Study Shows Opioid Deaths May be Linked to Drug Marketing

Opioid abuse is considered a major public health issue across the country. According to the CDC, 47,600 of 70,237 drug overdose deaths, involved opioids in 2017.¹ Even though heroin and synthetic drugs are playing a large role in overdose deaths, prescription opioids are involved in 40% of all opioid overdoses.² This demonstrates the importance of drug abuse awareness education among patients and healthcare professionals to prevent drug-related deaths.

Direct-to-physician marketing by pharmaceutical companies has sparked some controversy since evidence suggests it increases prescribing of the marketed products.² In fact, between 2013 and 2015, about 1 in 12 physicians in the United States received opioid-related marketing.² A recent study investigated the association of direct-to-physician marketing of opioid products by pharmaceutical companies and mortality from prescription opioid overdoses across the US.² This cross-sectional study linked county-level information from August 2013 to December 2016 across the following 3 national databases: CDC opioid overdose mortality rates, Centers for Medicare & Medicaid Services, and the CDC prescribing rates.² The type of marketing and physician practice location was also analyzed.

The study found that pharmaceutical companies spent almost $40 million in prescription opioid marketing to over 67,000 physicians across 2208 counties.² Additionally, the Northeast areas of the US had the highest amount of opioid marketing, while the Midwest had the lowest.² The study revealed that for each 3 additional payments made to physicians per 100,000 people in a county, opioid overdose deaths were up 18%.² The most common type of marketing is generally meals provided for physicians, and there is a growing amount of evidence demonstrating that this leads to increased prescribing.²

It is important to keep in mind some of the study limitations. Cross-sectional studies can only provide associations and do not assess causality. Future studies are needed to evaluate the nature of drug marketing to physicians and the relationship with prescribing practices and opioid overdoses. The study also was unable to evaluate long-term trends and whether other drugs or substances (e.g. synthetic drugs, benzodiazepines, alcohol) contributed to the overdoses.²

This study raises important questions about whether opioid drug marketing to physicians is ethical while there is a growing opioid epidemic. Pharmacists can play an important role in educating physicians and patients regarding opioid medications, which includes safety considerations to encourage appropriate prescribing practices. All of the risks and benefits of opioid medications should be disclosed during pharmaceutical company presentations. Providing food during presentations should be avoided to ensure that all prescribing decisions are based upon evidence-based medication practices and the most up-to-date guidelines. Physicians and pharmacists should consult their state prescription drug monitoring programs when prescribing and dispensing opioid medications to prevent prescription drug abuse.

References

• Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013—2017. MMWR Morb Mortal Wkly Rep 2019;67:1419—1427. doi: http://dx.doi.org/10.15585/mmwr.mm675152e1?rel=0" ?rel=0" .
• Hadland SE, Aguirre AR, Marshall BD, Cerda M. Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Netw Open. 2019;2(1):e186007. doi:10.1001/jamanetworkopen.2018.6007.