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How pharmaceutical companies caused the opioid epidemic, in a diagram



Physicians who only received an additional meal from an opioid company reported more opioids than physicians who received fewer free meals, according to a new research letter published in JAMA Internal Medicine ] The study Researchers Scott Hadland, Magdalena Cerdá, Yu Li, Maxwell Krieger, and Brandon Marshall show how dodgy marketing practices by opioid companies have contributed to the opioid epidemic in America that kills tens of thousands of people in the US every year

The study examined the Open Payments database, which was used in 2014 to make payments for non-research to physicians. She then compared this data with information in the Medicare Part D Opioid Prescriber Summary File from physicians who wrote Opioid Recipes in 201

5, "All physicians with complete, non-duplicated information who had at least 10 opioid claims in 2015."

The results are striking. Here is a table that examines the number of meals that doctors received from opioid companies in 2014, and the number of opioid prescriptions that doctors wrote the following year:


  A table showing the number of meals The doctors of opioids received companies in 2014 and the number of opioid prescriptions doctors wrote the following year.

JAMA Internal Medicine

Every meal paid by pharmaceutical companies seems to have made a difference, resulting in more opioid claims. (Pharmaceutical companies usually set up these meals through direct contact with doctors or their staff – by telephone, face-to-face visits, meeting with clinicians at conferences, etc.)

The graphic captures only part of the story. Opioid companies have also charged physicians with fees, free travel, counseling fees, and educational programs. In general, more non-research payments were correlated with more opioid prescriptions next year.

One company, Insys Therapeutics, accounted for half of these payments, according to the study. Insys has been under pressure since 2014, including through a Senate investigation into its extremely aggressive marketing for its fentanyl product Subsys. Founder John Kapoor and other executives were arrested for their dubious practices. Insys claims it has changed since then.

A limitation of the study: Not every doctor who prescribed Opioide received a free meal or any other payment from opioid companies. Only seven percent of physicians who prescribed opioids under Medicare Part D received non-research payments for opioid products in 2014, the researchers said.

The researchers also found that they found only correlations, not causality, causality, because physicians receiving industry payments may be predisposed to prescribe opioids. Our results are related, not cause and effect. "

However, the results are certainly suggestive, and in recent years we have received more and more reports of opioid companies aggressively marketing their products to physicians – and this seems to have led to more opioid prescriptions and overdose deaths.

Opioid Companies Aggressively Market Their Products

Evan Hughes in the New York Times magazine has a great review of Insys' previous marketing strategy, which involved paying for lecture events, often from a nice dinner with the seller and maybe the support staff of the doctor and friends existed, but no other licensed prescriber was present to learn about the drug. "The company apparently could not even bother to pay for their spokespeople a wrong audience.

A Los Angeles Times study by Harriet Ryan, Lisa Girion, and Scott Glover examined the aggressive marketing tactics of Purdue Pharma, manufacturer of OxyContin. They found that Purdue was tempting doctors about the effectiveness of OxyContin, claiming that it could take 12 hours.

"Even before OxyContin was launched, clinical trials showed that many patients did not receive 12-hour relief," said Ryan, Girion, and Glover. "Since the drug's debut in 1996, the company has been faced with additional evidence, including complaints from physicians, reports from its own sales staff, and independent research."

Claiming 12-hour relief was crucial to Purdue's competitive advantage. If OxyContin really did not provide 12-hour relief, then it was no more effective than other similar painkillers on the market.

However, given this evidence, Purdue remained with his claim for years. And it told the doctors that if the patients did not see the promised results, the problem would be that the doses were too low. This is an alarming result for public health: as the Centers for Disease Control and Prevention warned, higher doses increase the risk of overdose and addiction.

Nevertheless, the company celebrated its profits. A sale note unveiled by the Los Angeles Times literally said, "$$$$$

Other companies, such as Teva Pharmaceuticals and Janssen Pharmaceuticals, also participated in some of the aggressive marketing efforts for opioids, as the JAMA Internal Medicine study has shown.

The results: Opioid analgesics grew in the US. The drugs did not just end up in the hands of patients, but also of teenagers digging through their parents' medicine cabinets, friends and relatives receiving the drugs from patients, and a black market selling them for a huge price could sell. For a large part of the opioid epidemic, painkillers were the leading cause of drug overdose deaths, and most opioid-dependent people started taking painkillers.

This has changed in recent years as illegal opioids, especially heroin and fentanyl, have become major causes of overdose deaths and a more common starting point for opioid dependence. Painkillers, however, were the main cause of the current opioid crisis, which favored increased abuse and dependence on the drugs.

Given all this, there have been hundreds of lawsuits from governments and others against opioid companies. A judge in Cleveland is consolidating these cases to reach a massive settlement agreement. The hope is that an agreement would not only curtail the commercialization of opioid companies, but would also lead to a financial regulation that would fund addiction treatment in the US – both of which could help reverse the opioid crisis.

More about the lawsuits against opioid companies, read Vox's Explainer.


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