It's no surprise that marketing increases consumption, but the effect is powerful even when direct-to-consumer appeals are illegal.
Direct-to-physician marketing of opioid prescriptions is powerfully effective, according to a new study published in JAMA Network Open, and the findings could suggest they're also associated with opioid overdoses.
"We found that counties receiving such marketing subsequently experienced elevated mortality. In addition, opioid prescribing rates were strongly associated with the burden of opioid marketing across counties," researchers from Boston Medical Center wrote in the study.
Despite that finding, the link between opioid marketing and opioid overdoses fell short of statistical significance. For one thing, many of the overdoses in the researchers' data sets included illegal opioids such as heroin and fentanyl as well as other drugs, like alcohol, cocaine or benzodiazepines. This makes it more difficult to narrow the cause down to prescription opioids (not to mention marketing of those prescriptions).
It's also possible causality runs the other way: that counties with lots of overdoses receive more opioid marketing. Of course, as the study points out, that hardly absolves the marketers.
"Although there remains the possibility of reverse causality—that is, that counties with high opioid prescribing rates and already experiencing elevated mortality from overdoses are subsequently targeted by pharmaceutical company marketing—it is potentially concerning that physicians in such counties would receive further marketing for opioids," the researchers wrote.
Even if the link between marketing and overdoses were solidified, there isn't a huge amount of public policy available to address the problem. New Jersey, for instance, set a maximum payment to physicians of $10,000 annually. But most interactions between marketers and physicians involve meals, which don't come close to that figure.
"Because most marketing interactions with physicians involve meals that typically have a low monetary value, a high dollar cap would affect only a minority of prescribers who exceed this amount. As evidence mounts that industry-sponsored meals contribute to increased prescribing, data suggest that the greatest influence of pharmaceutical companies may be subtle and widespread, manifested through payments of low monetary value occurring on a very large scale," researchers wrote.
Prescription opioids contribute to more than 17,000 overdose deaths annually in the U.S., according to the American Public Health Association. Prescriptions are involved in 40% of all opioid overdoses in the country, and they are usually the first opioids people encounter.