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Do free meals to physicians affect opioid prescribing?



– Physicians who receive gifts and free meals from opioid manufacturers prescribe more opioids than do their counterparts, a new study suggests.

A sampling of doctors who reported marketing payments or gifts prescribed more of the drugs the following year even as their colleagues prescribed fewer. Researchers also found signs of a dose-effect relationship between more free meals received and more opioid medications prescribed.

The findings, presented at the annual meeting of the College on Problems of Drug Dependence and recently published, do not prove a link between free meals and the massive, deadly opioid epidemic. And the purpose of pharmaceutical marketing, of course, is to persuade physicians to prescribe medications, the researchers noted. The report was published in JAMA Internal Medicine.

Still, in light of the opioid epidemic, “there’s a national effort to reduce overprescribing. Our database suggests that the pharmaceutical industry may be a counterforce,” lead author and pediatrician Scott E. Hadland, MD, MPH, of Boston University, said in an interview.

The findings suggest “it doesn’t take much money to get doctors to potentially prescribe more opioids,” he added.

Dr. Scott E. Hadland of Boston University

Dr. Scott E. Hadland

According to data from the Centers for Disease Control and Prevention, a record number of people – 52,404 – died from drug overdoses in 2015, and nearly 13,000 of the deaths were attributable to prescription drugs (natural or semi-synthetic). An estimated 12.5 million people aged 12 and older in 2015, meanwhile, recently had misused prescription pain relievers.

For the new study, Dr. Hadland and his colleagues sought to understand whether opioid marketing in 2014 influenced prescribing in 2015.

The researchers retrospectively tracked 369,139 physicians in a Medicare Part D database who prescribed opioids in 2015 and found that 7% reported receiving opioid marketing – speaking fees ($6.2 million), meals ($1.8 million), travel ($731,000), consulting fees ($290,000), and education ($80,000).

Overall, those who received marketing had an adjusted 9% relative increase in claims (2015 vs. 2014), compared with those who had not received marketing.

“The effect is very subtle,” said Dr. Hadland, an addiction medicine specialist at the university. “Nine percent does not seem like a large number, but when you’re talking about hundreds of thousands of physicians, that’s a large number of opioids being prescribed.”

The study takes only Medicare Part D opioid prescriptions into account, and includes only about 42% of the active national physician workforce, he noted.

The researchers linked rising numbers of meals received in 2014 per physician – from 1 to more than 10 – to a steady increase in the number of opioid claims per physician. For example, physicians who received 1 meal made about 150 opioid claims, while those who received more than 10 made more than 700 claims.

As for physician motivations, Dr. Hadland said, he doesn’t believe “this is intentional for most physicians. If you asked the vast majority of physicians in our study, ‘Do you believe marketing is influencing your prescribing?’ most would say no.”

But the findings, he said, still raise questions.

Going forward, researchers plan to study the effect of opioid marketing on public health, he added.

Dr. Hadland reports funding from the National Institute on Drug Abuse, Society for Adolescent Health and Medicine, Thrasher Research Fund, and Academic Pediatric Association. Another author reports funding from NIDA. No additional relevant disclosures were reported.

SOURCE: Hadland SE et al. JAMA Intern Med. 2018 Jun 1;178(6):861-3.

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