Pay-for-Play Is Alive and Well for Physicians Prescribing Opioids

by Chris Centeno, MD /

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Most patients have no idea the extent to which pharma and device companies pay to influence their physicians’ beliefs and practices. Sometimes this is all a subtle dance; other times it’s outright and corrupt. Now a new study confirms and supports other studies that show what I have observed for years, that the payments of the pharma industry to doctors are directly related to their prescribing habits. In addition, a case this week filed against five physicians for blatant pay for play highlights just how bad this practice can be.

How the Game Is Played

Most of the time, the payola game is subtle. More like I’ll scratch your back if you scratch mine. Other times it’s less subtle. Then there are the blatant abuses that usually make the news.

The most common form of the payola game is the use of a product in exchange for stature. Usually, a doctor who would never be asked to lecture or educate other doctors on a topic because he or she has no original research or unique experience on it can get on the podium with a slide deck from a manufacturer. This only happens if the doctor uses a lot of that product. He or she may be paid an honorarium by the conference. In this case, the manufacturer paid for sponsorship of the conference to earn a speaking slot that it can then dole out to a big user of its product. Hence, payments are happening, but it’s a round robin. It’s like Cousin Vinny paid Carmine to pay Johnny for that “thing.”

The next level up in the physician payola game is the direct payment of physicians for research, consulting, and/or speaker’s fees. These doctors are usually bigger fish, those that because of a university appointment or their influence in the field can sway other doctors. These payments are usually reported (but sometimes not) and can be looked up at Dollars for Docs. As an example, a doctor may be paid a consulting fee to provide his advice on how to market a product or how a physician may want to use it. Oftentimes, this is a nebulous consulting arrangement in that the dollars that exchange hands may or may not be actually tied to verifiable hours that physician worked. Another example is a doctor who pulls down a private grant for research and sets his office up as a clinical research site. He or she can pull down big fees per patient placed in the study with a handsome profit for the doctor. This is a bit more like Vinny paid Carmine or his niece too much money for a car out of “respect.”

Finally, there’s out and out fraudulent direct payments for use of a device or writing a prescription. This is what happened this week when five physicians were indicted on the criminal charges of accepting kickbacks for writing scripts for a fentanyl spray. There were multiple e-mails showing that sales reps for the company were placing prescribing quotas on doctors in exchange for money, gifts, lap dances at the local strip club, and trips. Here, Vinny just pays Carmine directly for that “thing.”

Prescription Opioids Are Highly Addictive Narcotics

Prescription opioids, such as oxycodine, hydrocodone, morphine, Lorcet, Dilaudid, and so on, are narcotics prescribed by physicians to help relieve pain. The problem is that they are highly addictive and dangerous drugs with over 2 million people in the U.S. alone abusing prescription opioids. And with each passing day comes another 100-plus opioid overdose deaths—the majority due to prescription opioids. The opioid epidemic has reached staggering proportions, not just in the U.S. but globally as well, and rarely does a day go by that the news doesn’t report on the state of prescription opioid abuse in our nation. Why is this happening?

A simple look at statistics may give us a jumping-off point for answering this question. In 1991, according to the National Institute on Drug Abuse, 76 million opioid prescriptions were written in the U.S. CNN reported that in 2016, 236 million opioid prescriptions were written. That’s more than three times the amount of opioid prescriptions compared to just 25 years ago. The CDC states that between 1999 and 2010, the sale of prescription opioids to doctors, hospitals, and pharmacies quadrupled (despite the fact that pain hasn’t changed) and that, as of 2016, deaths from prescription opioids have also quadrupled since 1999!

So why the drastic increase in opioid prescriptions over the past couple of decades? A new analysis on this issue may give us some insight…

Analysis Suggest Physicians Are Getting Paid to Write More Opioid Prescriptions?

New reporting by CNN in conjunction with analysis by Harvard University suggests that over half of doctors who are prescribing opioids are getting money to do so from big pharma companies…and the more prescriptions written, the more money they are getting. The data reviewed was from 2014 and 2015 and looked at prescriptions written just for Medicare patients. The analysts reported that over 400,000 physicians wrote opioid prescriptions for these patients.

What did they discover? Fifty-four percent of these opioid-prescribing physicians received big pharma payments. However, perhaps the more disturbing finding was that the more opioids physicians prescribed, the greater the chance they got paid (e.g., 72% of physicians in the top 25th percentile received payments, 84% of physicians in the top fifth percentile received payments, and 95% of physicians in the top 10th percentile received payments). In addition, analysts revealed that the top 1% of doctors who write the most opioid prescriptions in the U.S. received four times higher pharma payments than the average opioid-prescribing physicians.

While the data would seem clearer that the top prescription writers are getting paid handsomely for their loyalty, one question still remaining, however, is whether most of these doctors are intentionally prescribing more opioids because they get stuff. Meaning are the doctors who are just receiving free lunches being psychologically led toward writing more scripts? This is where things get sketchy because while it is controversial, it isn’t illegal for big pharma to buy lunches.

On the other hand, while it’s also not illegal for pharma to pay doctors to speak and promote their drugs, IMHO, once you cross that line, you as the doctor are on the hook to perform by using that drug. For example, pharma knows that if a doctor is going to be paid to stand up in front of other physicians saying he loves drug X and here’s why, they are also purchasing a big user of the drug.

What if My Doctor Wants to Write Me a Prescription for Opioids?

Don’t let your physician write you a prescription for opioids! Refuse it. I recently posted a study showing that opioids are no better for pain than Tylenol, so say no to opioids from the start. A terrible cycle that exists with opioids is that with each prescription, it requires more and more to attempt to address your pain. You body effectively builds up a resistance to them, so don’t get pulled into the opioid loop and put yourself at risk for a horrible and potentially deadly addiction.

The upshot? Payola in medicine takes many forms. While most doctors aren’t making hundreds of thousands or millions a year using certain devices or drugs, it’s the subtle effects and psychological games that manufacturers have mastered that drive physician behavior. Just asking a physician to get on the podium as an “expert” when he or she is likely really not an expert has a huge effect on how much of that product a doctor will use. When it comes to opioids, this is a slam dunk. Don’t buy the song and dance that these drugs are a good idea. However, it’s the myriad of other drugs and devices out there that you also need to watch out for. So just recognize that the next time your doctor recommends X, make sure it’s because X is really the best thing for you!

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7 thoughts on “Pay-for-Play Is Alive and Well for Physicians Prescribing Opioids

  1. Bob P.

    Pay for play is also very alive with chiropractors and physicians involved with dehydrated human amnion chorion membrane also.

  2. Debra

    The academic talking heads that swear Tylenol is sufficient in pain control has never experienced the pain associated with grade 4 osteoarthritis of the knee, as well as degenerative disc disease that involves cervical and lumbar spine. Let them walk in my shoes or better yet , hobble around in my shoes!

    1. Barbara Meyer

      Totally agree! Same situation here cervical and lumbar, and early onset DDD with ACDF at c5-6, 25 years ago. That fusion gave me 24 years of good life till the discs above and below finally herniated along with stenosis and cord impingement. PRP disc injects and Norco allow me to function, but I am never PAIN FREE. Some pain is good as it keeps you from doing things that your body cannot tolerate. And while pain is no different now than in the past, I have to wonder that perhaps are bodies are not as healthy and strong as they were in the past. GMO foods certainly must play a role in the increase of all kinds of illness. Why not discs and joints as well???

  3. Bruce W.

    Either the writer has never had really serious pain or is some kind of superhuman. There is a point were Tylenol is not going to help.

    1. Regenexx Team

      Bruce,
      Pain is very real and there are certainly things that cause pain that would not be relieved by Acetaminophen. This study was done on patients who had back pain and knee arthritis pain, and the results of the study were very clear. But important to note that the patients in the study had never been treated with Opioids. Unfortunately, neither Tylenol, nor any other over the counter pain medication would work at all in a patient who has been on Opioids as Opioids increase pain, which is why more is needed to control pain over time. 116 Americans die every single day from Opioid overdose.

  4. Nancy Sloane

    I must concure with those writers, above, who need opiates so that we can merely get up and walk around every day to minimally care for ourselves. I have NOT and DO NOT take opiates for recreation or fun!!. I have 2 advanced degrees in Education & Counseling Psychology; my work was my joy and my life in addition to the income to help me raise & educate my son. Please read further…..
    I have endured pain for YEARS, all clearly seen & documented since the early 2000s on MRIs, CDs, spinal taps, xrays, for: DDD, Spondylolisthesis, Stenosis, multiple herniated discs, facette joint syndrome , cracked vertebrae, & and advancing Scheurman’s disease (“hunch back”) and sciatica in both hips. I have bad osteoarthritis in both knees and my spine, as well as Lupus and diabetes. (I lost 100 pounds by myself 4 years ago & changed my diet and lifestyle, to try to help my health, and I’ve kept it off so far!!)., as well as an autoimmune disease called Polymyalgia Rheumatica, (which causes pain in my neck, shoulders and hips and I run low grade fevers when it’s flaring.)
    I’ve had laminectomies, laporatamies, 2 nerve stimulators implanted and 3 rounds of Rhyzotomies (severing spinal nerves with lasers, to stop the pain pathways). I’ve had lots of physical, occupational and psychological therapy, counseling, group therapy, hypnosis and acupuncture. Surgery was needed for a torn shoulder rotator cuff and a torn meniscus in one knee. The other knee is so torn up & painful: I’m afraid the surgeon will recommend a new knee altogether so I’m avoiding him!
    Through all of this my main goal has been TO GO TO WORK EVERY DAY! I NEED THE INCOME, INSURANCE, COMPANIONSHIP AND FOR MY SANITY! My doctor kindly prescribed drugs which I took once I had safely driven to work, then was back home at night. The meds exhausted, nauseated and constipated me! It certainly HAS NOT BEEN A PARTY TAKING THESE DRUGS! AND THEY ATE UP MY SAVINGS AND SALARY. But have allowed me to live SOMEWHAT OF A LIFE!!
    NO ONE HAS THE RIGHT TO BLYTHLY DECIDE WHO CAN AND CAN’T RECEIVE NARCOTICS!!! I TAKE a small dose of long acting MS Contin when I wake up, usually followed by 5, yes just FIVE, MAYBE 10 mg of oxycodone and a cup of coffee. This allows me to get up, dress myself & get fed and groomed. I no longer work (I’m 65 plus at the end of my career, 7 yrs ago, the amount of meds I needed to block my pain and allow me to teach made me too nauseated and tired to be an effective teacher, so I resigned.)
    I DON’T expect to be 100 % pain free anymore, but a modicum of relief is all I ask for. A 2nd MS contin at night helps me get through the evening, and kinda gets me through until morning.
    I am tired of being ashamed of myself and my need for these drugs. I have worked since age 16, through grad school, after my divorce & raised my son alone. I’ve always done civic & religious volunteer work & contributed to my community. I don’t drink and I’m a decent percent…even if i say so myself. So what if I need a medication to numb or block some nerve endings in my spine for part of my awake hours every day? So what? Please leave me and others like me alone and done make judgements!!! I got lousy genes in the roll of the dice, thus a lousy spine and joints and I’m ill quite often. Just let me/us alone!!! I’m not robbing banks or pharmacies!

    1. Regenexx Team

      Nancy,
      Sounds like you’ve done an incredible job! Our intent is not, and has never been, to deny patients medication or pass judgement on patients. We are patient advocates! In a system where medical insurance covers surgeries which cause the need for additional surgeries, and procedures which kill nerves create bigger problems than they were designed to solve, and physicians all too often prescribe opioids simply because there is nothing covered by insurance that will help, a paradigm change is needed. Please see: https://regenexx.com/blog/interventional-orthopedics-will-change-world/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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