A new study found that New York doctors who received speaking fees, gifts and meals from the makers of addictive opioid drugs in 2014 and 2015 prescribed more opioids than their peers who did not receive anything.
The study, published Tuesday by the private New York State Health Foundation, is the first-ever statewide look at the financial entanglements between physicians and opioid manufacturers — entanglements that many say were and still are a contributing factor to the nation's deadly and growing opioid epidemic.
"Other studies have documented an association between payments and prescribing patterns, raising the inevitable chicken and egg question," said David Sandman, president and CEO of the foundation. "Do they prescribe more after they are paid or are they paid after they prescribe more? In this case, we wanted to look at the onset of payments, what happened when they went from nothing to getting paid?"
To determine that, the foundation looked at activity from 2013 through 2015 to analyze how opioid prescriptions for Medicare patients changed after their doctors started receiving payments from opioid manufacturers. Such payments include speaking fees or honoraria, food and beverages, travel and lodging, consulting fees, gifts, grants and educational materials.
The report compared two groups of physicians in New York, both with a similar specialty mix so as not to skew the data (they wouldn't, for example, compare physicians who never see pain patients to those who do, as the latter is naturally more inclined to prescribe painkillers based on patient need).
Additionally, both groups of doctors had similar payment histories: in the year 2013, neither group received payments from opioid manufacturers.
The analysis found a clear divergence. Doctors who got their first payments in 2014 increased their opioid prescribing more than twice as much over one year, compared with similar physicians who did not receive any payments that year. More specifically, the average cost associated with filling pain scripts rose 37.2 percent among the doctors who got paid compared to a 15.6 percent increase among those who did not. The total costs for filling the scripts include payments made by Medicare, patients and any other third party.
After two years, this gap widened even further — with the average cost of pain scripts increasing 24.7 percent among those who got paid compared to 1.9 percent among those who did not.
For every dollar a doctor received in payments, he or she prescribed at least $10 or more of additional opioids, the report summarized.
"The research shows clearly that promotional activities from drug companies lead to increased prescribing," said Mark Zezza, director of policy and research at the foundation.
While the report shows a link between payments and increased prescriptions, it cannot conclude whether the increased prescribing is inappropriate, he added.
A statewide physicians' group disputes the underlying assumption of the report, which sought to highlight potential conflicts of interest that could be fueling record levels of opioid abuse.
"Any physician that chooses to prescribe any medication for reasons other than patient need faces threat of significant sanction from the New York State Office of Professional Medical Conduct as well as potentially criminal and civil penalties," said Thomas Madejski, president of the Medical Society of the State of New York.
"To make an assertion that New York physicians are prescribing opioids because of payments from drug companies is completely at odds with recent statistics showing a significant decrease in opioid prescribing in New York," he said.
Indeed, as a result of increased prescription monitoring that went into effect statewide in 2013, the total number of opioid prescriptions has fallen statewide. The epidemic continues however — as those who got hooked on prescription painkillers have since turned to cheaper, easier-to-get heroin to fulfill their cravings and avoid withdrawal pains. That heroin is increasingly being laced with fentanyl, a potent opiate that's fueling overdose deaths.
"Thousands of New Yorkers die each year from opioid overdoses, and the numbers are growing at an alarming rate," Sandman said. "Spending by drug companies may be fueling the epidemic. Policymakers and law enforcement should take a hard look at these financial entanglements."
Overall, New York doctors received more than $3.5 million in payments related to opioids from pharmaceutical companies between 2013 and 2015, with those who prescribed more opioids receiving more payments, the report found.
The research comes as authorities at the city, county and state levels have filed more than a dozen lawsuits against opioid manufacturers, including INSYS Therapeutics, Purdue Pharma, Teva, Johnson & Johnson, and Janssen. Lawsuits have also been filed against individual doctors accused of taking kickbacks for opioid prescriptions.
Policymakers might consider additional regulation of doctor-drugmaker interactions as a result of the report, Sandman said. This could include banning promotional transactions outright.
The pharmaceutical industry has attempted to police itself on this front.
Pharmaceutical Research and Manufacturers of America, the trade group representing drugmakers, notes that in addition to strict state and federal regulations overseeing these interactions, its members are also encouraged to follow industry guidelines set out in the group's Code on Interactions with Health Care Professionals.
"We do not want our interactions with health care professionals to be perceived as inappropriate by patients or the public at large," " said PhRMA spokeswoman Priscilla VanderVeer. "And the code is to reinforce that these interactions are professional exchanges designed to benefit patients and enhance the practice of medicine."
The full report on opioid payments and prescribing can be viewed here.
Report: N.Y. Docs Who Got Paid Were More Likely To Prescribe Opioids