New research reports that the more aggressively opioids were marketed to doctors in a given county, the more overdose deaths that county experienced one year later. (Photo: Martin Brosy/Unsplash)

The United States' opioid epidemic is heading for court—or, rather, many courts, to be precise. An ever-increasing number of states, cities, and counties have either initiated or joined civil suits demanding damages from pharmaceutical companies. As Forbes puts it, these suits "contend that tens of millions of dollars were intentionally spent by pharmaceutical companies to downplay addiction concerns, market exaggerated benefits of opioids, and lobby doctors to prescribe more."

Those charges will be difficult to deny, but proving them is only the first step. If government entities want to recoup their health-care costs, they will presumably have to prove such deceptive marketing actually led to more overdose deaths.

Just-released research gives them some powerful ammunition to work with. It reports that the more aggressively opioids were marketed to doctors in a given county, the more overdose deaths that county experienced one year later.

"These findings held for multiple different measures of opioid marketing," writes a research team led by Dr. Scott Hadland of Boston University. "Our findings suggest that direct-to-physician opioid marketing may counter current national efforts to reduce the number of opioids prescribed, and that policymakers might consider limits on these activities."

For the study, published in the journal JAMA Network Open, the researchers analyzed all non-research-related marketing of opioid products from August 1st, 2013, to December 31st, 2015. They recorded the specific type of marketing that occurred (meals, speaking fees, consulting fees, honoraria), and the county in which the physician practiced. "$39.7 million in opioid marketing was targeted to 67,507 physicians," the study reports.

The team then compared this information to opioid prescribing rates at local retail pharmacies, and to the rate of opioid-related deaths in each county one year after the drugs were marketed (that is, between August 1st, 2014, and December 31st, 2016).

After taking various county-level socioeconomic factors into account, including poverty, unemployment, and education levels, the researchers found that, as the number of physicians exposed to a marketing campaign increased, so did the year-later rate of fatal overdoses.

"In addition, opioid prescribing rates were strongly associated with [aggressive] opioid marketing," they write. This fits the widely held belief that many if not most opioid addictions begin when a person in pain receives a prescription.

What can be done? Besides the aforementioned lawsuits, some states have enacted regulations on direct-to-physician marketing. "New Jersey, for example, recently passed a regulation to limit total payments to physicians at $10,000 annually," the study notes.

Alas, the researchers argue that such an approach is unlikely to be effective, since most marketing of this kind involves low-cost activities, like taking a physician to a nice dinner. Extolling the virtues of your company's product over a good steak often seems sufficient to change a doctor's prescribing habits.

Better, the researchers argue, to counter that sort of propaganda with objective information. "Professional medical organizations and licensing boards should continue to support education to help physicians prescribe opioids appropriately."

In an accompanying commentary, Jordan Trecki of the U.S. Drug Enforcement Administration agrees that "pharmaceutical marketing, in combination with excessive, inappropriate prescribing by physicians, could be viewed as one of the root causes of the current opioid epidemic."

But Trecki warns that "it is evolving beyond prescription medications and heroin to involve illicitly produced fentanyl" and other opioids. "A variety of approaches will be necessary to control this epidemic," he writes.

That is undoubtedly correct. But holding drug manufacturers accountable will be a key piece of that multifaceted response.