Payments, free meals and speaking fees from drug companies might be influencing physicians to prescribe opioids, with certain physicians who prescribe the highest amounts of painkillers receiving the most attention from the pharma industry, according to a study published in JAMA Internal Medicine.
"Amid national efforts to curb the overprescribing of opioids, our findings suggest that manufacturers should consider a voluntary decrease or complete cessation of marketing to physicians," the study authors wrote.
The study authors analyzed Medicare databases and the Open Payments database, which tracks payments made to physicians.
"We studied the extent to which pharmaceutical industry marketing of opioid products to physicians during 2014 was associated with opioid prescribing during 2015," the researchers wrote.
In 2015, the researchers found 369,139 physicians prescribed opioids to Medicare Part D patients. Nearly 26,000 of these physicians (7 percent) received some form of payment unrelated to research grants, and 436 of the physicians received $1,000 or more in total.
The study revealed INSYS Therapeutics, Teva Pharmaceuticals and Janssen Pharmaceuticals were the three companies with the highest payment totals to physicians, the study authors noted.
Insys payments were about $4.5 million, while Teva and Janssen each spent about $800,000.
"Marketing included speaking fees and/or honoraria, meals, travel, consulting fees, and education," the researchers wrote. "Each meal received in 2014 was associated with an increasing number of opioid claims in 2015."
The study authors acknowledged the possibility that physicians who most often prescribe opioids have more expertise and may be called on by the drug companies more frequently.
"[Study] limitations include the possibility of reverse causality because physicians who receive industry payments may be predisposed to prescribe opioids," the study authors wrote. "Our findings establish an association, not cause and effect."
Insys officials said a new management team has been working to build a culture of "high ethical standards" in recent years, according to NBC News.
"The number of Insys-hosted physician speaker programs related to Subsys and the amount in honoraria paid to those physician speakers went down by 87 percent and 82 percent, respectively, in 2017 compared to 2015," a spokesperson told NBC News. Insys makes Subsys, a spray form of fentanyl squirted under the tongue to treat extreme pain in cancer patients. "The company no longer hosts speaker programs for Subsys, which has been on the market for more than six years."
Separately, in response to the opioid epidemic, the FDA announced a public, patient-focused meeting will be held July 9. The meeting will allow patients to discuss opioid use and abuse as the agency searches for alternative treatments for chronic pain.