Opioid Prescriptions Translate to Big Profits for Doctors

Opioid Prescriptions Translate to Big Profits for Doctors

Hundreds of thousands of Americans’ lives have been ruined by opioids

From 1999-2017, nearly 400,000 people died from an overdose involving an opioid. On average, 130 Americans die every day from an opioid overdose. There are other opioid users who are fighting agonizing, lonely and often losing battles with their addition.

An exclusive analysis by three CNN reporters and researchers at Harvard University found that opioid manufacturers are paying physicians huge sums of money to keep prescribing these killer dosages. Shockingly, the more opioids a doctor prescribes, the more money he/she makes.

Six-figure sums for writing opioid prescriptions

In 2014 and 2015, opioid manufacturers paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid more than $25,000 during that time. Those doctors who prescribed particularly large quantities of opioids were the most likely to get paid.

We are taught to trust our doctors

One woman, Carey Ballou, said she trusted her doctor and figured that if he were prescribing opioids, it would be because they were the best option for her pain. Ballou later learned that opioid manufacturers paid her doctor more than $1M over a two-year period.

The payoff from the pharmaceutical companies

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. 54% of those doctors—more than 200,000 physicians–received a payment from pharmaceutical companies that make opioids. There is no reason the doctors should be receiving money from the drug companies, yet look at these stats.

Among doctors:

  • In the top 25th percentile of opioid prescribers, 72% received payments.
  • In the top 5th percentile, 84% received payments.
  • In the top 10 of 1%–95% received payments.

Doctors in the top 1% of opioid prescribers received four times as much money as the typical doctor.

Paying doctors for promotion services is legal, but it raises huge conflict of interest issues

This practice is defended as a way for experts in their fields to share important experience and information about medications, but it has long been a controversial practice.

Pharmaceutical company payments to doctors are not unique to opioids. Drug companies pay doctors billions of dollars for various services. In 2015, 48% of physicians received some kind of payment from pharmaceutical companies. Yet it’s illegal for doctors to prescribe the drug in exchange for kickback payments from a manufacturer—which clearly is happening here.

Sharing drug information can be a legitimate activity

Dr. Steven Stanos, president of the American Academy of Pain Medicine, defended doctors’ getting paid for promoting drugs. “They know those medicines, so they’re going to be more likely to prescribe those because they have a better understanding,” Stanos said.

Stanos’ group accepted nearly $1.2 million from five of the largest opioid manufacturers in the U.S. between 2012 and 2017. Stanos said the money was used for various projects, including courses on safe opioid prescribing.

Money from drug companies influences doctors’ prescribing habits

But Dr. Daniel Carlat, former director of the Prescription Project at the Pew Charitable Trusts, said the CNN and Harvard findings are in line with other studies suggesting that money from drug companies does influence a doctor’s prescribing habits. “It’s another very significant data point in the growing evidence that marketing payments from drug companies are not good for medicine and not good for patient care,” said Carlat, a psychiatrist who blogs about conflicts of interest. “It makes me extremely concerned.”

“I trusted my doctor”

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 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, an opioid that’s 50-100x more powerful than morphine

Dr. Thiyagarajah prescribed Subsys, an ultrapowerful form of fentanyl, which is 50 to 100 times more potent than morphine. “He said it would do wonders for me, you just spray it in your mouth.”  While Subsys helped her pain, it left her in a zombie-like state. She couldn’t be left alone with her three young children. She’d black out, find herself on the kitchen floor or the front lawn. If she missed even one day of the drug, she’d have uncontrollable diarrhea and vomiting.

She shared her concerns with Dr. Thiyagarajah, but he assured her it couldn’t be the Subsys that was causing her health problems. “I trusted him. I trusted my doctor.” When she eventually asked Thiyagarajah to switch her to a non-opioid medication, he became belligerent and told her it was Subsys or nothing.

Her doctor was getting paid more than $200K for prescribing Subsys

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. Cantone is now suing Thiyagarajah, accusing him of setting out to “defraud and deceive” her for “the sole purpose of increasing prescriptions, sales, and consumption of Subsys to increase profits.”

Through his attorney, Thiyagarajah denied any wrongdoing but declined to comment on this story due to the pending litigation. Thiyagarajah denied all of the allegations against him. He might be expected to write a relatively high number of prescriptions for opioid painkillers, given that he’s board-certified in physical medicine and rehabilitation with a subspecialty in pain medicine.

After about two years on Subsys, Cantone took herself off the drug cold turkey 

According to an affidavit by an investigator for the DEA, Thiyagarajah’s office was inspected by the agency in June 2015 and found to be prescribing another opioid, buprenorphine, “for nonlegitimate medical need” in violation of federal law.

Insys sued for a range of crimes

Cantone is suing Insys, the company that makes Subsys. Separate from Cantone’s lawsuit, John Kapoor, the founder and largest shareholder of Insys, was arrested and arraigned on charges of bribing doctors to overprescribe the drug. Kapoor resigned from the Board, and several other Insys executives were arrested in connection with an alleged racketeering scheme. Insys is being accused of falsifying medical records, misleading insurance companies and providing kickbacks to doctors in league with the company.

Doctors vague on the conflict of interest drug companies and physicians

Dr. Patrice Harris, a spokeswoman for the American Medical Association, said that the CNN and Harvard data raised “fair questions” but that that the analyses don’t prove that one causes the other.

But other doctors worry that the large amounts of money from opioid manufacturers could influence a doctor’s decision about which drugs to prescribe, ultimately prescribing opioids over less-dangerous options. At least one company has decided to stop paying doctors for promotional activities such as speaking engagements.

Health and healthcare are frequent topics in the CDP offices

Many of our clients are seniors who come in to our offices to create their Living Trusts, and health, healthcare and the continued escalation of drug prices are common concerns. The CNN reporters’ revelation of the conflict of interest between the pharmaceutical industry and the medical community suggests that it may be time for more government oversight.

Our Living Trust package includes a Power of Attorney and an Advance Healthcare Directive. We guide our clients through the process and prepare the legal documents. For most of our services, we charge one flat fee. We’re helpful, compassionate and affordable. Schedule an appointment today at one of our three Bay Area offices in Dublin, Walnut Creek or Oakland.

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CNN reporters Aaron Kessler, Elizabeth Cohen and Katherine Grise reported on this story.