The opioid epidemic in the United States is quickly becoming one of the biggest health disasters our country has ever faced. It has killed hundreds of thousands of people and is estimated to have cost the U.S. over half a trillion dollars in 2015 alone.
And while the true causes of this devastating crisis are varied, one of the biggest contributors to the problem has been overprescribing doctors. These physicians have helped fuel the epidemic by giving out far too many opioid prescriptions over the years, either because of greed or simply because of ignorance.
A shocking new report reveals that such problem prescribers in Colorado received more pharmaceutical kickbacks than any other state. Below, we’ll take a closer look at why this is a topic of concern for many in Colorado and what it really means to be a problem prescriber.
Colorado Ranks as Top State for “Problem Prescribers”
An NBC report recently highlighted a study conducted by the Boston Medical Center which found that Colorado doctors were paid out more money than any other state – $4.6 million to be exact.
Researchers from the medical center parsed through the public records from 2013 to 2015 to find that Colorado collected more payments from manufacturers of painkillers like hydrocodone and fentanyl than states where the opioid epidemic is even more severe.
Payouts to these doctors made up a whopping 10% of the total kickbacks recorded during the same period ($46 million).
And while these types of kickbacks don’t necessarily point to any wrongdoing on the part of state doctors, studies have shown that monetary compensation provided by companies does in fact influence prescribing behaviors.
Given how serious the opioid epidemic has become in Colorado (almost a quarter of a million residents misuse prescription drugs each year), honing in on the main causes for the crisis is imperative. The Colorado Consortium for Prescription Drug Abuse Prevention was formed in part for just such a purpose.
The Consortium works with a variety of agencies, task forces, health care providers and more to “improve education, public outreach, research, safe disposal, and treatment” with regards to prescription opioids.
“There’s obviously some potential for pharmaceutical companies to try to influence doctors and get them to prescribe their drug,” says Rob Valuck, director of the Consortium.
How Strong Is the Correlation Between Prescribing & Payments?
In a word: strong. A ProPublica analysis that looked at payments from medical device manufacturers and pharmaceutical companies to doctors in 2014 found a significant difference in how financially influenced doctors prescribe drugs. The more money they receive, the more brand-name medications these doctors tended to write prescriptions for.
These kickbacks could include anything from consulting contracts and research grants to golf clubs and comped meals.
The report found that doctors who received more than $5,000 from such companies in 2014 were among the highest brand-name prescribers. Doctors or interns who received no payments prescribed such brand names at a rate of around 20%. Problem prescribers who received more than $5,000, however, did so at a rate of about 30%.
The proof is undeniable: financial incentives undoubtedly alter the prescribing practices of physicians.
Are These Problem Prescribers Doing Anything Illegal?
Payments from pharmaceutical companies have been a problem for years.
The implementation of the Anti-Kickback Statute as part of the Social Security Amendments of 1972 aimed to combat this problem directly. The statute, however, failed to curb the growth of fraud and abuse in the medical community for several years.
It was in 1977 that the statute truly got its teeth and increased the penalty from a misdemeanor to a felony charge. Today, the statute carries criminal penalties of up to $25,000 and a five-year prison sentence while civil penalties can soar to $50,000 per kickback.
However, that isn’t to say that doctors and pharmaceutical titans aren’t finding ways to circumvent the laws in place today.
For example, while it may be illegal for a company to directly pay a prescribing physician to recommend their brand, it isn’t necessarily illegal to pay these doctors for things like:
- Research work
- Travel and meal expenses during research & consulting
- Research grants
- Exorbitant payments for speaking engagements
- Material gifts
- Free labor
As you can see, kickbacks don’t necessarily come in the form of direct cash payments. However, they can still be quite influential when it comes to prescribing practices of physicians today.
How Are Problem Prescribers Impacting the Opioid Epidemic?
One of the main contributors to the growing opioid epidemic is the fact that prescription opioids are given out at a much higher rate than ever before.
The Centers for Disease Control and Prevention (CDC) reports that sales of prescription opioids have almost quadrupled in the United States from 1999 to 2014. However, the amount of pain that Americans are reporting has remained the same throughout.
Beyond that, the efficacy of opioid pain relievers is still under review. At this time, there still is not enough evidence to support the claim that opioids improve chronic pain, function, and the quality of life according to the CDC.
And when these drugs are used in the long-term, the likelihood of abuse and overdose increases drastically.
In fact, around 20% of patients that use opioids for non-cancer related pain are estimated to have an opioid use disorder today.
As a result, these incredibly potent and highly addictive drugs are being prescribed for pain at a rate that is undoubtedly contributing to a large-scale dependency problem – and these drugs may not even be effective in the first place!
How Easy Is It to Become Addicted to Prescription Pain Pills?
Opioids in general are extremely addictive. In fact, according to data from the CDC, taking just a small dose of prescription opioids (even a single short-term prescription) can end up causing an eventual substance use disorder down the line.
Researchers have found that a single day prescription of opioids correlates with a 6% probability that the patient will still be using opioids a year later with a 2.9% increase in the risk of using 3 years later. For prescriptions lasting over a month, that number jumped to 30%.
In addition to the pleasure of the euphoria felt during an opioid high, these drugs can be especially addictive solely due to their extremely uncomfortable symptoms of withdrawal – second in severity only to benzodiazepines.
These symptoms include:
- Muscle aches
- Increased tearing
- Runny nose
- Abdominal cramping
- Dilated pupils
- Goose bumps
In some cases, opioid dependent individuals may want to kick their prescription painkiller habit but struggle to get through the symptoms of withdrawal that occur during detox.
Luckily, there are a number of medication-assisted treatments (MATs) and opioid replacement therapies (ORTs) that are used in addiction treatment centers to help reduce the severity of these symptoms and boost the chances of recovery.
A Few Numbers on The Severity of the Opioid Epidemic
In order to fully grasp just how these problem prescribers are affecting the health of the general population as a whole, it’s helpful to understand just how dire the opioid epidemic is today. And one of the best ways to do that is by taking a look at the numbers.
- At least 91 Americans die every day due to an opioid overdose (including prescription drugs and heroin).
- The number of overdose deaths related to opioid abuse has quadrupled since 1999.
- Over half a million people died as a result of an opioid overdose from 2000 to 2015.
- More than six out of ten drug overdoses involved an opioid.
- Prescription opioid overdoses kill an average of 40 people every day.
- As many as one quarter of patients that receive long-term opioid therapy struggle with an opioid addiction.
- Almost 2 million U.S. citizens either abused or were physically dependent on prescription opioids in 2014.
- Over 1,000 people end up in the emergency department every day for misusing prescription opioids.
- 2015 saw over 15,000 deaths from prescription opioid overdoses.
Prescription Medications & Heroin
One of the most common misconceptions about addiction to prescription medications is the notion that dependency on these types of drugs is far safer than dependency on street drugs like heroin.
This idea is false. In fact, certain prescription drugs like fentanyl have been shown to be as much as 50 times as potent as street-grade heroin, making it significantly more dangerous when in the wrong hands.
But another aspect of the opioid epidemic that many people may be unaware of is the fact that prescription medication abuse has a strong correlation with eventual addiction to heroin.
The National Institute on Drug Abuse reported that nonmedical pain reliever users were 19 times more likely to abuse heroin than the general population. What’s more, nearly 80% of heroin users report using prescription opioids before jumping into heroin.
Part of the reason for this shift is that street heroin has actually become cheaper and easier to obtain than many prescription opioid painkillers. As such, when a dependent patient’s prescription runs out or a doctor cuts them off, they can simply turn to heroin as a cheaper and similarly effective source for their opioid buzz.
Problem prescribers, then, aren’t only contributing to a population that’s more addicted to prescription painkillers. They’re also creating more heroin addicts as well.
What’s Being Done About Problem Prescribers?
There are already a number of laws in place that aim to control the irresponsible prescribing of painkillers in the medical field today.
The Anti-Kickback Statute discussed earlier is the main line of defense against these practices but the implementation of the Stark Law also helps to reduce certain unethical actions by doctors. This 1989 law focuses on barring doctors from unfairly referring their patients to affiliates to which they have a financial arrangement.
What’s more, there are a number of programs that combat the issue of problem prescribers by disseminating information. The Dollars for Docs program, for instance, is a searchable national database from ProPublica that allows patients to look up their doctor and see how many payments they’ve received from companies and the dollar value of each.
This program was made possible by the provisions set forth by the 2010 Affordable Care Act which mandated the disclosure of payments made to doctors for consulting, meals, research, promotional speaking and more.
There is still quite a bit more that needs to be done with regards to complete visibility in the medical field, but the fact that the public is becoming increasingly aware of these trends is a step towards decreasing prescription drug abuse.
Problem Prescribers: A Critical Issue in Medicine Today
Problem prescribers have undoubtedly contributed to the proliferation of prescription opioid abuse and dependency across the nation. Lax prescribing guidelines as well as financial influence from pharmaceutical companies have added to an already deadly problem that’s ruined countless lives.
If you need help dealing with your prescription drug abuse, it’s critical that you talk to your doctor today about your dependency and seek out professional help. Otherwise, you may slip even further down the hole of addiction.