Direct-to-physician marketing of opioids by pharmaceutical companies is associated with an increased prescribing of opioids, and is further linked to deaths from prescription opioid overdoses, according to study results published in JAMA Network Open.

The investigators of this population-based study sought to identify the association between direct-to-physician marketing of opioids by pharmaceutical companies with physician prescribing rates and subsequent deaths from opioid-related overdoses across US counties.

Study investigators extracted industry marketing data from the Centers for Medicare & Medicaid Services Open Payments database and linked this information, using a 1-year lag, with opioid prescribing data and deaths from overdoses for all US counties extracted from the Centers for Disease Control and Prevention databases.

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Primary study outcomes included the relative risk (RR) of county-level mortality from prescription opioid overdoses and exposure to opioid marketing measured by total marketing value in dollars per 1000 county population, number of payments to physicians per 1000 county population, and number of marketing interactions per 1000 county population. Opioid prescribing rates were analyzed as a potential mediator between opioid marketing and death from prescription opioid overdoses. County-level sociodemographic factors were included as covariates based on their previous association with death from overdose, including gender, age, race/ethnicity, unemployment, median household income, and education level.

Between August 2013 and December 2015, the investigators found 434,754 payments totaling $39.7 million for nonresearch-based opioid marketing. These payments were distributed to 67,507 physicians across 2208 US counties. Adjusting for county-level sociodemographic factors, mortality from opioid overdoses between August 2013 and December 2016 was significantly associated with all 3 opioid marketing measures: opioid-related deaths increased with each 1 standard deviation increase in marketing value in dollars per capita (aRR 1.09; 95% CI, 1.05-1.12), number of payments to physicians per capita (aRR 1.18; 95% CI, 1.14-1.21), and number of marketing interactions per capita (aRR 1.12; 95% CI, 1.08-1.16).

Furthermore, direct-to-physician marketing of opioids was associated with increased opioid prescribing rates; through mediation analysis, opioid prescribing rates were found to partially mediate the association between all opioid marketing measures and mortality.

One limitation of the study included the inability to exclude reverse causation; however, the 1-year lag in data extraction was designed to address this. Mortality outcomes related to prescription opioid overdose may have included other potent, nonprescription opioids or substances. Data sources did not differentiate between prescribed or illicitly acquired opioids, nor were they able to distinguish between appropriate or inappropriate opioid prescribing. Finally, the potential effects of opioid marketing on prescribing rates and death were not examined for long-term trends.

Opioid marketing is associated with increased prescribing of opioids, countering national efforts to reduce opioid prescriptions in the US. The influence of the pharmaceutical industry marketing of opioid products should be reexamined amid the national opioid crisis, the researchers concluded.


Hadland SE, Rivera-Aguirre A, Marshall BDL, Cerdá M. Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses  JAMA Netw Open. 2019;2(1):e186007.