Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses | Psychiatry and Behavioral Health | JAMA Network Open | JAMA Network
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    2 Comments for this article
    Marketing drugs
    Frederick Rivara, MD, MPH | University of Washingtonn
    While the results of this study may not be surprising to many, they are nevertheless very disturbing. The more money drug companies spent marketing opioids, the more physicians prescribed them. What is the role of the FDA in restricting marketing of the drugs?
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Cash vs Accrual
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
    Most physicians in a private practice use cash flow accounting processes for taxation reporting requirements. Accrual accounting processes are better for budgeting and management. The details for a service business become difficult when dealing with insurance since the revenue and expense accounting processes are difficult to define. Unfortunately, the cash basis for a service business is easier, especially for profit determinations. But, the reality of a business becomes less rigorous to manage carefully when using cash basis accounting.

    With this in mind, I am aware that 40% of total cash income is
    generally equal to profit and promotion for the pharmaceutical industry. Agreed, profit is a balance sheet account and promotion is an income statement account. Putting aside the accounting realities, the business model for a pharmaceutical company demands a certain commitment to meeting this business model to survive. The Hadland et al report is just one more in a long history of sad tales regarding big Pharma. We will continue to honor the First Amendment for all sorts of endeavors, for better or worse.

    Other than the first few months of our 40 year commitment, my small-group private practice chose not to be accessible or available for "detailing." And, our mail was cleansed by our administrative staff before "in-house" delivery including any and all samples. The only exception was for the glucometers of a certain brand for a few years.

    It is likely that the professional organizations should take on the mantra of encouraging their physicians to refuse any & all pharmaceutical marketing. I am not holding my breath about this attribute for their expression of social responsibility.
    Original Investigation
    Substance Use and Addiction
    January 18, 2019

    Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses

    Author Affiliations
    • 1Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
    • 2Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
    • 3Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
    • 4Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento
    • 5Department of Population Health, New York University School of Medicine, New York
    • 6Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
    JAMA Netw Open. 2019;2(1):e186007. doi:10.1001/jamanetworkopen.2018.6007
    Key Points español 中文 (chinese)

    Question  To what extent is pharmaceutical industry marketing of opioids to physicians associated with subsequent mortality from prescription opioid overdoses?

    Findings  In this population-based, cross-sectional study, $39.7 million in opioid marketing was targeted to 67 507 physicians across 2208 US counties between August 1, 2013, and December 31, 2015. Increased county-level opioid marketing was associated with elevated overdose mortality 1 year later, an association mediated by opioid prescribing rates; per capita, the number of marketing interactions with physicians demonstrated a stronger association with mortality than the dollar value of marketing.

    Meaning  The potential role of pharmaceutical industry marketing in contributing to opioid prescribing and mortality from overdoses merits ongoing examination.


    Importance  Prescription opioids are involved in 40% of all deaths from opioid overdose in the United States and are commonly the first opioids encountered by individuals with opioid use disorder. It is unclear whether the pharmaceutical industry marketing of opioids to physicians is associated with mortality from overdoses.

    Objective  To identify the association between direct-to-physician marketing of opioid products by pharmaceutical companies and mortality from prescription opioid overdoses across US counties.

    Design, Setting, and Participants  This population-based, county-level analysis of industry marketing information used data from the Centers for Medicare & Medicaid Services Open Payments database linked with data from the Centers for Disease Control and Prevention on opioid prescribing and mortality from overdoses. All US counties were included, with data on overdoses from August 1, 2014, to December 31, 2016, linked to marketing data from August 1, 2013, to December 31, 2015, using a 1-year lag. Statistical analyses were conducted between February 1 and June 1, 2018.

    Main Outcomes and Measures  County-level mortality from prescription opioid overdoses, total cost of marketing of opioid products to physicians, number of marketing interactions, opioid prescribing rates, and sociodemographic factors.

    Results  Between August 1, 2013, and December 31, 2015, there were 434 754 payments totaling $39.7 million in nonresearch-based opioid marketing distributed to 67 507 physicians across 2208 US counties. After adjustment for county-level sociodemographic factors, mortality from opioid overdoses increased with each 1-SD increase in marketing value in dollars per capita (adjusted relative risk, 1.09; 95% CI, 1.05-1.12), number of payments to physicians per capita (adjusted relative risk, 1.18; 95% CI, 1.14-1.21, and number of physicians receiving marketing per capita (adjusted relative risk, 1.12; 95% CI, 1.08-1.16). Opioid prescribing rates also increased with marketing and partially mediated the association between marketing and mortality.

    Conclusions and Relevance  In this study, across US counties, marketing of opioid products to physicians was associated with increased opioid prescribing and, subsequently, with elevated mortality from overdoses. Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted.