Why drug firms paying doctors could be a factor in overdoses

Drug company payments to doctors may influence not just how many opioid prescriptions they write but the overdose death toll in their communities, according to a new study released Friday. Aggressive marketing of prescription narcotics over the past 20 ye

The findings

The new study, published in JAMA Network Open, shows that counties receiving such payments later experience higher death rates — even when researchers controlled for many other possible influences.

The study did not prove a cause and effect relationship; the link between the two is an association.

The study also suggests, surprisingly, that consistent, trust-building visits — such as periodic lunches sponsored by drug sales reps — do more to promote prescribing of a company’s drugs than high-dollar payments to physicians.

What they mean

“What seems to matter most wasn’t the amount of money doctors were paid, it was the number of times they were paid,” said Magdalena Cerdá, an associate professor of population 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 the Harvard T.H. Chan School of Public Health who has studied the role of physicians in the opioid epidemic, called the findings “deeply concerning for the raging [opioid] crisis that we’re all quite aware of.”

Behind the numbers

The annual number of prescriptions for painkillers such as oxycodone, hydrocodone and methadone has declined in recent years as physicians, states and public health authorities have responded to the opioid epidemic. Still, overdoses from those medications killed nearly 18,000 people in 2017, according to the Atlanta-based Centers for Disease Control and Prevention, even as illicit fentanyl has become the main driver of the opioid crisis.

The new study found 434,754 payments totaling $39.7 million to 67,507 physicians — about one in every 12 doctors. Researchers discovered that one in every five family physicians had received this kind of marketing.

“Counties receiving such marketing subsequently experienced elevated mortality,” they wrote. “In addition, opioid prescribing rates were strongly associated with the burden of opioid marketing.”

Opioid overdoses killed nearly 18,000 people in 2017, the CDC says.