Dr. Mercola: 1 Out of 12 Doctors Collecting Bonuses for Pushing Opioids

1 Out of 12 Doctors Collecting Bonuses for Pushing Opioids

    August 22, 2017 • 23,296 views

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opioid-related payments to physicians
Story at-a-glance

    Drug companies made more than 375,000 non-research opioid-related payments to more than 68,000 physicians, totaling more than $46 million
    This amounts to 1 in 12 U.S. physicians collecting money from drug companies producing prescription opioids
    The top 1 percent of physicians received nearly 83 percent of the payments, and the drug fentanyl was associated with the highest payments
    Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were those showing the most opioid-related payments to physicians

By Dr. Mercola

More than 33,000 Americans were killed by opioids in 2015, and nearly half of them involved a prescription for the drugs. Each day, the U.S. Centers for Disease Control and Prevention (CDC) notes, 91 Americans die from an opioid overdose, and the numbers keep rising, nearly quadrupling since 2015.1 Knowing that these drugs carry the serious risk of addiction, abuse and overdose, they should be prescribed sparingly and only for the most severe cases of pain, for which no other options are available.

Instead, they are often prescribed widely to treat milder cases of chronic pain, such as that from osteoarthritis or back pain. "In the past decade, while the death rates for the top leading causes of death such as heart disease and cancer have decreased substantially, the death rate associated with opioid pain medication has increased markedly," the CDC noted. "Sales of opioid pain medication have increased in parallel with opioid-related overdose deaths."

It's shocking that, in the midst of this epidemic of opioid overdose deaths, the pharmaceutical industry would still be making payments to physicians to prescribe more opioid products, but this is precisely what's occurring, according to a study published in the American Journal of Public Health.2
1 in 12 Doctors Being Paid by Drug Companies Marketing Opioids

Using the online Open Payments Program from the Centers for Medicare and Medicaid Services, you can easily search to find out what (if any) payments your doctor has received from the pharmaceutical industry, along with the nature of the payments. The researchers used Open Payments to reveal opioid-related payments to physicians between August 2013 and December 2015.

More than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling more than $46 million. This amounts to 1 in 12 U.S. physicians collecting money from drug companies producing prescription opioids.

The top 1 percent of physicians received nearly 83 percent of the payments, and the drug fentanyl, a synthetic opioid that can be anywhere from 500 to 1,000 percent more potent than morphine, was associated with the highest payments. Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were also those showing the most opioid-related payments to physicians.3

Also unsettling, family physicians received the most payments (close to 1 in 5 family medicine doctors was a recipient4), which is "an indicator that opioids are being really heavily marketed for pain," Dr. Scott Hadland, the study's author, told The Washington Post.5 "The next step is to understand these links between payments … and prescribing practices and overdose deaths," he said. "It's very common that the first opioid … [many people are] ever exposed to is from a prescription."6
Overprescription of Opioids a 'Fundamental Cause' of the Opioid Epidemic

A Harvard study, "The Opioid Epidemic: Fixing a Broken Pharmaceutical Market," explains that the overprescription of opioids was, and continues to be, a fundamental cause of the opioid epidemic, noting that such prescriptions rose 104 percent from 2000 to 2010.7,8 In 2015 alone, the report noted, about 300 million prescriptions for opioids were written, which is more than one for every U.S. adult.

While pharmaceutical company payments to physicians may play some role in this overprescribing, the Harvard report suggests the surge in prescriptions can be traced back to the widespread prevalence, and undertreatment, of chronic pain. This, in turn, spurred a campaign for more aggressive pain management. It's true that many Americans struggle with unaddressed chronic pain but, unfortunately, most doctors are ill-equipped to treat it.

As a result, they resort to the only treatment they know: prescription drugs. It wasn't long ago — during the 1980s and 1990s — that many prominent physicians and health organizations urged the use of opioids for chronic, noncancer pain, even going so far as to state that the risk of misuse and addiction was low. The game-changer occurred in 1995, when Purdue Pharma received U.S. Food and Drug Administration (FDA) approval for extended-release oxycodone (Oxycontin) for the management of moderate to severe pain.

The company launched an extensive marketing blitz surrounding the drug, including doubling its marketing team and paying $40 million in bonuses, offering free initial supply coupons to patients, and hosting "all-expenses-paid pain management and speaker training conferences at lavish resorts" for clinicians. The drug became a blockbuster, in large part due to non-rigorous patenting standards and lack of policing of fraudulent marketing, the report notes:9

    "Purdue's success was attributable in part to low patenting standards that enabled the company to secure and extend market exclusivity for extended-release oxycodone, providing motivation for its aggressive marketing.

    A history of tepid enforcement against pharmaceutical companies engaging in illegal marketing further incentivized Purdue to make false claims about the safety and effectiveness of the drug. Both practices helped drive opioid overuse and misuse, with tragic public health consequences."

Taxpayer Funds Will Now Be Paying Drug Companies to Fight Epidemic They Created

Before President Trump declared the opioid epidemic a public health emergency on a federal level,10 six states had already taken matters into their own hands and declared it as such, in some form or another. Doing this allowed them to access certain resources that might otherwise have been out of reach outside of a declared emergency.

In some cases, such as in Arizona, the emergency declaration allowed for increased funding, which the state has used to train law enforcement officers on how to administer naloxone, the lifesaving opioid antidote.11

In Massachusetts, the emergency declaration made a prescription monitoring program mandatory for physicians and pharmacies, while also allowing first responders to carry naloxone. The sad irony is that taxpayer funds will now be paying drug companies for naloxone, another one of their products. So Big Pharma gets richer off the epidemic they created, leaving U.S. taxpayers to pay the bill. As the price of naloxone rises, so do the reported sales and profits of the companies providing the drug.

Amphastar, the primary provider of injectable naloxone to emergency personnel, reported net revenue of $77 million in the last quarter of 2015.12 As recently as the early 2000s, the cost of naloxone hovered around $1 per dose. Today the drug costs close to $40 per dose and the price keeps rising.13 Apparently, Big Pharma is taking full advantage of the race to get the medication in the hands of all first responders and even into most households.

Meanwhile, in 2016 the federal government proposed adding $1.1 billion in the 2017 budget to expand prescription drug and heroin abuse treatment and make naloxone more available.14 The funding included millions to help individual states treat opioid abuse as well as to fund 700 health care providers within the National Health Service Corps, but ignored the many ways the government itself enabled the opioid epidemic.
Leftover Pain Meds After Surgery Fuel Opioid Epidemic

Opioids are frequently prescribed to treat post-surgery pain, but rather than individualizing prescriptions according to a patient's needs, some surgeons use a one-size-fits-all approach.15 The result, according to a study published in JAMA Surgery, is that 67 percent to 92 percent of patients report having unused opioids after their surgical procedures.16

"Unused opioids prescribed for patients after surgery are an important reservoir of opioids available for nonmedical use and could cause injuries or even deaths," the researchers noted, pointing out, "Rates of safe storage and/or disposal of unused prescription opioids were low." Leftover drugs could be taken by teens or other family members, posing an overdose risk, for instance.

These addictive and potentially deadly drugs are even being prescribed to women who have just given birth, putting them and their children at serious risk. One study in Obstetrics and Gynecology revealed that more than 1 in 10 Medicaid-enrolled women filled a prescription for an opioid following vaginal delivery to treat post-delivery pain.17

Fourteen percent of them then went on to fill a second prescription within six to 60 days after delivery. Separate research has shown that 1 in 300 women who fill a prescription for opioids following cesarean delivery go on to become persistent users.18 A second study revealed that young children of mothers prescribed opioids were at a significantly increased risk, by 2.5 times, of overdose.19 Among children, 1 in 10 of overdoses occurred in infants under 1 year, while half occurred in children 2 years or younger.
Ohio County Morgues Overflowing With Opioid Overdose Victims

In Montgomery County, Ohio, an area at the crossroads of distribution for black market opioids, an estimated 800 people are expected to die in 2017 due to opioid overdose — more than double last year's number. CNN reported:20

    "Most nights, the freezer in Montgomery County's morgue is stacked floor-to-ceiling with bodies. Dr. Kent Harshbarger, the coroner whose office services more than 30 counties, estimates that 60 [percent] to 70 [percent] of these corpses are the result of an opioid overdose. 'What's most challenging is seeing the same story repeated over and over again,' he said. 'It seems, from my perspective, inevitable.'

    … Since last year, to deal with the surge in overdose deaths, Harshbarger has hired six part-time coroners, two autopsy technicians and three field investigators. He also extended some of the staff's workday by three hours so they had time to perform more autopsies and remodeled the morgue freezer to fit more bodies.

    Several times in 2015 and 2016, the office was overwhelmed, and he had to house some of the corpses in mobile morgues — trucks with refrigerated trailers … 'Staff is overwhelmed,' he said. 'This is a mass fatality crisis.'"

West Virginia, meanwhile, which has a $2 million annual budget to provide funeral assistance for families who cannot afford them, has been overwhelmed with funerals for the past five years, driven in part by the opioid epidemic. In 2017, the program was nearly out of money four months before the end of the fiscal year.21
Opioid Deaths May Be Underreported

While it's clear that opioid overdose deaths have reached epidemic proportions, research published in the American Journal of Preventive Medicine found that such deaths may actually be underreported.22 Many death certificates do not identify the specific drug involved in the death, which results in an underestimate of the involvement of specific drugs in fatal overdoses, the study found.23

"For instance, mortality rates calculated using imputed data on specific drugs where such information was lacking on death certificates suggest that in 2014 opioid- and heroin-involved death rates were understated by more than half in Pennsylvania," the researchers wrote. In all, when death certificates were corrected, they found mortality rates related to opioids and heroin were 24 percent and 22 percent greater than reported, respectively. According to the study:24

    "Current death certificate data are problematic for understanding the drug poisoning epidemic, with a particular issue being the frequency with which no specific drug is identified. This results in an underestimate of the involvement of specific drugs in fatal overdoses (but not in the overall number of drug fatalities), which is sometimes substantial."

Safer Options for Overcoming Chronic Pain

Even when taken as directed, prescription opioids can lead to addiction as well as tolerance, which means you need an increasingly stronger dose to get the pain-relieving effects. People of all ages and from all walks of life are being affected, and please understand that anyone can become addicted to opioids.

So, if you have chronic pain of any kind, know that there are many safe and effective alternatives to prescription and even over-the-counter painkillers. The pain remedies that follow are natural, providing excellent pain relief without any of the health hazards that pain medications often carry.

Astaxanthin: One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required and one may need 8 milligrams or more per day to achieve this benefit.

Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.

Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 milligrams of curcumin a day to their treatment plan had reduced pain and increased mobility.25 In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.

Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites, as I have seen it work well with many rheumatoid arthritis patients.

Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.

Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.

Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma-linolenic acid (GLA), which is useful for treating arthritic pain.

Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.
Dietary Changes and Additional Pain Relief Options

When physicians don't know how to effectively treat chronic pain, they often resort to prescription drugs, which will do nothing to solve the underlying reasons why you're in pain. Toward that end, if you suffer from chronic pain, there's a good chance you need to tweak your diet as follows:

    Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work; they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
    Reduce your intake of most processed foods as they not only contain sugar and additives, but most are also loaded with omega-6 fats that upset your delicate omega-3 to omega-6 ratio. This, in turn, will contribute to inflammation, a key factor in most pain.
    Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
    Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain. This satisfies your body's appetite for regular sun exposure.

Finally, the natural pain-relief methods that follow are useful for ongoing and lasting pain relief and management:

    Chiropractic adjustments: According to a study published in the Annals of Internal Medicine and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks compared to those who took medication.26
    Massage: Massage releases endorphins, which help induce relaxation, relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline.
    Acupuncture: Researchers concluded that acupuncture has a definite effect in reducing chronic pain such as back pain and headaches — more so than standard pain treatment.27

+ Sources and References
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