A new study out today has found a link between the marketing of opioids by pharmaceutical companies and overdose deaths. The study was led by researchers at Boston Medical Center’s Grayken Center for Addiction, and published in the journal JAMA Network Open. It comes on the heels of news this week that Massachusetts Attorney General Maura Healey is accusing the Sackler family — which owns Connecticut-based Purdue Pharma, the maker of OxyContin — of continuing to rake in money despite knowing that the drug was causing fatal overdoses. One of the study’s authors, Dr. Scott Hadland, spoke with WGBH All Things Considered Anchor Barbara Howard. The transcript below has been edited for clarity. You can read the study here.
Barbara Howard: Here's a brief quote from Dr. Richard Sackler of the Sackler family, which owns Purdue Pharma. Back in 2001, he wrote in an email, “We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.” What’s your reaction to that?
Scott Hadland: Well, it's really disturbing language to hear people who are struggling with substance use disorder described in such a way. And people who struggle with substance use disorder have been targeted by opioid manufacturers. Once they started to struggle with prescription opioids and found themselves having a difficult time with addiction, heroin and fentanyl became the cheaper alternative to the prescription medications that they once had access to.
Howard: Probing data over a 29-month period, you and your fellow researchers found that overdose deaths are higher where opioids are most prescribed, and that they're most prescribed where doctors are most marketed to by drug companies. How do the drug companies market to doctors?
Hadland: The most common way is to take doctors out for a meal. There's a number of other strategies, including paying for speaker fees or honoraria, but it's these meals that are most common. The same doctor will be taken out sometimes dozens of times.
Howard: What is said over dinner?
Hadland: Dinner really gives them an opportunity to talk about their products. Now, it's important to remember that sometimes, that education can be beneficial. It can help a physician to understand how to more safely prescribe a medication. But the majority of the time, the true intent is really to get that doctor to prescribe medications more.
Howard: Are these practices legal?
Hadland: Meals are perfectly legal. And more than that, they're commonplace and widespread across the country.
Howard: Well, what kind of money are we talking about? How much is spent on marketing opioids to doctors?
Hadland: Millions of dollars are spent. But what's really important to note is that a simple meal for a doctor is often very inexpensive. It typically comes in at a price of about $15 to $20. And yet, our study has shown that it's these small, sort of inexpensive meals that actually tend to turn the tide and influence prescribers, potentially, to prescribe more and more. It's not these large-value payments, it’s in fact these inexpensive and yet very commonplace meals that are probably having the bigger effect.
Howard: Doctors are well-educated, smart people, and they tend to say, 'Yes, I do have a meal here and there, but I am not influence-able.' Is that so?
Hadland: I think a lot of doctors really, truly believe that, and I think that they're very well-intentioned. I don't think that they intend to change their prescribing behaviors in response to the marketing that they get. But that's the reason why we do objective studies like this, to understand the potential association that exists. Multiple meals over time can increasingly change a doctor to get them to prescribe more. When you think about this practice taking place all across the country, it really does amount to an enormous number of medications being prescribed.
Howard: Is there any part of the country that stands out to you, where marketing opioids was most intense?
Hadland: We found some areas, particularly rural areas — for example Kentucky, West Virginia, Ohio, and Pennsylvania — where overdose deaths were already known to be high. And yet we saw an enormous amount of marketing going into those areas.
Howard: How about Massachusetts? How did the counties in this state look?
Hadland: Massachusetts is one of the states with the most opioid marketing in the country. The same goes for Rhode Island and other surrounding New England states. And we do see opioid overdose deaths that go along with that.
Howard: Which counties in Massachusetts are hit hardest?
Hadland: All of the counties.
Howard: Is it isolated more in rural areas, or is it in urban areas like Boston?
Hadland: We see that both urban and rural areas are receiving extensive marketing and continue to have a problem with prescription opioid overdose deaths.