As efforts intensify to blunt the ongoing opioid crisis, a new study finds that increased marketing of the addictive painkillers to physicians was associated with more prescribing and, subsequently, more deaths from overdose. Interestingly, industry influence over physicians was greater based on the number of interactions, not the amount of money paid for speaking or the value of freebies, such as meals.

Between August 2013 and December 2015, drug makers made nearly 435,000 payments totaling $39.7 million to 67,500 doctors in 2,200 counties across the U.S. The payments were for meals, travel costs, speaking and consulting, but not research. And the data showed that the more marketing directed at physicians in a given county, the higher the number of overdoses, regardless of the money spent.