Cheap-date doctors prescribed more opioids after pharma picked up dinner tab: JAMA

Doctor putting money in pocket
Were doctors bought by opioid makers with nonresearch payments as simple as a free lunch? (Getty/Niyazz)

It's just lunch? Maybe not, researchers found after sifting the data on free meals and opioid prescription numbers. A new JAMA analysis published Monday found that the more meals opioid drugmakers bought for physicians in 2014, the higher the number of opioids prescribed in 2015.

Each additional meal purchased was associated with an increase of 0.7% in opioid claims by doctors, according to the research published in JAMA. Meals were the perk most frequently accepted by doctors—more than 97,000 physicians let pharma pick up the tab for breakfasts, lunches or dinners for a total of $1.81 million spent by pharma companies in the study year.

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The paper looked at more than just paid meals, though: The analysis included speaker fees, travel, consulting fees and education, spending that totted up to $9.07 million in 2014. Insys Therapeutics, which markets Subsys fentanyl spray and is under federal investigation for its marketing practices, spent the most in total nonresearch payments to doctors during the year at $4.54 million, followed by Teva at $869,000, and Johnson & Johnson's Janssen unit at $854,251.

The study had its limitations, noted Scott Hadland, a pediatrician and addiction specialist who helmed the study. Physicians who received industry payments may have been predisposed to prescribing opioids—essentially, it’s possible the drugmakers paid, wined and dined opioid-friendly doctors, not vice versa. Still, the association validates other, similar findings and should merit action, the authors proposed in the paper’s discussion.

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“Amidst national efforts to curb the overprescribing of opioids, our findings suggest that manufacturers should consider a voluntary decrease or complete cessation of marketing to physicians. Federal and state governments should also consider legal limits on the number and amount of payments,” the paper stated.

Most manufacturers do not market their opioids to physicians any longer. Purdue stopped earlier this year and Endo, Teva, Allergan and Johnson & Johnson’s Janssen told FiercePharma then that they had previously backed off those promotions. Only Insys declined at the time to comment on whether they still promote opioids to doctors.

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Another potential association? Between 2014 and 2015, when Hadland’s study found the associated increase in opioid prescriptions after pharma payments, Insys saw its revenue jump from $219 million to $330 million. 

Insys' total payments to physicians spiked around the same time, to $7.73 million in 2014 from $2.8 million in 2013, according to CMS’ Open Payments database. The only drug Insys sold in 2014 was Subsys—and the company's outlays accounted for half of the payments studied in the JAMA paper.

Hadland was also a co-author of research published last year in the American Journal of Public Health that found 1 in 12 physicians had received opioid-related payments—all unrelated to research—over 29 months spanning 2013-2015. Food and beverage payments were by far the most frequent types payments in that study as well, accounting for 93.9% of all payments. Hadland did not respond to requests for an interview.