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  • Association between industry payments for opioid products and physicians’ prescription of opioids: observational study with propensity-score matching

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Original research
Association between industry payments for opioid products and physicians’ prescription of opioids: observational study with propensity-score matching
  1. Kosuke Inoue1,
  2. Jose F Figueroa2,3,
  3. E John Orav2,4,
  4. Yusuke Tsugawa5,6,7
  1. 1 Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
  2. 2 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  3. 3 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  4. 4 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  6. 6 Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
  7. 7 UCLA Center for Health Policy Research, Los Angeles, California, USA
  1. Correspondence to Dr Kosuke Inoue, Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; koinoue{at}ucla.edu

Abstract

Background Industry marketing to physicians for opioids has received substantial attention as it can potentially influence physicians’ prescription of opioids. However, robust evidence demonstrating a causal link between industry payments for opioids and physicians’ prescription practice for opioids is lacking.

Methods Using the national databases of physicians treating Medicare beneficiaries, we examined the association between physicians’ receipt of opioid-related industry payments in 2016 and (1) the number of opioids prescribed and (2) the annual expenditures for the opioid products by those physicians in 2017, using propensity-score matching in a 1:1 ratio adjusting for the physician characteristics (sex, years in practice, medical school attended, specialty), the number of opioid prescriptions in 2016, and physicians’ financial relationships with industry in 2015. We compared matched pairs of physicians using the estimated effect and paired t-test.

Results Among 43 778 physicians included after propensity-score matching, physicians who received opioid-related industry payments in 2016 prescribed more opioids (153.8 vs 129.7; adjusted difference (95% CI), 24.1 (19.1 to 29.1)) and accounted for more spending due to opioids ($10 476 vs $6983; adjusted difference (95% CI), $3493 (2854 to 4134)) in 2017, compared with physicians who did not receive payments. The association was larger among primary care physicians than surgeons or specialists. The dose–response analysis revealed that even a small amount of industry payments was sufficient to effectively affect physicians’ prescription practice of opioids.

Conclusions Opioid-related industry payments to physicians in the prior year were associated with a higher number of opioid prescriptions and expenditures for opioid products in the subsequent year.

https://doi.org/10.1136/jech-2020-214021

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    Footnotes

    • Contributors All authors had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. KI, JF and YT contributed to the design and conduct of the study, data collection and management and analysis and interpretation of the data; and preparation, review or approval of the manuscript. EJO contributed to the analysis and interpretation of the data and preparation, review or approval of the manuscript.

    • Funding KI was supported by the Burroughs Wellcome Fund Interschool Training Program in Chronic Diseases (BWF-CHIP) and Honjo International Scholarship Foundation.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethical approval The study was exempted from human subjects review by the institutional review board at University of California, Los Angeles.

    • Data sharing statement All data are publicly available: CMS.gov (https://www.cms.gov/openpayments), Medicare.gov (https://www.medicare.gov/physiciancompare) and CMS.gov (https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Part-D-Prescriber.html).

    • Provenance and peer review Not commissioned; externally peer reviewed.