Association between Opioid Prescribing in Medicare and Pharmaceutical Company Gifts by Physician Specialty

Abstract

BACKGROUND: The association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown. OBJECTIVE: To examine the relationship between opioidrelated gifts to physicians and opioid prescribing in the subsequent year across 7 physician specialties. DESIGN: Panel study using data from 2014 to 2016. PARTICIPANTS: 236,103 unique Medicare Part D physicians (389,622 physician-years) who received any gifts from pharmaceutical companies measured using Open Payments and prescribed opioids in the subsequent year. MAIN MEASURES: Amounts paid by pharmaceutical companies for opioid-related gifts including meals and lodging; quartile of opioid prescribing as a percent of total prescribing compared with other same-specialty physicians. KEY RESULTS: In 2014-2015, 14.1% of physician received opioid-related gifts from the industry with 2.6% receiving > $100. Gifts varied by specialty and were concentrated among two pharmaceutical companies responsible for 60% of the value of opioid-related gifts. Receiving opioid-related gifts was associated with greater prescribing of opioids compared with same-specialty physicians in the next year. Primary care physicians are nearly 3.5 times as likely to be in the highest quartile of prescribing versus the lower quartiles if they were paid ≥ $100. Psychiatrists and neurologists were 7 to 13 times as likely to be in a higher quartile of opioid prescribing compared with colleagues who were paid $0 in the preceding year. CONCLUSIONS: The value of opioid-related gifts given to physicians varies substantially by provider specialty, as does the relationship between payment amounts and prescriber behavior in the following year.

Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation

“…During this time, physicians wrote more than seventy opioid prescriptions per year for every hundred Americans (CDC 2019b). Unsurprisingly, studies have found the receipt of payments from opioid companies is associated with increases in physicians' prescribing rates (Hadland et al 2018;Hollander et al 2019). That is, of course, the reason drug companies engage in such practices, and similar effects have been found in relation to a variety of other prescription drugs.…”

“…Between 2014 and 2015, roughly one in seven physicians in the United States received opioid-related gifts from pharmaceutical companies (Hollander et al 2019); another analysis of a similar period puts the figure for family physicians even higher at one in five (Hadland, Krieger, and Marshall 2017). During this time, physicians wrote more than seventy opioid prescriptions per year for every hundred Americans (CDC 2019b).…”

Association Between Open Payments–Reported Industry Transfers of Value and Prostaglandin Analog Prescribing in the US

“…Branded PGA use for each prescriber was calculated as a percentage of total days supplied of PGA eye drops. Previous works comparing Open Payments data and individual-level prescribing patterns identified prescriber sex, 3,5,13,34-37 specialty, [2][3][4][5][6][7][8][34][35][36][37][38][39][40][41][42] total prescribing volume, 5,34,35,39,41 US Census region, 34,35 and zip code-based urban vs rural designation 5 as potentially significant covariates. Our analysis showed collinearity between US Census region and USPS Rural Urban Commuting Area urban vs rural designation, with Rural Urban Commuting Area being a stronger predictor of both branded PGA use and reported TOV from PGA makers.…”

Interactions with the pharmaceutical industry and the practice, knowledge and beliefs of medical oncologists and clinical haematologists: a systematic review

“…Four of these had medical oncologist participants (27,(38)(39)(40), and five had both haematologists and oncologists. (26,(41)(42)(43)(44) All were based in the US, and eight used the Open Payments database as an exposure against Medicare prescribing data as a dependent variable.…”