In January, the Journal of the American Medical Association (JAMA) published Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses, a study that explores the connection between opioid marketing and opioid overdose.
The study involved a population-based, county-level analysis that compared three sets of data.
The first data set was industry marketing information pulled from the Centers for Medicare and Medicaid Service (CMS) Open Payments database, which tracks every transfer of value in marketing from a pharmaceutical company to a physician. This data includes the monetary value of payments in dollars, the medications marketed, the type of marketing, and the physician practice location. For this study, data was limited to payments tied to an FDA-approved opioid product.
This marketing payment data was compared to two data sets from the Centers for Disease Control and Prevention (CDC); one on opioid prescribing and another on opioid mortality from overdoses.
Overall, study data was limited to the period of August 1, 2013 through December 31, 2015. Approximately $39.7 million was spent in opioid marketing, targeting 67,507 physicians across 2,208 U.S. counties.
The study found that increased county-level opioid marketing was associated with elevated opioid overdose mortality, an association mediated by higher county-level opioid prescribing rates as well.
An interesting finding was that, per capita, a higher number of marketing interactions with physicians was demonstrated with greater opioid overdose mortality, as opposed to the dollar value of opioid marketing, indicating that a consistent marketing persistence may be what fuels increased prescribing and associated mortality.
The study also found that marketing dollars were highly concentrated in counties with:
- Mixed racial demographics
- A lower percentage of individuals aged 65 or younger
- Higher prevalence of high school completion
- Greater unemployment
- Lower poverty
- Higher median household income
- Lower income inequality
- Metropolitan location
The U.S. Northeast saw particularly high concentrations of opioid marketing, with the Midwest seeing the lowest concentrations.
This study is particularly interesting as, circa March 2018, over 41 states and over 200 cities and counties have filed lawsuits against opioid manufacturers over the last few years, claiming manufacturers misled doctors and patients regarding the safety of opioid products. Investigative reports from the Los Angeles Times even claim that manufacturers encouraged doctors to prescribe higher doses of opioids than necessary to avoid changing dosing schedules, while also encouraging doctors to prescribe opioids for common conditions such as back aches and knee pain.
Last year, the U.S. District Attorney announced the creation of a new Prescription Interdiction & Litigation Task Force to hold opioid manufacturers accountable for unlawful practices and examine existing state and local government lawsuits against opioid manufacturers to determine what assistance, if any, federal law can provide in those lawsuits.
Just how this JAMA study will impact the bigger picture of opioid marketing remains to be seen, but research like this could potentially impact aspects of regulation and policy down the road.