Gifts to Doctors Influence Their Prescribing of Opioids

Could the gift of a $13 lunch (little more than a burger and a soft drink) influence a doctor to over prescribe opioids?

“NO” says common sense. “Yes” says research.

A study published in JAMA Internal Medicine reported that physicians who received lunches from drug companies prescribed 9% more opioids than did doctors who had not.

Researchers got their prescribing information from Medicare Part D, which represents about 43% of the active physician workforce. They compared that to information from the Open Payments Database to see payments from pharmaceutical companies. In all, about 7%, or around 25,000 doctors, received opioid-related payments.

Scott Hadland, M.D., the study’s lead author who is from the Grayken Center for Addiction at Boston Medical Center, noted that the increase took place even as the overall rate of opioid prescriptions was falling. “It is a lot when you think about how large this sample was, how many physicians there are across the United States and how widespread this practice is.”

The vast majority of the payments (92%) were made in the form of meals at an average cost of about $13. But they added up to about $9 million worth of total payments. “That’s a lot of interactions,” Hadland noted.

Why do physicians accept a gift of free meals? Hadland believes they do because it’s a small reward that physicians can get in their practice and, like any other professional, they appreciate small rewards,

Neither Hadland or other members of his team believe doctors are acting nefariously or unprofessionally “I think if we could talk to the vast majority of physicians, most would not believe the meal they went out on influenced their prescribing behavior. I think the effect here is very subtle. But it’s widespread. That has a large public health effect,” said Hadland.

The study’s findings confirm previous studies which have found that smaller payments from drug companies could have a larger impact on prescribing habits than large ones.

Hadland plans to focus next on convincing lawmakers about the importance of these small gifts. He noted that New Jersey is working on a rule change that would cap the total dollar value of gifts from drug companies to doctors at $10,000 a year.