May 10, 2018
By Dr. Mercola
Opioid addiction is at an all-time high in the U.S. — so much so, it’s been identified as a significant factor in unemployment among men,1 and opioid overdoses are now the leading cause of death among Americans under the age of 50.2 According to the Centers for Disease Control and Prevention (CDC), of the more than 63,600 Americans who died from drug overdoses in 2016,3,4 more than 42,000 were related specifically to opioids5 — a 28 percent jump in opioid deaths from the year before.
As if that’s not disturbing enough, recent research6 suggests opioid overdose deaths are being undercounted by 20 to 35 percent, due to drug omissions on death certificates.7 In many cases, the specific drug that contributed to the death isn’t listed on the death certificate, and it’s quite likely that many of the general “drug deaths” are actually due to opioids specifically. According to this paper, a more accurate count would probably put the opioid-related death toll at nearly 40,000 for 2015 and closer to 50,000 for 2016.
The most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®),8 and evidence suggests opioid makers such as Purdue Pharma, owned by the Sackler family, knew exactly what they were doing when they claimed opioids — which are chemically very similar to heroin — have an exceptionally low addiction rate when taken by people with pain.
In fact, the massive increase in opioid sales has been traced back to an orchestrated marketing plan aimed at misinforming doctors about the drug’s addictive potential. Remarkably, despite widespread discussion about the dangers of opioids and the high risk of addiction, and despite updated treatment guidelines for back pain that stress nondrug interventions over pain killers, doctors are still overprescribing these drugs.
Paying Doctors Who Prescribe Opioids May Be a Significant Part of the Problem
One of the reasons for this appears to be financial. As reported by CNN, “The more opioids doctors prescribe, the more money they make.”9 According to an analysis by CNN and Harvard researchers, in 2014 and 2015, hundreds of doctors received in excess of $25,000 each from opioid manufacturers, and those who prescribed the most opioids received the largest payments.
Dr. Andrew Kolodny, senior scientist at the Institute for Behavioral Health, co-director of the Opioid Policy Research Collaborative and executive director of Physicians for Responsible Opioid Prescribing told CNN, “This is the first time we’ve seen this, and it’s really important. It smells like doctors being bribed to sell narcotics, and that’s very disturbing.”
At least one doctor received more than $1 million over those two years. One of his patients, who is struggling with opioid addiction, was shocked when she discovered her doctor had received such large payments from the drugmaker. “Once I found out he was being paid, I thought, ‘Was it really in my best interest, or was it in his best interest?’” she told CNN.
Dr. Michael Barnett, assistant professor of health policy and management at Harvard T.H. Chan School of Public Health added, “I don’t know if the money is causing the prescribing or the prescribing led to the money, but in either case, it’s potentially a vicious cycle. It’s cementing the idea for these physicians that prescribing this many opioids is creating value.”
Source: CNN March 12, 2018
One-Quarter of All Doctors Prescribe Opioids to Medicare Patients and Receive Payments From Opioid Makers
To assess the link between drug company payments and prescription habits, the team reviewed data from two federal government sources — one that tracks drug company payments to doctors and another that tracks prescriptions made to Medicare patients. Of the 811,000 doctors who wrote prescriptions for Medicare recipients during 2014 and 2015, more than 200,000 prescribed opioids and received payments from the drug makers.
While a majority of them received only minor payments, ranging from $100 to $1,000, more than 31,400 of them received as much as $15,000, and nearly 4,000 of them received more than $15,000. As you’d expect with a kickback scheme, those who prescribed the most opioids received the most money. According to CNN:10
“On average, doctors whose opioid prescription volume ranked among the top 5 percent nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1 percent of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1 percent, on average, received nine times more money than the typical doctor.”
Does Your Doctor Have a Financial Incentive to Prescribe Opioids?
While it’s legal for drug companies to pay doctors for a variety of services, including speaking and consulting fees — and nearly half of all doctors get paid by drug companies each year — it’s illegal for doctors to prescribe drugs in exchange for kickback payments from the manufacturer. This investigation reveals the line is thin indeed between what’s legal and what’s illegal. Are doctors prescribing opioids with the expectation or promise of payment?
At bare minimum, the data provides additional proof that payments influence a doctor’s prescribing habits, even if it’s not wholly intentional. A number of previous studies have confirmed this trend, showing that regardless of what the payments are for, when a doctor receives money from a drug company, he or she is far more likely to prescribe that company’s drugs.
As noted by Dr. Daniel Carlat, a psychiatrist and former director of the Prescription Project at the Pew Charitable Trusts who writes about conflicts of interest in medicine:11 “It’s not proof positive, but it’s another very significant data point in the growing evidence base that marketing payments from drug companies are not good for medicine and not good for patient care. It makes me extremely concerned.”
Did Fentanyl Maker Bribe Doctors to Overprescribe?
In one particularly disturbing case highlighted by CNN, a woman with Crohn’s disease was prescribed Subsys, an “ultrapowerful form of fentanyl” for her abdominal pain by a pain specialist in Greenville, South Carolina. Subsys is up to 100 times more potent than morphine, and while it eliminated her pain, the drug also put her in a “zombie-like state,” making her unable to care for her children. What’s worse, she couldn’t quit.
Skipping a day led to “uncontrollable diarrhea and vomiting,” and when she asked her doctor for another option, “he became belligerent,” saying “it was Subsys or nothing.” As it turns out, this doctor received more than $190,000 from the maker of Subsys between 2014 and 2015.
A lawsuit is now pending in which she’s accusing her doctor of “setting out to ‘defraud and deceive’ her for ‘the sole purpose of increasing prescriptions, sales and consumption of Subsys to increase … profits.’” Incidentally, in October 2017, John Kapoor, the founder of Insys, which makes Subsys, was arrested and charged with bribing doctors to overprescribe the drug. Other Insys executives have also been arrested on racketeering charges.12
Other Research Shows Payments to Doctors Could be Fueling Opioid Epidemic
The investigation by Harvard and CNN is not the first to suggest drug company payments may be a driving factor in the opioid epidemic. According to a study13 published in August 2017, between August 2013 and December 2015, more than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling more than $46 million. This means 1 in 12 U.S. physicians collected payments from drug companies producing prescription opioids during those 29 months.
Here, fentanyl prescriptions, specifically, were associated with the highest payments, and many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, also had the most opioid-related payments to physicians. In other words, this study showed there’s a direct link between doctors’ payments and patient addiction rates and deaths.