It has long been known that the payments from pharmaceutical companies to doctors influence the number of opioid prescriptions they write. But a Friday-released study offers the first suggestion that they may also be related to an overdose surcharge in their community.
Aggressive marketing of prescription-only drugs over the past 20 years has been widely blamed for the dizzying death toll of the opioid epidemic. But little research supported that claim.
The new study, published in JAMA Network Open, shows that provinces that receive such payments later experience higher death rates from overdoses – even when researchers are checked for many other possible influences.
The research proved no cause-effect relationship; the link between the two is an association.
The study also suggests that consistent, confidence-building visits – such as periodic lunches sponsored by drug vendors – do more to promote the prescription of a company's drugs than high-dollar payments to doctors.
"What mattered most was not the amount of money that doctors received, the number of times they were paid," said Magdalena Cerdá, an associate professor of public health and director of the Center for Opioid Epidemiology and Policy at the NYU School of Medicine .
Michael Barnett, an assistant professor of health policy and management at Harvard T.H. Chan School of Public Health, who studied the role of physicians in the opioid epidemic, called the findings "deeply troubling for the furious [opioid] crisis of which we are all aware. & # 39;
The annual number of prescriptions for painkillers such as oxycodone, hydrocodone and methadone has decreased in recent years because doctors, states and public health authorities have responded to the opioid epidemic.
Nevertheless, overdoses of these drugs killed almost 18,000 people in 2017, according to the Centers for Disease Control and Prevention, even if illicit fentanyl has become the main cause of the opioid crisis.
Prescription painkillers – instead of heroin or fentanyl – are often the first opioid to which consumers are exposed.
Previous research has linked the marketing of pharmaceutical companies to opioid prescribing, but the researchers said their study was the first to extend the comparison to deaths from overdose.
The new study corresponded to federal data on overdose deaths in each province from 1 August 2014 to 31 December 2016, with payments to physicians for meals, speaking, consulting and traveling for the period from 1 August 2013 to 31 December 2015.
The one-year time delay was an attempt to ensure that payments affected prescribing, rather than high-prescribers who would attract larger payments from pharmaceutical companies.
In March, Harvard researchers and CNN released an analysis that showed that physicians who had prescribed more opioids were attracting more payments from drug companies.
Barnett said that no matter how the payments work, they are influential. Known in the trade as "detailing", these efforts affect the decision-making by the prescriber, he said.
"What it does is, it creates a consciousness … It will come closer to the top of your mind, it's just easier to reach out to them," said Barnett.
The new study found 434,754 payments for a total of US $ 39.7 million to 67,507 physicians – about 1 in 12 physicians. Researchers found that 1 in 5 GPs had received this type of marketing.
"Provinces that received such marketing later experienced increased mortality," they wrote.
"Moreover, opioid prescription rates were strongly associated with the burden of opioid marketing."
In the majority of the country, this type of marketing is legal and unlimited.
Another author of the research, Scott Hadland, a pediatrician and researcher at the Grayken Center for Addiction at the Boston Medical Center, says drug representatives play a legitimate role in informing physicians about medicines.
But he said that doctors have other ways to learn about drugs such as conferences and continuing education courses. To reduce deaths from overdose, doctors, pharmaceutical companies and the government can regulate marketing, he said.
In 2017, New Jersey introduced a regulation that excludes the amount of marketing funds that doctors can receive from pharmaceutical companies. And last year, Purdue Pharma, the maker of OxyContin, stopped marketing opioids for doctors.
The Pharmaceutical Research and Manufacturers of America, the major trade group for the pharmaceutical industry, said in a statement that prescribers involved in the management of patients with pain "should be informed about the fundamentals of acute and chronic pain management, the range of available treatment options and relevant benefits and risks. "
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