Study: opioid epidemic related to marketing of pharmaceutical companies

We now have more evidence that pharmaceutical companies have contributed to the opioid epidemic in America, which has been associated with a record 47,600 opioid overdose deaths in 2017: a new study has linked the marketing of opioid analgesics by pharmaceutical companies; and a greater number of overdose deaths.

Pharmaceutical companies have spent billions of dollars for years marketing their products to doctors, wary doctors and other prescribers, for a fee, free lunches, paid trips, and so on. When the pharmaceutical companies commercialized their new opioid pills, such as OxyContin, from the 1990s, they used many of these same tactics to convince doctors, contrary to the evidence, that narcotics were safe and effective, persuading them to prescribe many more drugs. .

The new study in JAMA Network open now examined the potential link between opioid marketing to US physicians and overdose deaths from opioid analgesics at the county level. The researchers found that where there was more marketing, there were more deaths.

Researchers at Boston, UC Davis, New York and Brown Universities have reviewed more than 430,000 marketing payments, for a total of $ 39.7 million, for nearly 68,000 physicians in the United States between August 2013 and December 2015. They then looked at county level data to see if the payments had an effect on the overdose death rates of a painkiller a year later. If marketing led to more opioid prescriptions, and more opioid prescriptions resulted in more abuse, addiction and overdoses, you could expect to see an increase in the number of overdose deaths from painkillers in places that have received more marketing.

That's exactly what the researchers discovered: the counties that stepped up their marketing activities the year before saw more prescriptions for pain medications. and more overdose deaths.

"[T]The United States continues to vastly outstrip the rest of the developed world in terms of opioid prescription, and many people with opioid use disorder are first shown to opioids by means of a prescription, "wrote the researchers. "Our findings suggest that marketing opioids directly to physicians may counteract current national efforts to reduce the number of opioids prescribed and that policy makers might consider limiting these activities as part of a strong and consistent response. evidence-based epidemiology of opioid overdose in the country. United States."

The cost of marketing did not seem to have as much impact as the number of marketing interactions, suggesting that it is not so much the financial impact as the contact between the seller and the doctor that has a significant effect on the prescribers. practices. For states (such as New Jersey) that are trying to limit the marketing of opioids, it is essential to understand this dynamic to implement the most effective policies.

"Evidence suggests that industry-sponsored meals contribute to the increase in prescribing, the data suggests that the greatest influence of pharmaceutical companies could be subtle and pervasive, manifesting itself through payments at very high levels. monetary value occurring on a very large scale, "the researchers warned.

The study included important caveats. On the one hand, researchers have not ruled out reverse causality. For example, marketers may consult doctors who are already prescribing more opioids because they consider these doctors to be reliable targets. In this case, marketing may not have resulted in more prescriptions and overdose deaths, but more drugs may have resulted in more marketing.

Another caveat: Opioid analgesics are not the only cause of overdose deaths in the United States, especially since illegal opioids, such as fentanyl and heroin, have taken off, though 39, they are still involved in 40% of overdose deaths from opioids, according to the same source. study. The researchers cautioned whether and how a greater number of opioid prescriptions could lead to other types of opioid overdose deaths, should be investigated.

The study also fails to distinguish between deaths caused by opioid analgesics prescribed to the victim and those illegally obtained through a family member or the black market.

Yet, coupled with a study published in JAMA Internal Medicine Last year, the results are certainly suggestive: they reveal one of the ways that pharmaceutical companies have probably helped to provoke the most deadly drug overdose crisis in the history of the United States .

There is further evidence that opioid marketing has contributed to the overdose crisis

The epidemic of opioids can be understood in three waves. In the first wave, beginning in the late 1990s and early 2000s, doctors prescribed many opioid analgesics. This led to a widespread proliferation of drugs and their addiction – not only to patients, but also to friends and families of patients, teenagers who took drugs in the medicine cabinets of their parents and those who bought drugs in excess on the black market.

A second wave of drug overdoses took off in the 2000s, when heroin invaded the illicit market. Traffickers and drug traffickers have benefited from a new population of people who have used opioids but have lost access to painkillers or are simply seeking a higher, cheaper drug. And in recent years, the United States has experienced a third wave, with fentanyls offering an alternative to heroin that is even more powerful, less expensive and more lethal.

However, this is the first wave that really triggered the opioid crisis – and this is where the marketing of opioid analgesics is probably the most relevant. (However, the study can only be based on recent data, since similar statistics do not exist for previous years, so we do not know if the situation is getting worse or better for marketing.)

In recent years, more and more information has been reported that opioid companies market their products aggressively, even though it was becoming increasingly apparent that drugs n & # 39; 39 were not the safe and effective alternative to other painkillers on the market, that they claimed to be opioids. .

Recently, a lawsuit filed by Massachusetts Attorney General Maura Healey against Purdue Pharma, the maker of OxyContin, revealed that Richard Sackler, then president of Purdue and a member of the Sackler family to which Purdue belongs, was personally involved in some of these efforts. The filing claims that Sackler pushed OxyContin into the market as "non-narcotic" in other countries, even though it was an opioid; Robert Kaiko, who created OxyContin, had to dissuade him from the idea.

The company also reportedly neglected excessive prescriptions in the United States, even though some Purdue staff had warned that pill mills should have been reported to federal officials, Maia Szalavitz told Tonic.

Purdue retorted that the filing "was littered with biased and inaccurate descriptions of these documents and each of the accused, often highlighting potential solutions that were ultimately rejected by the company."

Other reports, however, suggest that opioid companies were largely irresponsible. As a group of public health experts explained in the Annual Public Health Review, opioid companies overstated the benefits and safety of their products, supported advocacy groups and "education" campaigns encouraging widespread use of opioids, and urged lawmakers to relax their use of opioids. access to medicines. Purdue, as the maker of the all-new OxyContin, has played an important role in these efforts, as have companies such as Endo, Teva and Abbott Laboratories.

The result: with the increase in opioid sales, addiction and overdoses have also increased.

Annual Public Health Review

It's not just that the drugs were deadly; they were not as effective as Purdue and others said. There is very little scientific evidence that opioid analgesics can effectively treat long-term chronic pain as patients develop opioid tolerance – but there is ample evidence that prolonged use can lead to very serious complications, including increased risk of addiction, overdose, and death. In short, the risks and harms outweigh the benefits for most patients with pain.

In some cases, pharmaceutical companies have had consequences for their erroneous claims. In 2007, Purdue Pharma and three of its top executives paid more than $ 630 million in federal fines for their misleading marketing. The three leaders were also sentenced to three years probation and 400 hours of public works.

And last year, under increasing public pressure and criticism, Purdue announced that it would stop marketing its opioids to doctors.

But Purdue and others may soon face greater consequences. A Cleveland judge has consolidated lawsuits against opioid companies with the goal of reaching a major deal. The hope is that an agreement would not only limit the marketing of opioid companies, but would also result in a financial settlement that would pay for a treatment against addiction across the United States.

The last study in Open Network JAMA suggests that these measures, particularly marketing restrictions, could help reverse the current opioid crisis and possibly prevent other crises.

To learn more about how to combat the problem of opioid painkillers in America, read the Vox Exploder.

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