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June 12, 2018, New York City— For every dollar a doctor receives in opioid-related payments, he or she prescribes at least $10 or more of additional opioids. This data is part of a new report by the New York State Health Foundation (NYSHealth) that analyzed payments from manufacturers of opioids to doctors across New York State.
The report, Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing Patterns in New York State, is the first study to examine the impact of physician–industry relationships on opioid prescribing in New York State. The Foundation looked at activity from 2013 through 2015 to analyze how opioid prescribing for Medicare enrollees changed after physicians received payments from pharmaceutical companies that manufacture opioids. It identifies potential conflicts of interest that may lead to increased opioid misuse.
Follow the Money documents a clear trend; doctors who receive opioid-related payments from pharmaceutical companies write more opioid prescriptions. Payments might take the form of speaking or consulting fees or gifts such as meals. New York State doctors received more than $3.5 million in payments related to opioids from pharmaceutical companies between 2013 and 2015. Roughly one in ten physicians who prescribe opioids received a payment. Physicians who prescribe more opioids got more opioid-related payments.
Doctors who received $20 or less—the cost of a lunch—wrote opioid prescriptions worth $34,000, on average, from 2013 through 2015. That is equivalent to about 8,000 days supply of opioids, based on the average opioid costs during this time period.
The numbers grow when doctors receive larger payments. Doctors who received between $20 and $50 (the cost of a dinner) prescribed almost $50,000 of opioids—enough for about 12,000 days supply of opioids.
At the top of the pyramid, a small group of physicians, who received payments of more than $10,000 between 2013 and 2015 from pharmaceutical companies, prescribed over $1.24 million in opioids— enough for about 300,000 days supply of opioids.
“Thousands of New Yorkers die each year from opioid overdoses, and the numbers are growing at an alarming rate,” said David Sandman, Ph.D., President and CEO of NYSHealth. “Spending by drug companies may be fueling the epidemic. Policymakers and law enforcement should take a hard look at these financial entanglements.”
To help identify the impact of these payments from drug companies, NYSHealth compared physicians who received payments with a control group of doctors who did not receive any payments. This analysis found a clear divergence. Doctors who got their first payments in 2014 increased their opioid prescribing more than twice as much over one year, compared with similar physicians who did not receive opioid-related payments. After two years the gap widened even further.
“The research shows clearly that promotional activities from drug companies lead to increased prescribing,” said Mark Zezza, Ph.D., director of policy and research, NYSHealth. Zezza explained that the report shows a link between payments and increased prescriptions, but cannot determine whether the prescribing is inappropriate.
This research comes as New York authorities at the city, state, and county levels have filed more than a dozen lawsuits against opioid manufacturers like INSYS Therapeutics, Purdue Pharma, Teva, Johnson & Johnson, and Janssen. Lawsuits have also been filed against individual doctors accused of taking kickbacks for opioid prescriptions.
One potential solution, according to NYSHealth, is additional regulation of physician- industry interactions, including banning promotional transactions. “At a minimum, it is critical that information about potential conflicts of interest, including industry- related payments, are more easily accessible to the public,” said Sandman.
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The New York State Health Foundation (NYSHealth) is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Today, NYSHealth concentrates its work in two strategic priority areas: building healthy communities and empowering health care consumers. The Foundation is committed to making grants, informing health policy and practice, spreading effective programs to improve the health care system and the health of New Yorkers, serving as a neutral convener of health leaders across the State, and providing technical assistance to its grantees and partners. Find NYSHealth online at www.nyshealth.org and on Twitter at @nys_health.
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