Study examines opiate makers' payments to physicians

Aug 26 2017

Study examines opiate makers’ payments to physicians

One in 12 U.S. doctors accepted payments from opioid manufacturers from 2013 to 2015, a team of researchers has found, in a study reported in the September issue of the American Journal of Public Health.

More than 68,000 physicians received more then $46 million between 2013 and 2015 in non-research payments from drug companies that manufacture pain-killing opioids or medication-assisted opioid treatments like buprenorphine, according to the study.

The average payment received by doctors was relatively small, $15. However, the top 1 percent of physicians received 82 percent of all opioid drugmaker payments, or $38 million at an average of $2,600 per top physician.

Dr. Scott E Hadland, of Boston University School of Medicine, (Boston University) and Maxwell S. Krieger, and Brandon D. L. Marshall, both of Brown University School of Public Health, used the Open Payments program database from the Centers for Medicare and Medicaid Services.

They identified payments involving an opioid to physicians between August, 2013 and December, 2015.
During the study period, 375, 266 non-research, opioid-related payments were made to 68,177 physicians, totaling $46,158 388. The top 1 percent of physicians received 82.5 percent of total payments in dollars.

Abuse-deterrent formulations accounted for 20.3 percent of total payments, and buprenorphine marketed for addiction treatment made up 9.9 percent. Most payments were for speaking fees or honoraria (63.2 percent of all dollars); food and beverage payments were the most frequent (93.9 percent of all payments). Physicians specializing in anesthesiology received the most in total annual payments.

In their report, the researchers said their findings “should prompt an examination of industry influences on opioid prescribing.”

Most of the payment funds, 63 percent, covered speaking fees while the most frequent payments went toward covering the cost of meals, which accounted for 93 percent. While most physicians didn’t receive much from opioid drugmakers, even those small payments or industry-sponsored meals can influence prescribing habits, previous studies have indicated.

“Physicians may not feel as though they are being influenced when a drug company provides them a meal or offers them an educational talk, but the data suggest that physicians who are exposed to this sort of marketing are more likely to prescribe these medications,” Hadland said.

Opioid prescriptions fell by 18 percent between 2010 and 2015, yet the 2015 number is still three times higher than the number of prescriptions written in 1999, according to the Centers for Disease Control and Prevention.

Hadland and his fellow researchers found the amount of total payments increased by 11 percent between 2014 and 2015, from $18 million to $20 million. Also, the number of payments made to physicians rose by 26 percent during that period, from more than 145,000 to more than 184,000.

Payments involving abuse-deterrent formulations of prescription opioid pain relievers made up only 20 percent of the funds that went to physicians, which researchers suggested may mean that such medications may not be as heavily marketed to doctors as other opioids.

Companies that make buprenorphine were involved in one-tenth of all payments made to physicians, some of which may have gone toward educating doctors about addiction treatment, the researchers said.

Physicians received $21 million in payments related to fentanyl, according to the study.

Among medical specialties, anesthesiologists received the most annually at more than $11 million during the study period, followed by physical medicine and rehabilitation, and pain specialists. Payments to family medicine physicians accounted for about 7 percent of the total amount paid to doctors, but they received the largest total number of payments at more than 20,000.

Sen. Chuck Grassley (R-Iowa) issued a statement praising the disclosures that enable researchers to track opioid manufacturer payments to physicians. “Payments don’t mean doctors are doing something wrong. Disclosure allows for the analysis of trends, like the fact that opioid makers were reaching a lot of doctors as the opioid crisis was getting worse. This is information the public should know.”

“In the broader setting of a public health emergency, I think we have to ask ourselves the question, is it appropriate for tens of millions of dollars to be transferred to physicians for medications whose prescribing we’re trying to reduce,” Dr. Hadland told Modern Health Care.

Hadland is an adolescent addiction medicine specialist at Boston Medical Center’s Grayken Center for Addiction Medicine.