One
in twelve doctors accepts payment
from pharmaceutical companies related to opioids
Boston University Medical Center
This is the first large-scale, national study of industry payments involving opioids and suggests that pharmaceutical companies may have a stronger hold than previously known on how doctors prescribe the powerful drugs. The study results are published online ahead of print in the American Journal of Public Health.
Using Centers for Medicare and Medicaid Services data, researchers identified 375,255 non-research, opioid-related payments to 68,177 physicians between August 2013 and December 2015 totaling over $46 million.
Payments are defined as "transfers of value" -- which could be direct money to physicians, a reimbursement for travel, speaking or consulting fees, education or meals. The average payment to physicians was $15, with most receiving one payment per year.
However, the top one percent of doctors collectively received more than $38 million (82 percent of the total) and averaged more than $2,600 in yearly payments during the study period.
The Physician Payment Sunshine Act, passed under the Affordable
Care Act in 2010, requires drug companies to report all payments to physicians
in the United States. Previous research suggests that payments from drug
companies may lead to increased prescribing by doctors for marketed
medications, even when payments are of low monetary value such as for meals.
"Even though most payments were small, they add up to a
shocking number and may have a wide-reaching influence on physician behaviors.
We need to take a hard look at how the pharmaceutical industry may be
influencing care and prescribing at the ground level," said Scott Hadland,
MD, MPH, pediatrician and adolescent addiction specialist who led the study.
Speaking fees accounted for the largest amount of payments and
food/beverage payments were the most frequent. Anesthesiologists received the
most in total annual payments, but the largest number of payments went to
family medicine physicians.
"There's no denying that we have a widespread and
systematic problem," said Michael Botticelli, executive director of the
Grayken Center for Addiction Medicine and former director of the White House
Office of National Drug Control Policy under President Obama.
"Pharmaceutical companies should take responsibility for how these
payments are contributing to the growing epidemic. Physicians also have a role
to play by prescribing judiciously and advancing safe opioid prescribing
education on the front lines."
Study authors note that payments related to marketing opioids
may run counter to national efforts to reduce excess opioid prescribing. They
suggest policymakers consider whether caps should be imposed on certain
payments as one possible solution and encourage future research to examine
whether payments are related to opioid misuse and overdose.
"The opioid epidemic, which is responsible for thousands of
deaths every year, is a national tragedy that we must work at every level to
combat. It's our hope that this study sparks a bigger conversation about the
role of pharmaceutical companies in the over-prescribing of opioid medications,
and prompts a more thorough investigation about what we need to do to tackle
this problem," said Brandon Marshall, PhD, associate professor of
epidemiology at the Brown University School of Public Health, who served as the
study's senior author.