was also associated with the marketing of opioids across all three measures, with overdose mortalities most strongly associated with the number of marketing interactions as well (aRR 1.18 for each 1-SD increase, 95% CI 1.14-1.21), they wrote in JAMA Network Open.
The dollar amount spent on marketing had the weakest association with both opioid prescribing rates (aRR 1.82, 95% CI 1.00-2.65) and opioid-related mortalities (aRR 1.09, 95% CI 1.05-1.12) for each 1-SD increase, according to the study.
“A lot of national attention has been paid to drug companies paying large amounts of money to doctors to promote their product, but what’s actually much more widespread, legal, and occurring practically all across the U.S. is much lower cost meals that drug companies offer to doctors,” Hadland said in an interview in which a media relations representative was present. “That actually seems to be the more important factor of prescribing and potential overdose deaths.”
Boris Tabakoff, PhD, a pharmacology researcher at the University of Colorado, said that certain states are now putting forward penalties regarding the marketing of opioid products to doctors. Last year, New Jersey set limits on the number of manufacturer gifts and payments that can be given to prescribers. More recently, Massachusetts filed a lawsuit against Purdue Pharmaceuticals, alleging that the company established tight relationships with academic centers in order to increase physician prescribing habits and influence medical students’ attitudes toward the painkillers.
In addition to regulating the quantity of marketing, the nature of these tactics should also be monitored, he said.
“These individuals that go out are called detail men, and they should live up to their names,” Tabakoff told MedPage Today. “They should detail not only the benefits of the product that they’re trying to have the physician prescribe but also the side effects and dangers.”
Tabakoff noted that because the data in this study did not indicate deaths in which other substances — such as heroin, fentanyl, or alcohol — were involved, it’s likely that many of the individuals died in this sample because of drug interactions.
To conduct their study, the researchers obtained data from two CDC databases on the number of national overdose deaths and prescribing rates by county, and the Centers for Medicare & Medicaid Services Open Payments database to examine pharmaceutical marketing payments targeted toward physicians. The authors used a 1-year lag time between mortality rates and marketing in order to combat possible reverse causation.
Jordan Trecki, PhD, of the Drug Enforcement Administration in Washington, noted in an accompanying commentary that not only did pharmaceutical companies actively market opioids to physicians with a propensity to prescribe opioids, they also appear to have targeted geographical areas where patients were more likely to become dependent on them.
Indeed, the highest rates of marketing were focused in coastal areas and the Northeast, which could reflect these areas having a higher proportion of practicing physicians, or a higher number of patients with health insurance.
“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.
In total, the researchers found 434,754 opioid marketing payments totaling $39.7 million, which were distributed across 67,507 physicians in 2,208 U.S. counties.
The authors noted several limitations to the study, one of which was that long-term trends were unavailable since marketing data on this subject has only recently been published. They also acknowledged that some industry payments recorded in this study may have included educational materials to promote safer prescribing practices.
The authors received grants from the NIH/National Institute on Drug Abuse for this study.
Two authors received grants from the Thrasher Research Fund and the Academic Pediatric Association as well.
No other disclosures were reported.