Courting Doctors with Incentives
According to NBC News, one out of every 12 doctors in America receives either money paid directly to the doctor or perhaps a nice lunch or dinner hosted by opioid drug company representatives. The doctors are incentivized in other various ways, such as speaking fees, reimbursement for travel, consultant fees and in some cases an honorarium (1).
It’s not uncommon for doctors to receive other types of incentives, such as promotional swag, gifts and in some cases “paid vacations to luxury resorts that were ostensibly for advanced medical education”. (2)
Millions Spent Marketing Opioids
The relationship between drug company marketing campaigns and the opioid addiction problem plaguing the United States reveals a disturbing emphasis by drug companies to promote their opioid drugs to doctors. According to NBC News, very little marketing dollars go towards drug companies’ “less addictive painkillers”.
In August 2017, NCB News quoted former director of the White House Office of National Drug Control Policy, Michael Botticelli. Speaking about the opioid crisis, Botticelli said,
“I think that first and foremost we have known that one of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications.”
Botticelli currently serves the Boston Medical Center as executive director of the Grayken Center for Addiction Medicine.
NBC News reported that in an effort to better understand the opioid epidemic, Dr Scott Hadland of the Boston Medical Center, along with colleagues combed the databases of the Centers for Medicare and Medicaid Services.
This federal government office is charged with oversight of public health insurance. The team’s findings was published in the American Journal of Public Health led to the conclusion that one of the main causes of the opioid crisis was “the vast overprescribing of prescription pain medications.”
The team discovered that between 2013 and 2015, $46 million in payments were made to more than 68,000 doctors. Out of those thousands of payments, 681 doctors received a whopping 82.5% ($37.950,000) of those 375,266 payments.
This data demonstrates how the pharmaceutical companies’ marketing efforts influence the doctors’ prescribing of addictive opioids over non-addictive drugs not marketed as extensively. The conclusion is that doctors have been a very significant factor in the “opioid overuse epidemic”.
It may sound unlikely that a simple $15 meal (average spent by pharmaceutical representative for doctor’s meal) could actually influence a physician to prescribe a drug. However, NBC News reports, “A study published last year found that physicians who accepted even one meal sponsored by a drug company were much more likely to prescribe a name-brand drug to patients later.”
Government Enabling Opioid Crisis
While marketing efforts to doctors is a major part of the opioid problem, another player in creating this crisis is the government. According to Dr Mercola, over the past decade, the prescribing of opioids increased 300%.
Dr Mercola points out that the addiction habit often grows beyond the prescribed dosage. Addicts then turn to heroin to make up for the dosage. Desperate, some addicts turn to heroin when their prescriptions no longer have refills (3).
Dr Mercola states that the epidemic has been enabled by the government and is being subsidized by taxpayers. He points to the conflict of interest within the Interagency Pain Research Coordinating Committee. He explains that some of the panelists work for groups that receive funding from drug manufacturers or they receive speaking fees, various reimbursements for travel, meals and accommodations from drug companies producing pain killers. Dr Mercola points out the obvious conflict of interest this creates for panelists who are responsible for developing drug policies.
Medicare Beneficiaries and Opioids
Another agency that Dr Mercola highlights is the American Geriatrics Society. In 2009, the society revised its guidelines. Instead of doctors recommending patients use over-the-counter pain relief, the new recommendation stated doctors should prescribe opioids “to all patients with moderate to severe pain.”
Dr Mercola also notes that journalist John Fauber discovered that over half of the American Geriatrics Society panel’s experts had some kind of “financial ties to opioid companies, as paid speakers, consultants or advisers at the time the revised guidelines were issued.”
The government and taxpayer involvement doesn’t stop there. In fact, Dr Mercola points out other conflicts of interest that include:
- University of Wisconsin’s Pain & Policy Studies Group: Received $2.5 million from opioid makers and promoted a relaxed policy on the use of “narcotic painkillers”.
- Drug companies lobbying: IMMPACT (drug company funded group) conducts intense lobbying of Federal officials.
- Medicare: Opioids spending grew faster than spending on all drugs from 2006-2014. The spending grew from $1.5 Billion to $3.9 Billion.
- Medicare beneficiaries: Number for opioids prescribed increased 92%. Per beneficiary grew 20% compared to only 3% for all drugs.
Within the Medicare system, many pharmacies (believed to be thousands) are over-dispensing opioids. The opportunities for defrauding Medicare are made easy since Medicare beneficiaries are typically given multiple prescriptions for opioids. This makes it much easier for pharmacies to defraud Medicare when prescription over-dispensing is common practice.
In a Detroit case, one pharmacy “billed opiate prescriptions” for 93% of its Medicare patients during a one-year period. Another taxpayer funded program, Medicaid, is also prone to being defrauded for opioid (usually generic) over-dispensing.
1 in 5 Americans Prescribed Opioids
With over-prescribing, incentivized marketing to doctors, conflict of interest within government panels/agencies and Medicare fraud, it’s easy to see that the opioid epidemic is a complex issue with many causes. All of these factors, as well as others, contribute to perpetuate an addiction cycle that has reached a national crisis level.