Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing

Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BDL. JAMA Int Med 2018; May 14. [Epub ahead of print] [CrossRef]

Pharmaceutical industry marketing to physicians is widespread, but it is unclear whether marketing of opioids influences prescribing. The authors studied the extent to which pharmaceutical industry marketing of opioid products to physicians during 2014 was associated with opioid prescribing during 2015 using the Open Payments Database and Medicare Part D Opioid Prescriber Summary File. In 2015, 369,139 physicians prescribed opioids under Medicare Part D and met study inclusion criteria. In 2014, 25,767 (7.0%) of these physicians received 105,368 non-research opioid-related payments totaling $9,071,976. Only 436 (1.7%) physicians received $1000 or more in total. Marketing included speaking fees and/or honoraria ($6,156,757; n = 3115), meals ($1,814,340; n = 97,020), travel ($730,824; n = 1862), consulting fees ($290,395; n = 360), and education ($79,660; n = 3011). In multivariable modeling, receipt of any opioid related payments from industry in 2014 was associated with 9.3% (95% CI, 8.7%-9.9%)more opioid claims in 2015 compared with physicians who received no such payments. Each meal received in 2014 was associated with an increasing number of opioid claims in 2015. In multivariable modeling, each additional meal was associated with an increase of 0.7% (95% CI, 0.6%-0.8%) in opioid claims. The authors point out that their findings establish an association, not cause and effect. Amidst national efforts to curb the overprescribing of opioids, the authors suggest that manufacturers should consider a voluntary decrease or complete cessation of marketing to physicians and governments should consider legal limits on the number and amount of payments.