By David Reese
(CN) – As the U.S. opioid epidemic peaked in 2015, so did the amount of money spent to market prescription opioid painkillers to health care providers, according to a new study.
Researchers examined how pharmaceutical companies’ marketing of opioids to physicians corresponded to deaths from overdoses. They analyzed marketing data, prescription data from Medicare and Medicaid, and overdose data from the U.S. Centers for Disease Control and Prevention for every U.S. county.
They found about $40 million in opioid marketing was directed to roughly 67,500 physicians across 2,208 counties from August 2013 to December 2015. More money spent on direct opioid marketing to physicians correlated to higher opioid prescription rates and subsequently more deaths from prescription opioid overdoses a year later, according to the study written by Scott E. Hadland of Boston Medical Center.
Prescription opioids are involved in 40 percent of all deaths from opioid overdose in the United States, according to the study. Opioids killed 42,000 people in 2016 – twice the number who died from opioid overdoses in 2010, according to the Office of Inspector General.
This week’s study showed that from August 2013 to December 2015 there were 434,754 payments totaling $39.7 million in opioid marketing that targeted 67,507 physicians.
Deaths from opioid overdoses increased when more money was spent on marketing and payments to physicians and when more doctors received marketing, the researchers found.
“Findings suggest opioid marketing to physicians may counter national efforts to reduce the number of opioids prescribed and policymakers might consider limits on those activities,” the study says.
Pharmaceutical sales tactics are at the heart of a lawsuit against Purdue Pharma and its owners. Court documents filed this week in a lawsuit against Purdue filed by the state of Massachusetts say the drug companies knowingly directed and encouraged physicians to over-prescribe opioids such as Butrans and OxyContin.
“Purdue Pharma created the epidemic and profited from it through a web of illegal deceit,” attorneys for Massachusetts wrote.
The lawsuit names eight members of the Sackler family, the owners of Purdue Pharma. Other lawsuits have been filed recently against Purdue Pharma and other drug companies by the city of Eureka, California, and at least one Native American tribe, the Hoopa Tribe, claiming their residents were harmed by over-prescription of opioids.
Amerisource Bergen, a drug distributor that has been named in several lawsuits, said it has a moral obligation to continue to distribute opioids.
CEO and president Steve Collis said in a blog entry, “I, along with others at AmerisourceBergen, have at times wanted to divorce our company from these therapies entirely.
“Stopping distribution of opioids would be an easy but amoral choice for a distributor.”
Purdue Pharma’s chief medical officer, Marcelo Bigal, said electronic prescriptions, using state-based prescription monitoring systems and distributing medication guides to patients would help fight the opioid abuse crisis. Bigal said in “sponsor content” on the pharmaceutical news site Stat that electronic prescribing would help prevent diverting prescribed drugs into illegal sales.
Purdue Pharma also said it ended its direct sales to health care providers of opioids in February 2018.
“As an opioid manufacturer, we recognize we have a role to play to help address this public health crisis and have taken action to do so,” Bob Josephson, executive director of communications for Purdue Pharma, said in an interview. He added Purdue Pharma has provided $3.4 million in funding to help bring naloxone, an opioid-overdose medication, to the market.
Pharmacists are beginning to take a more active role in solutions to the opioid epidemic, according to Lucinda Maine, executive vice president and CEO of the American Colleges of Pharmacy.
She said American pharmacy schools are putting more effort into training students about pain management, noting that opioids “are not the agent of choice for all kinds of pain, but that was not as well-understood 10 or 15 years ago.”
Pharmacists previously would not intervene with a prescriber when, for instance, a dentist might prescribe several opioid pills for a simple tooth extraction when a patient might need only one or could use safer painkillers like ibuprofen.
“Now those sorts of checks and balances are being put in place, making it easier for everyone to do the right thing,” Maine said in an interview. “These are all complicated factors, and they are all changing as people are beginning to understand the complexities of the situation we’re in.”
According to a June 2018 Medicare report by the Office of the Inspector General, Medicare paid $3.4 billion for opioids in 2017, down slightly from $4 billion in 2016. Medicare spending on opioids peaked at $4.2 billion in 2015.