from the speechless dept.
The CNN/Harvard analysis looked at 2014 and 2015, during which time more than 811,000 doctors wrote prescriptions to Medicare patients. Of those, nearly half wrote at least one prescription for opioids.
Fifty-four percent of those doctors -- more than 200,000 physicians -- received a payment from pharmaceutical companies that make opioids.
Among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments. Among those in the top fifth percentile, 84% received payments. Among the very biggest prescribers -- those in the top 10th of 1% -- 95% received payments.
On average, doctors whose opioid prescription volume ranked among the top 5% nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1% of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1%, on average, received nine times more money than the typical doctor. [...]
Some studies have looked at whether the amount of money a doctor receives makes a difference. Studies by researchers at Yale University, the George Washington University Milken Institute of Public Health and Harvard Medical School have all found that the more money physicians are paid by pharmaceutical companies, the more likely they are to prescribe certain drugs.
Angela Cantone says she wishes she had known that opioid manufacturers were paying her doctor hundreds of thousands of dollars; it might have prompted her to question his judgment.
She says Dr. Aathirayen Thiyagarajah, a pain specialist in Greenville, South Carolina, prescribed her an opioid called Subsys for abdominal pain from Crohn's disease for nearly 2½ years, from March 2013 through July 2015.
Subsys is an ultrapowerful form of fentanyl, which is 50 to 100 times more potent than morphine, according to the US Centers for Disease Control and Prevention.
"He said it would do wonders for me, and it was really simple and easy. You just spray it in your mouth," Cantone said.
She says Subsys helped her pain, but it left her in "a zombie-like" state. She couldn't be left alone with her three young children, two of whom have autism and other special needs.
"I blacked out all the time. I'd find myself on the kitchen floor or the front lawn," she said.
She says that if she missed even one day of the drug, she had uncontrollable diarrhea and vomiting.
She said she brought her concerns to Thiyagarajah, but he assured her it couldn't be the Subsys that was causing her health problems.
"I trusted him. I trusted my doctor as you trust the police officer that's directing traffic when the light is out," she said.
She says that when she eventually asked Thiyagarajah to switch her to a non-opioid medication, he became belligerent.
"He said it was Subsys or nothing," she said.
Cantone would later learn that from August 2013 through December 2016, the company that makes Subsys paid Thiyagarajah more than $200,000, according to Open Payments, the federal government database that tracks payments from pharmaceutical companies to doctors.
CNN compared the $190,000 he received from 2014 to 2015 with other prescribers nationwide in the same medical specialty and found that he received magnitudes [50 times] more than the average for his peers.
Nearly all of the payments were for fees for speaking, training, education and consulting.
Dr. Aathirayen Thiyagarajah wrote nearly twice as many opioid prescriptions per patient annually compared to his colleagues
Dr. Patrice Harris, a spokeswoman for the American Medical Association, said that the CNN and Harvard data raised "fair questions" but that such analyses show only an association between payments and prescribing habits and don't prove that one causes the other.
It's "not a cause and effect relationship," said Harris, chairwoman of the association's opioid task force, adding that more research should be done on the relationship between payments and prescriptions.
"[We] strongly oppose inappropriate, unethical interactions between physicians and industry," she added. "But we know that not all interactions are unethical or inappropriate." Harris added that relationships between doctors and industry are ethical and appropriate if they "can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients."
Synthetic opioids such as fentanyl have overtaken prescription opioids as the No. 1 killer in the opioid epidemic, according to a new report.
The report, published Tuesday in the journal JAMA [DOI: 10.1001/jama.2018.2844] [DX], calculated the number and percentage of synthetic opioid-related overdose deaths in the United States between 2010 and 2016 using death certificates from the National Vital Statistics System. The researchers found that about 46% of the 42,249 opioid-related overdose deaths in 2016 involved synthetic opioids such as fentanyl, while 40% involved prescription drugs.
That's more than a three-fold increase in the presence of synthetic opioids from 2010, when synthetic drugs were involved in approximately 14% of opioid-overdose deaths.
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U.S. Life Expectancy Continues to Decline Due to Opioid Crisis
Purdue Pharma to Cut Sales Force, Stop Marketing Opioids to Doctors
The More Opioids Doctors Prescribe, the More Money They Make
Two More Studies Link Access to Cannabis to Lower Use of Opioids
A former regional sales director for Insys Therapeutics allegedly gave a lap dance to a doctor as the company was pushing him to prescribe its deadly opioid painkiller to patients. That's according to multiple reports of testimony given Tuesday from a former Insys colleague in a federal court in Boston.
The testimony is part of a federal racketeering trial getting underway this week against Insys founder John Kapoor and four former executives, including the sales director, Sunrise Lee. Federal prosecutors allege that the Insys executives used bribes and kickbacks to get doctors to prescribe the company's powerful and addictive fentanyl spray, called Subsys—which was intended only for cancer patients experiencing pain that's not alleviated by other medications (aka "breakthrough pain"). The former executives are also accused of misleading and defrauding health insurance companies that ended up covering the drug for patients who did not need it. A congressional investigation in 2017 concluded that Insys sales representatives bluntly lied and tricked insurers to do that—and the investigators released the tapes to prove it.