MONDAY, May 14, 2018 (HealthDay News) – Doctors who accept benefits from companies that manufacture opioid painkillers are more likely to prescribe medicines for their patients, new studies said.
The money in question paid the doctors meals, consulting and speaking fees as well as travel expenses.
Typically, physicians receive less than $ 1,000 a year, said lead investigator Drs. Scott Hadland. Less than 2 percent of physicians receive more than that, so many physicians "probably believe that such relatively small amounts do not affect their practice," he added. "The data shows it's easy."
The PhRMA Pharmaceuticals Trade Group (PhRMA) did not comment on the findings.
Hadland said that the opioid prescription rates among physicians who received these benefits averaged about 9 percent in the year after the payment. Opioid analgesics include oxycontin and vicodin.
"Unlike previous research focusing on the impact of large payments on a small group of physicians, what we found is much more subtle but much more widespread, involving many physicians," said he.
"And while we see a trend for a small decline in opioid prescriptions now being written by doctors, that's not the case for doctors receiving an opioid marketing payment," added Hadland. Their opioid prescription rates rose, he said
Hadland is an addiction expert with the Grayken Center for Addiction at the Boston Medical Center. He and his colleagues reported in a letter published online on May 1
Researchers indicated that 40 percent of all overdose deaths in the US are due to prescription opioids
And despite the recent drop in prescription rates overall, the number of prescriptions issued in 2015 was three times higher than in 1999.
A federal database review found that around 369,000 physicians prescribed opioids to Medicare beneficiaries in 2015. Of these, 7 percent in 2014 had accepted more than 105,000 different opioid-related marketing payments, which added up to more than $ 9 million
About half of all payments came from a single pharmaceutical company: INSYS Therapeutika. The company manufactures a single opioid spray drug called Subsys, approved in 2012 by the US Food and Drug Administration for cancer pain. The spray contains fentanyl, a particularly potent and often deadly synthetic opioid.
Other large pharmaceutical companies in 2014 included Teva Pharmaceuticals USA and Janssen Pharmaceuticals, which spent approximately $ 869,000 and $ 854,000 on physicians, respectively. 19659002] Doctors who did not receive any payments in 2014 prescribed fewer opioids in 2015. But those who took money prescribed more, found the investigators.
Meals accounted for more than 90 percent of the value of such payments, with each meal associated with a 0.7 percent increase in opioid prescriptions, as the results showed. "But it was cumulative," Hadland explained. "Each meal resulted in an additional 0.7 percent increase and many doctors were discharged more than once, so it can add up."
And while a total of physicians spent 0.6 fewer opioid prescriptions in 2015 than in the US The year before, those who had received marketing payments had issued about two more prescriptions over the same period.
"So patients need to know that doctors get this marketing and that if they are prescribed an opioid, opioid option may be preferable," Hadland added.
Dr. David Katz, director of the Yale University Prevention Research Center at Griffin Hospital in Derby, Connecticut, said the results were "the furthest from surprising".
According to Katz, "marketing is practiced because it works."
But he noted that the study does not prove cause-and-effect, and physicians who make such payments can simply treat more pain patients or those who are most likely to prescribe opioids.
"The other possibility is more worrying, and monetary incentives may encourage opioid dependence when other approaches to pain therapy work just as well or better and fuel the opioid crisis," Katz suggested.
"This study invites us to take care of the latter, and to clarify it with further research, even though alternatives to opioids are routinely taught and promoted." 19659002 Julie Donohue, Co-Director of the Center for Pharmaceutical Policy and Prescribing The University of Pittsburgh, agreed that the study does not call for benefits, prompting doctors to prescribe more opioids.
But in the context of an opioid epidemic that kills more than 60,000 people each year, "we have good reason to believe that the promoted ion industry influences prescribing behavior," she said.
What to do, "Transparency is probably not enough," Donohue said.
"Some academic medical centers have introduced much more stringent practices to limit industry contact," she said.
There is more on the opioid epidemic at the American National Institute on Drug Abuse.
SOURCES: Scott Hadland, MD, MPH, MS, pediatrician and addiction expert, Grayken Center for Addiction and Department of Paediatrics, Boston Medical Center and Boston University School of Medicine; David Katz, MD, MPH, Director, Yale University Prevention Research Center, Griffin Hospital, Derby, Connecticut; Julie Donohue, Ph.D., Co-Director, Center for Pharmaceutical Policy and Prescription, University of Pittsburgh; May 14, 2018, JAMA Internal Medicine online