The more opioids a doctor prescribes, the more likely he or she receives large sums of money from opioid manufacturers, according to a March 12, 2018, analysis from CNN and researchers at Harvard University. The researchers found that in 2014 and 2015, hundreds of doctors received six-figure payments from opioid manufacturers for speaking, consulting, and other services. Thousands more were paid at least $25,000 by the companies over that period. The authors examined two federal databases for information on more than 811,000 doctors who wrote prescriptions for Medicare recipients. Nearly half of those doctors wrote at least one prescription for opioids. More than 200,000 providers, or 54% of those who wrote opioid prescriptions, received payments from a company that makes opioids. The physicians who prescribed larger quantities of the drugs were the most likely to have received payments, CNN said. "It smells like doctors being bribed to sell narcotics, and that's very disturbing," said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. It is unclear whether the payments encourage doctors to prescribe more opioids or if the manufacturers seek out high-volume prescribers and then reward them, the researchers said. Either way, one of the researchers said, it is "a vicious cycle." CNN interviewed two women who struggle with opioid addiction. The women said the news made them feel betrayed by their doctors. "I trusted my doctor as you trust the police officer that's directing traffic when the light is out," one of the women said.
HRC Recommends: To reduce the risk of opioid misuse—by patients themselves or by family members—it is important to ensure that the quantity of opioids prescribed represents only what is necessary. Determining what is necessary requires an individualized assessment, which may include consideration of the patient's opioid tolerance; the amount and type of pain the patient is experiencing; the patient's previous use of and response to opioids; and other factors. In some cases, opioids might not be necessary at all; nonopioid pain medications (e.g., acetaminophen, ibuprofen) may be adequate to manage the patient's pain. Healthcare organizations may wish to promote awareness of and adherence to pain management guidelines that reflect these principles. In addition, risk managers, corporate compliance officers, and clinical leaders should understand what interactions take place between industry representatives and providers in their organizations. With that understanding, they can assess whether policies should be set in place that go beyond the legal requirements of the Physician Payments Sunshine Act, and what steps they may take beyond disclosure. Such steps might include banning all gifts to physicians from pharmaceutical sales representatives (even gifts with only nominal value, such as pens); limiting industry interaction on the organization's premises; and prohibiting staff from acting as paid consultants to pharmaceutical or medical device manufacturing organizations.
