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Opioid Crisis: Pharmaceutical Payments to Physicians Affect Excessive Opioid Prescribing Essay

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Updated: Jun 21st, 2022

Introduction

Deaths from opioids have increased sharply in the US over the previous couple of decades. The typical elucidation blames prolonged prescription and advertisement of opioids that started in the 1990s. The manufacturers of opioids are giving physicians money to talk and consult about the drug (Nguyen et al., 2019). The affirmations that increased prescription augments deaths have elicited enhanced legal restrictions regarding opioid medications. While supporters are convinced that pharmaceutical payments to doctors affect the extreme opioid prescribing, critics believe that other aspects such as too many restrictions are resulting in the creation of underground markets hence a high probability of overdose. Although a ban on pharmaceutical payments to doctors might seem severe, it is the only suitable solution to the opioid crisis.

Arguments Supporting the Effects of Pharmaceutical Payments on Prescribing

Physician-directed payments from opioid manufacturers have increased the rate of prescribing. From the mid-1990s, remarkable transformations have happened in the field of pain management. For example, the Food and Drug Administration endorsed oxycontin, which led to its being highly marketed since it has minimal chances of abuse, unlike the existing and less effective opioids. This was the beginning of the problem since it created the initial wave of newly self-administered opioids in the market. Hollander et al. (2020) have established that physicians who obtain money from manufacturers of opioids such as oxytocin tend to prescribe the drugs than their counterparts who do not get such direct payments. The connection between payments and prescription is most significant for oxycodone and hydrocodone, the most prescribed opioids amongst Medicare patients. The Medicare populace is believed to have a high and fast-rising frequency of opioid usage problems in the United States.

Pharmaceutical companies make indirect payments to health professionals so that they endorse their drugs. They may not give compensation to doctors to directly recommend their medications since such a form of inducement is unlawful. However, they reward physicians for mentioning their drugs in their speeches, conferences, or consulting services. The companies also send sales agents to physician’s workplaces to promote the drugs and perhaps buy lunch or leave samples of the products (Nguyen et al., 2019). Such simple incentives make health professionals either wittingly or unwittingly more likely to prescribe the drug even in greater quantities.

Hadland et al. (2017) affirm that about 50% of all the physicians in the United States receive payments in the form of gifts or money from pharmaceutical companies, totaling more than 2 billion dollars each year. Sometimes the companies offer free meals where physicians are invited to listen to drug representatives, pay for doctors’ travels, or provide luxurious settings where doctors can operate as paid consultants. Such forms of payments generate an apparent conflict of interest. Nevertheless, medical providers have not stopped these payments since they argue that industry inducements cannot harm patients and might benefit them. Relentless efforts such as a ban on payments to doctors from pharmaceutical companies are vital to resolving the opioid crisis.

Pharmaceutical companies’ payments to doctors lead to increased care costs by making physicians more likely to prescribe brand-name opioids over inexpensive generics. While uncontrolled prices of drugs are draining the Medicare resources and patients’ savings, the companies’ payments are forcing things in the wrong course (Hollander et al., 2020). The government’s ban on payments from pharmaceutical companies is vital because the doctors’-led initiative is unlikely. Most physicians are convinced that obtaining money or gifts from pharmaceutical companies is acceptable. Moreover, with the continued mounting of evidence concerning the negative impact of industry payments, supporters of this move continue to spread arguments in their favor.

Pharmaceutical companies usually take details about drugs, for example, in the form of slide decks, to hospitals alongside catered lunch or inducement. For busy health facilities, this could be an appropriate means of ensuring that physicians remain up to date. The most substantive affirmation could be that physicians depend on pharmaceutical companies to learn concerning new drugs. Nonetheless, evidence shows that pharmaceutical companies’ information is biased and, therefore, it makes physicians worse instead of improving their care provision (Nguyen et al., 2019). There are several alternative sources of information, such as communication in medical professional communities, where doctors can acquire enlightenment concerning new drugs and approaches instead of that role being played by pharmaceutical companies. Such medical societies have created dependable, unbiased sources of information for physicians.

There are numerous misconceptions floated to cover up the vice of pharmaceutical payments to physicians to prescribe their drugs. There are assertions that the collaboration of physicians with pharmaceutical companies drives innovation. The argument states that the doctors’ insights are vital for establishing suitable cures, while paid consultancy services are valuable for patients’ proper enlightenment. The more than 2 billion dollars used each year are not utilized in research for new drugs (Hollander et al., 2020). Instead, the money is spent on the promotion of medications that are already on the market. Since the money is used after innovation has already succeeded, it is merely meant for persuasion. In other words, it is not entirely by chance that health professionals who obtain the highest amount of money from manufacturers also mainly prescribe drugs from the same companies.

The affirmation that pharmaceutical payments to doctors influence the disproportionate opioid prescribing is not indubitable anymore. Therefore, the argument that such payments do not affect the rate of opioid prescribing is no longer factual considering the existing evidence. Accepting pharmaceutical payments cannot be deemed helpful or even acceptable. Physicians take an oath to continuously operate in patients’ best interest, which is an obligation that they should honor (Hadland et al., 2017). The most significant problem that should be confronted is that the present situation shows that pharmaceutical payments have been working against the interest of patients.

Payments provided to doctors by drug companies negatively influence the quality of drugs and may lead to the overprescription of such opioids. This translates to diminished quality of care, unwarranted risks to innocent patients, and increased costs attributable to overmedication. Physicians have fallen for the tricks employed by pharmaceutical companies in their efforts to increase their profits. To address this issue, countries around the world should enforce stringent laws that will limit the level of interactions between health professionals and representatives from pharmaceutical companies (Guy Jr et al., 2019). Regular use of some medications in high quantities, for example, vasodilators and benzodiazepines, raises the threat of recognized side effects of such drugs coupled with occasional severe or lethal consequences. Gifts translate to a feeling of indebtedness and eventually sway prescription practices negatively. It is high time that physicians understood that the amount of money or rewards provided accounts for only a small segment of their income. At the same time, they represent an insignificant monetary engagement for drug manufacturers compared to their profits from the sale of opioids.

Medical representatives from drug companies use rewards, compliments, and gifts to create a good rapport with doctors to increase the prescription of their opioids. Such medical representatives receive training to evaluate the personalities and inclinations of doctors. They use knowledge from such physician assessments to manipulate information regarding both themselves and the opioids they sell. Although some doctors believe that promotion and payments from pharmaceutical companies do not influence their personal views, promotion practices sway physicians’ insights regarding such opioids and the likelihood to prescribe them (Carrico et al., 2018). Constant associations of representatives from drug companies and doctors influence the level of prescriptions and ensuing patients’ costs.

Though some doctors depend on sales representatives to correctly inform them concerning opioids, the details are often incorrect. The sales representatives neither have the correct information regarding rival therapies nor accurate data of the opioids they sell. Additionally, medical representatives either overlook or hide specifics concerning adverse drug events. Some physicians feel that they extract helpful information from sales representatives about the drugs (Nguyen et al., 2019). However, doctors cannot differentiate between false and truthful details given by medical representatives. Moreover, exposure to the information provided by drug manufacturers is linked to an increased rate of prescription and high costs.

Arguments Against the Effects of Pharmaceutical Payments on Prescribing

Guy Jr et al. (2019) affirm that it is not pharmaceutical payments to physicians that influence increased prescribing but the existence of too many restrictions on opioid prescription. The threat of opioid overdose from appropriate medication is minimal as doctors only rely on manufacturers to learn about new drugs. Moreover, prescription restrictions compel users to seek diverted or illegal sources, which augments overdose threat since they cannot rigorously evaluate drug potency, efficacy, or quantity in underground markets. On the contrary, from 2011, fast mounting deaths from opioids, for example, fentanyl, resulted in an increased fatality rate irrespective of decreased legal prescriptions.

Pharmaceutical payments to physicians do not influence increased prescribing, but patients’ needs for the drugs warrant it. Carrico et al. (2018) affirm that pharmaceutical payments to physicians neither cause long-term medical administration of opioids nor pose any significant risk to patients. This proof, in conjunction with the notion of some critics that doctors might be undertreating pain, led to the medical board, non-governmental organizations, and other support groups to recommend opioid treatment for conditions such as chronic aches. Pharmaceutical companies appreciated this occurrence and asserted that opioids such as oxycontin have minimal risks to patients. Quite the reverse, the proponents of the impact of pharmaceutical payments to physicians on prescriptions state that the early optimism emanates from minimal and unconvincing evidence. They affirm that increased opioid prescriptions of the 1990s resulted in increased overdose, dependence, and deaths. Therefore, restriction of pharmaceutical payments to doctors is necessary to reduce unnecessary prescriptions and ultimately the resultant harm.

Lo and Grady (2017) assert that pharmaceutical payments to physicians do not influence increased prescribing as opioids are exclusively availed on prescription and only when doctors find it essential to do so. Consequently, although many forms of opioids are lawfully produced, distributed, and administered within the guidelines of the Controlled Substances Act, they are not as commonly accessible as common legitimate goods. Physicians usually restrict prescriptions to healthcare norms and lawful limitations. Quite the opposite, the increased prescription of opioids happens in health facilities and not only in the underground markets. The effects of opioids from illicit sources are insignificant compared to the ones prescribed by doctors, which necessitates stringent measures such as prohibiting all forms of gifts or payments to physicians by pharmaceutical companies.

Pharmaceutical payments and gifts to doctors do not influence increased prescribing because physicians uphold integrity and the best interest of patients. Physicians are not so crooked or lacking in integrity to the point of auctioning the interests of their patients for a pack of candies, a few donuts, or any amount of money (Lo & Grady, 2017). Health providers resist such temptations and arrive at judgments solely anchored on the welfare of patients. Pharmaceutical companies should not be prohibited from offering gifts and payments to physicians. This is only meant as a token of their appreciation for attending meetings where they are enlightened concerning different medications. Conversely, though doctors are honest and ethical professionals who do everything possible to help patients, they are human beings hence susceptible to external influence. Money is a crucial suspect for undue influence, which is not a surprise as to why pharmaceutical companies use billions of dollars every year to entice doctors into prescribing their drugs.

Conclusion

The more doctors prescribe opioids, the higher the amount of money they receive from the manufacturers. While proponents are convinced that pharmaceutical payments to physicians influence the extreme opioid prescribing, opponents believe that other factors such as many limitations push consumption to underground markets, thereby creating a high possibility of overdose. A prohibition of pharmaceutical payments to doctors may appear severe but is the only appropriate solution to the opioid problem. Despite doctors being honest and ethical professionals, they are human beings thus vulnerable to external influence.

References

Carrico, J. A., Mahoney, K., Raymond, K. M., Mims, L., Smith, P. C., Sakai, J. T., Mikulich-Gilbertson, S. K., Hopfer, C. J., & Bartels, K. (2018). The association of patient satisfaction-based incentives with primary care physician opioid prescribing. The Journal of the American Board of Family Medicine, 31(6), 941-943. Web.

Guy Jr, G. P., Haegerich, T. M., Evans, M. E., Losby, J. L., Young, R., & Jones, C. M. (2019). Vital signs: Pharmacy-based naloxone dispensing—United States, 2012–2018. Morbidity and Mortality Weekly Report, 68(31), 679-686. Web.

Hadland, S. E., Krieger, M. S., & Marshall, B. D. (2017). Industry payments to physicians for opioid products, 2013–2015. American Journal of Public Health, 107(9), 1493-1495. Web.

Hollander, M. A., Donohue, J. M., Stein, B. D., Krans, E. E., & Jarlenski, M. P. (2020). Association between opioid prescribing in Medicare and pharmaceutical company gifts by physician specialty. Journal of General Internal Medicine, 35(8), 2451-2458. Web.

Lo, B., & Grady, D. (2017). Payments to physicians: Does the amount of money make a difference? Jama, 317(17), 1719-1720. Web.

Nguyen, T. D., Bradford, W. D., & Simon, K. I. (2019). Pharmaceutical payments to physicians may increase prescribing for opioids. Addiction, 114(6), 1051-1059. Web.

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