Counties where drug makers did more marketing had higher rates of overdoses from prescription painkillers, national study finds

Counties where doctors got more attention and favors from drug manufacturers were more likely to have a higher rate of overdoses from prescription opioids a year later, says a new study, published in the American Medical Association journal JAMA Network Open, looked at $40 million in marketing to 67,500 U.S. physicians from mid-2013 through 2016.

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The study stops short of finding a cause and effect. But it "offers some of the strongest evidence yet of the connection between the marketing of opioids to doctors and the nation’s addiction epidemic," writes Abby Goodnough of The New York Times. "It found that counties where opioid manufacturers offered a large number of gifts and payments to doctors had more overdose deaths involving the drugs than counties where direct-to-physician marketing was less aggressive." The payments included trips, meals and consulting fees. Meals seemed especially influential, the study said.

The researchers from New York University and Boston Medical Center "found that for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher," Goodnough reports. "The authors acknowledged several caveats in the study, including that it could not differentiate between overdose deaths involving painkillers that are prescribed versus illicitly acquired."

The researchers wrote, "Prescription opioids are involved in 40 percent of all deaths from opioid overdose in the United States and are commonly the first opioids encountered by individuals with opioid use disorder. It is unclear whether the pharmaceutical industry marketing of opioids to physicians is associated with mortality from overdoses. . . . Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted."

The study found that opioid prescribing rates were somewhat higher outside metropolitan areas, but the non-metro mortality rate from overdose deaths was somewhat lower than in metros. "The study found that opioid-related spending on doctors was most highly concentrated in counties in the Northeast; the Midwest had the lowest concentration," Goodnough notes. "Areas with large numbers of payments and high overdose rates included four cities in Virginia — Salem, Fredericksburg, Winchester and Norton — as well as Cabell County, W.Va., which has one of the highest overdose death rates in the nation."