Opioid-Related Deaths Associated with Pharmaceutical Marketing of Opioid Products

Scott E. Hadland, MD, MPH, MS

Almost 400,000 Americans died from opioid overdoses between 1999 and 2017, and 47,600 deaths occurred in 2017 (67.8% of deaths related to drug overdoses for that year), according to the Centers for Disease Control and Prevention (CDC). Among all opioid-related deaths, approximately 40% were due to involvement with prescription opioids—the first opioids individuals with opioid use disorder usually encounter.

With such a large percentage of addicted individuals finding initial opioid access through prescriptions, a team of investigators sought to evaluate the association between pharmaceutical marketing for opioid products to physicians and opioid-related overdoses. Among their findings, the team found increased opioid prescribing correlated with marketing opioid products to physicians, which subsequently with an increase in mortality from overdoses.

“We knew that increasing national attention was being paid to opioid manufacturers and some of their concerning marketing practices,” lead author Scott E. Hadland, MD, MPH, MS, told MD Magazine®. “However, to date, no one had put national numbers to this potential public health problem.”

By using data on opioid prescribing and mortality from overdoses from the Centers for Medicare & Medicaid Services Open Payments database in combination with data from CDC, investigators conducted a population-based, county-level analysis of industry marketing information through US counties in all 50 states.

The team used a 1-year lag to include data on overdoses from August 1, 2014, to December 31, 2016, which was then synced to marketing data from August 1, 2013, to December 31, 2015.

Among the main outcomes and measures, the team measured county-level mortality from prescription opioid overdoses, number of marketing interactions, total cost of marketing of opioid products to physicians, sociodemographic factors, and opioid prescribing rates.

Across 2208 US counties, $39.7 million of non-research-based opioid marketing that amounted to 434,754 payments between August 1, 2013, and December 31, 2015, was distributed to 67,507 physicians.

“For each 3 additional payments made to physicians per 100,000 people in a county, opioid overdose deaths were up 18%, according to the research,” Hadland highlighted.

Following adjustments 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), the number of payments to physicians per capita (adjusted relative risk, 1.18; 95% CI, 1.14-1.21, and the number of physicians receiving marketing per capita (adjusted relative risk, 1.12; 95% CI, 1.08-1.16).”

In addition to increasing with marketing, opioid prescribing rates the association between marketing and mortality.

“The most surprising finding was that the prescribing rates and subsequent overdose deaths involving prescription opioids were more strongly linked with the number of marketing interactions, not the total dollar value of the interactions,” Hadland added.

From their results, the team of investigators concluded that increased opioid prescribing was associated with the marketing of opioid products to physicians. Subsequently, increased mortality from overdoses also occurred. The authors noted that reassessing the pharmaceutical industries’ influence may be warranted since the nation is in the midst of a national opioid overdoes crisis.

Looking forward, Hadland told MD Mag® how the issue of opioid marketing in association with of opioid-related overdoes and mortality can be addressed in 3 ways. “Opioid pharmaceutical companies can cease marketing of their opioid products directly to doctors, which Purdue recently did,” she said. “Physicians, hospitals, and medical schools can restrict the interactions that pharmaceutical companies have with their providers and trainees.

“Lastly, legislation focused on limiting the number of interactions that pharmaceutical companies can have with physicians (rather than solely focusing on the total dollar amount) could help stop the widespread potential effect of marketing on the opioid overdose crisis.”

The study, titled, “Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses,” was published online in The Journal of the American Medical Association (JAMA).