Lauren Vogel | CMAJ | January 29, 2019
Areas where opioid marketing to doctors was more aggressive saw higher rates of opioid prescribing and deaths.
Doctors may think free pens or lunches from pharmaceutical companies have no effect on their behaviour. But a recent study suggests that even small freebies may contribute to physicians’ opioid-prescribing habits.
The study, published in JAMA Network Open, found a strong association between aggressive marketing of opioids to doctors in the United States and increases in opioid prescribing and overdose deaths. Last year, more than 72,000 Americans and nearly 4000 Canadians died from opioid overdoses. “Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted,” the study authors wrote.
Drug companies spent US$39.7 million promoting opioids to more than 67,500 US doctors between 2013 and 2015. Roughly 1 in 12 doctors received opioid-related marketing during that period, including 1 in 5 family doctors. Counties where doctors received marketing saw subsequent increases in opioid prescribing and opioid-related deaths. Researchers also found that the rates of prescribing and deaths were higher in areas where marketing was more concentrated. This held across multiple measures, including the amount companies spent on opioid promotion to doctors, the frequency of pharma–physician interactions, and the number of doctors reached.
Notably, how often a company spent money on a doctor seemed to have more influence than how much was spent. According to the authors, “the greatest influence of pharmaceutical companies may be subtle and widespread, manifested through payments of low monetary value occurring on a very large scale.” This may be undermining efforts to curb industry influence, which tend to focus on capping total payments to physicians, they warned. “Because most marketing interactions with physicians involved meals that typically have a low monetary value, a high dollar cap would affect only a minority of prescribers.”
The authors cautioned that the study does not differentiate between appropriate and inappropriate prescribing, or whether deaths involved prescription or illicit opioids. However, they noted that prescription opioids are involved in 40% of opioid overdoses and are frequently the first opioids that people use. And despite a drop in opioid prescribing in the US since 2010, current rates remain three times higher than in 1999 and have not decreased as quickly in areas that have suffered the most overdose deaths.
Hundreds of local governments and more than 20 states in the US have taken legal action against drug makers for their role in the crisis. In 2007, Purdue Pharma executives pleaded guilty to criminal charges that they misled doctors and patients about the addictive potential of the opioid OxyContin.
Last May, a Toronto Star investigation found Purdue had spent nearly three-and-a-half times more on marketing to Canadian physicians than it had to US prescribers. Canadian physicians and researchers have since called on the federal government to undertake a criminal investigation into the marketing of opioids to doctors.
In the summer of 2018, Health Canada asked more than 100 industry players to cease promoting opioid to health professionals as it works on new regulations. By the fall, only a quarter of the companies had responded and just six, including Purdue, agreed to stop promotions.
Photo credit: Ridofranz/iStock
Connect with CMAJ