Physician-Targeted Marketing Is Associated With Increase in Opioid Overdose Deaths

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Aggressive marketing of opioids has been a core argument of the plethora of court cases filed against opioid drugmakers and distributors. Now, a report from the NYU School of Medicine and Boston Medical Center lends evidence to that legal argument.

The report, released late last week, showed that “increased marketing of opioid products to physicians -- from consulting fees to free meals -- is associated with higher opioid prescribing rates and elevated overdose deaths in the U.S.” The data was published in JAMA Network Open on Jan. 18.

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The investigation found that $39.7 million in opioid marketing was distributed to almost 68,000 physicians in 2,208 U.S. counties. The marketing tools included payment for physician meals, travel costs, speaking fees, consulting fees and honoraria. Magdalena Cerdá, associate professor of Population Health and director of the Center for Opioid Epidemiology and Policy at NYU School of Medicine and the study's senior author, said that the data suggests when physicians are targets by opioid marketing specialists, they tend to prescribe more opioids. The U.S. counties that saw the heaviest marketing efforts saw an increase in the prescribing of opioids and an increase in opioid deaths.

The increased prescribing of opioids has had an impact on opioid-related deaths, Cerdá said. About 116 Americans die daily from opioid overdoses, which includes illegal narcotics like heroin and fentanyl. Prescription opioids contribute to more than 17,000 overdose deaths annually, according to the report.

According to the report, researchers found that the marketing effort from the companies to physicians was “more strongly associated with overdose deaths than the amount spent.” The authors said that for every three additional payments made to physicians per 100,000 people in a county, opioid overdose deaths were 18 percent higher. While opioid prescribing rates in the U.S. have fallen since 2010, current prescribing rates remain three times higher than they were in 1999, and counties in states experiencing high opioid-related overdose rates, such as Kentucky, Tennessee and West Virginia, also have some of the highest rates of opioid prescribing.

The study measured the marketing of opioids in three different ways -- the total dollar value of marketing received by physicians; the number of payments made by the pharmaceutical industry; and the number of physicians receiving any marketing. One interesting finding of the study shows that small marketing efforts, such as taking out a physician for a meal multiple times was more effective in increasing the prescribing of opioids than one significant financial payment.

Scott Hadland, a pediatrician and addiction researcher at Boston Medical Center's Grayken Center for Addiction and lead author of the study, said that opioid marketing efforts were aimed at one in 12 physicians in the United States. For family physicians, the marketing rate was one in five, according to the study.

“Our findings suggest that direct-to-physician opioid marketing may run counter to national efforts to reduce overdose deaths, and that policymakers should consider limits on marketing as part of a robust, evidence-based response to the U.S. overdose crisis,” Hadland said in a statement.

The researchers were able to link overdose data for U.S. counties from 2014 to 2016 with marketing data. They found that the mean overdose mortality rate was 6.5 per 100,000 person-years across counties based on data from 2014 to 206. At the same time, mean marketing per county was valued at $732 monthly dollars, and accounted for a mean of 7.6 monthly payments distributed to a mean of two physicians monthly, the study showed.

It is unknown at this time how the study information may be used in the multiple lawsuits against the pharmaceutical companies. Last year BioSpace highlighted a number of the lawsuits that have been filed against the opioid-makers. The arguments cited in the lawsuits typically say that the companies, such as Purdue, engaged in deceptive marketing practices that contributed to high addiction rates.

While the study paints the pharma companies in a poor light due to their marketing efforts, there are some limitations, which the authors address. While the study examined that outcome or deaths related to prescription opioids, many deaths are related to illegal opioids, or opioid use in combination with other substances. The data sources used do not allow differentiation between prescribed opioids and those that are acquired illicitly, the authors noted.

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