The Impact of Opioid Manufactures Contributions to Doctors on Prescriptions for Opioids in Medicare Part D

The American opiate epidemic has spread rapidly since the early 2000s and continues to worsen, with devastating consequences for families and communities. In 2015 over 33,000 deaths were attributable to opioid overdoses in the United States; this represents an increase of almost 320% since 2000. While the most rapid increase in mortality over the 2000-2015 time period were associated with heroin, where the number of deaths increased from 1,832 n 2000 to 13,051 by 2015 (an increase of 612.4%), deaths associated with opioids which are approved for prescription use have also risen precipitously, from 6095 in 2000 to 20,152 by 2015 (a 230.6% increase). One common practice, which is nonetheless controversial, is when pharmaceutical manufactures give physicians gifts, presumably with the implicit expectation that the physicians will prescribe that manufacturer’s medications. While manufacturers may expect that these gifts alter physician prescribing behavior, little is actually known about the association. This is a particularly relevant issue with respect to gifts from manufacturers that produce opioids, the over-prescribing of which may be socially worrisome.

I extract data on all Medicare Part D prescribing for opioids at the individual physician level in the U.S. 2013-2015, and combine that with data on the value of gifts from opioid manufacturers to each physician using the CMS the Open Payments dataset. I estimate the association between pharmaceutical gifts and opioid prescribing both at the physician and county level, and how that relationship is mediate by prominent opioid prescribing control policies. Finally, I discuss the implications of the results for managing the opioid mortality epidemic.