The Insidious Relationship between Pharmaceutical Marketing to Physicians, Opioid Prescriptions, and Overdose Deaths

By Weir, R. J. | Chicago Policy Review (Online), May 16, 2019 | Go to article overview

The Insidious Relationship between Pharmaceutical Marketing to Physicians, Opioid Prescriptions, and Overdose Deaths


Weir, R. J., Chicago Policy Review (Online)


In 2017, as opioid-related deaths surpassed deaths from car accidents and gun homicides combined, the Trump Administration declared the opioid crisis a public health emergency. Since then, policymakers have responded with solutions ranging from pharmacological remedies to prescription drug monitoring programs; however, there has been little accountability of those who have profited off of the epidemic. While the criminal actions of pharmaceutical companies contributing to the opioid epidemic have received significant media attention, there has been far less focus, and little research, on the role that pharmaceutical marketing to physicians played in creating the opioid epidemic.

In a recent study, Hadland et al. sought to determine the association between pharmaceutical companies’ direct-to-physician marketing of opioid products, opioid prescribing rates, and mortality from prescription opioid overdoses. To do so, they linked county-level data from August 2013 to December 2016 across several national databases and obtained data on opioid-related deaths, opioid prescriptions, pharmaceutical marketing, and sociodemographic characteristics. Hadland et al. obtained data on overdoses and opioid prescribing rates from the Centers for Disease Control and Prevention (CDC); data on pharmaceutical marketing to physicians from the Centers for Medicare & Medicaid Services (CMS) Open Payments database; and sociodemographic characteristics from the U.S. Census Bureau’s American Community Survey. This linkage of data across disparate sources allowed researchers to not only analyze the association of pharmaceutical marketing with opioid overdoses, but also to assess the mediating role of opioid prescriptions.

The researchers then measured the relationship between opioid marketing from 2013-2015 and mortality rates from prescription opioid overdoses one year later, using three major markers of pharmaceutical opioid marketing to physicians: marketing spending in dollars, number of payments to physicians, and number of physicians receiving marketing. The researchers found that all three measures of pharmaceutical companies’ direct-to-physician opioid marketing were correlated with increased mortality rates. Additionally, they found that mortality rates were most strongly correlated with the number of payments made to physicians and most weakly correlated with marketing spending per capita. The authors speculated that the reason for this is that most marketing interactions with physicians include industry-sponsored meals, free samples, and other low-cost interactions unlikely to sum to large amounts over time. …

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