Pharmaceutical payments to physicians may increase prescribing for opioids

Background and aims: Given the recent complete suspension of opioid-related promotional activities aimed at physicians, interest has renewed in understanding the role of promotion in the US opioid crisis. The present analysis aimed to measure associations between such interactions and opioid prescribing.

Design: Data on all promotions by pharmaceutical companies directly to physicians were linked to physician-level data on opioid prescriptions filled in a federal insurance program and analyzed using multivariate regression.

Setting: United States.

Participants: A total of 865 347 US physicians, with prescriptions filled in Medicare Part D, that might receive payments from pharmaceutical promotional activities from 2014 to 2016.

Measurements: The outcome variable was days' supply dispensed by each prescriber, by year, for all opioids (collectively) and separately for the following opioid classes: hydrocodone, oxycodone, fentanyl, tapentadol, morphine and a catch-all 'other opioids'. The independent variables were receipt of any payments and dollar amounts of payments received by each prescriber by year for all opioids and separately for opioid categories.

Findings: Prescribers who received opioid-specific payments prescribed 8784 opioid daily doses per year more than their peers who did not receive any such payments (P < 0.001). Recipient of hydrocodone-related payments was associated with 5161 additional daily doses of hydrocodone (P < 0.001). Recipient of oxycodone-related payments was associated with 3624 additional daily doses of oxycodone (P < 0.001). Prescribers receiving any fentanyl-specific payments prescribed 1124 daily doses per year more than their peers (P < 0.001). Among recipients of opioid-specific payments (63 062 physicians), a 1% increase in amount of payments was associated with 50 daily doses of opioid prescription (P < 0.001).

Conclusions: In the United States, physicians who receive direct payments from providers for opioid prescribing tend to prescribe substantially larger quantities, particularly for hydrocodone and oxycodone.