Opioid Related Deaths and Pharmaceutical Drug Marketing– Is There a Link?

by | Feb 18, 2019 | 2018, Pharmaceutical Hazards

Written by Joyce Smith, BS. This study correlates the direct-to-physician marketing of opioids by the pharmaceutical companies with increased deaths from opioid prescription overdoses.

health hazardsFrom 1999-2017, almost 400,000 people died from an overdose involving any opioid, including prescription and illicit opioids. 1 In 2017, 47,600 deaths occurred (67.8% from drug overdoses) according to the CDC. 2 Although heroine and synthetic drugs factored in, prescription opioids counted for 40% of all opioid overdoses. 1

To what extent is the pharmaceutical industry marketing of opioids to physicians associated with mortality from prescription opioid overdoses? To answer this question, researchers, using a population-based cross-sectional study, investigated the association between direct-to-physician marketing of opioid products by pharmaceutical companies and prescription opioid overdose mortality across the US. 3 They linked county-level information from August 2013 to December 2016 across the following three national databases:

  • CDC Opioid Overdose Mortality Rates 2
  • Centers for Medicare & Medicaid Services Open Payments Database (Includes all payments made to physicians by pharmaceutical companies which are required to report under a section of the Affordable Care Act) 4
  • CDC Data on Opioid Prescriptions (dispensed at pharmacies) 5

Included also for analysis were marketing types and locations of physician practices.

Results revealed that between August 1, 2013, and December 31, 2015, $39.7 million in opioid marketing was linked to 67,507 physicians across 2,208 US counties. This increased opioid marketing at a county level was associated with elevated overdose mortality one year later, an association that was related to opioid prescribing rates. Specifically, the prescribing rates and subsequent overdose deaths involving prescription drugs were more strongly associated with the number of marketing interactions with physicians per capita than the dollar value of marketing. For every three additional payments made to physicians per 100,000 people in a county, opioid overdose deaths were up 18%.

This cross-sectional study can provide associations only and cannot prove causality. The study was also not able to evaluate long-term trends and whether other drugs or substances such as synthetic drugs, benzodiazepines, or alcohol contributed to the overdoses. 6 However, the study does suggest that “direct-to-physician opioid marketing may counter current national efforts to reduce the number of opioids prescribed 7 and that policymakers might consider limits on these activities as part of a robust, evidence-based response to the opioid overdose epidemic in the United States. Policy makers should hold pharmaceutical companies responsible for inappropriate prescribing of opioids, and stop marketing opioid products directly to physicians. 8 Professional medical organizations should also educate on “appropriate opioid prescribing practices” and using “safer nonpharmacologic and nonopioid analgesics”. 9

Source: Hadland, Scott E., Magdalena Cerdá, Yu Li, Maxwell S. Krieger, and Brandon DL Marshall. “Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing.” JAMA internal medicine 178, no. 6 (2018): 861-863.

This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2019;2(1):e186007. doi:10.1001/jamanetworkopen.2018.6007

Click here to read the full text study.

Posted February 18, 2019.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013–2017. Morbidity and Mortality Weekly Report. 2019;67(5152):1419.
  2. CDC. Wide-ranging online data for epidemiologic research (WONDER). 2012; WONDER online databases include county-level Compressed Mortality (death certificates) since 1979; county-level Multiple Cause of Death (death certificates) since 1999; county-level Natality (birth certificates) since 1995; county-level Linked Birth / Death records (linked birth-death certificates) since 1995; state & large metro-level United States Cancer Statistics mortality (death certificates) since 1999; state & large metro-level United States Cancer Statistics incidence (cancer registry cases) since 1999; state and metro-level Online Tuberculosis Information System (TB case reports) since 1993; state-level Sexually Transmitted Disease Morbidity (case reports) since 1984; state-level Vaccine Adverse Event Reporting system (adverse reaction case reports) since 1990; county-level population estimates since 1970. Available at: https://healthdata.gov/dataset/wide-ranging-online-data-epidemiologic-research-wonder.
  3. Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BD. Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing. JAMA internal medicine. 2018;178(6):861-863.
  4. CMS. 2018; A complete set of all data from the 2014 Program Year, which includes data reported about payments made from January 2011 through December 2031, 2014. Available at: https://www.cms.gov/openpayments/explore-the-data/dataset-downloads.html. Accessed February 12, 2018.
  5. CDC. U.S. Opioid Prescribing Rate Maps. 2018; The data in the maps show the geographic distribution in the United States, at both state and county levels, of retail opioid prescriptions dispensed per 100 persons per year from 2006–2017. Available at: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed January 8, 2018.
  6. Kandel DB, Hu M-C, Griesler P, Wall M. Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances. Drug and alcohol dependence. 2017;178:501-511.
  7. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. 2016;315(15):1624-1645.
  8. Whalen J. Purdue Pharma to Stop Promoting Oxycontin to US Doctors. Purdue Pharma LP to stop promoting Oxycontin and other opioids to US doctors. Available at: https://www.wsj.com/articles/purdue-pharma-to-stop-promoting-oxycontin-to-u-s-doctors-1518307565. Accessed November 19, 2018.
  9. Lowenstein M, Grande D, Delgado M. Opioid prescribing limits for acute pain-striking the right balance. New England journal of medicine. 2018;379(6):504-506.