Doctors Receiving Gifts From Pharma Companies Prescribing More Opioids, Says Study

The Hippocratic oath that doctors take before they dedicate their life to the noble profession of saving lives directs them to uphold specific ethical standards. Unfortunately though, many are influenced by the likes of Big Pharma, who could have a conflict of interest with the practitioners of medicine, as their primary aim to expand their business is against the doctor’s – to treat.

With the opioid epidemic causing thousands of fatalities year after year, a collusion between the medical fraternity and drug manufacturers is often blamed for it. Doctors have been questioned for prescribing opioid painkillers excessively even for the conditions that could be treated with alternatives. In a recent study by the Boston Medical Center’s Grayken Center it was found that doctors who received gifts and other benefits in kind from pharma companies had been prescribing more opioids to their patients.

The study findings are significant as the government is under increased pressure to stem the crisis by hook or crook. The researchers have suggested that drug manufacturers should cease to market their products to physicians. They are also of the opinion that both federal and state governments should consider capping the number of payments that physicians could receive from the pharmaceutical companies.

Some significant findings of the study are as under:

The three companies associated with the most significant payments to clinicians were INSYS Therapeutics, Teva Pharmaceuticals, Janssen Pharmaceuticals. INSYS manufactures Subsys, a fentanyl-based product which comes in the form of a sublingual spray.

INSYS Therapeutics also accounted for 50 percent of the non-research payments. The perks that doctors received for furthering the cause of opioids were in the form of free meals, vacations, payments for speaking at seminars, etc. The company is now under federal investigation on charges of marketing the spray to doctors and patients under the guise of a “sham” educational program. The company has a history of facilitating drug abuse; a former employee had notified that the company engaged in malpractices such as using the speaker program to coerce more doctors to prescribe their product which should ideally be used only for cancer pain. Doctors wrote 30 million worth of the opiate prescriptions for Subsys.

In 2015, 369,139 doctors prescribed opioids under Medicare Part D. In the previous year, 25,767 (7 percent) of these doctors had received 105,368 non-research payments related to opioids amounting to over $9 million. Non-research related payments were linked with greater opioid prescribing practices, the researchers however cautioned against associating cause and effect.

Payments included speaking fees and/or honoraria amounting to more than $6 million for 3,115 physicians, meals amounting to nearly $2 million for 97,020 physicians, travel costs amounting to $730,824 for 1,862, consulting fees amounting to $290,395 for 360 physicians, and $79,660 on educating 3,011 physicians.

Help for opioid addiction

The opioid crisis is one of the worst public health emergencies the country has ever faced. It has been affecting millions of people across America directly or indirectly. Apart from the prescription opioids, which are considered as the number one public health hazard if used indiscriminately, benzodiazepines and other prescription drugs have also been partly responsible for the country’s grim situation.

Any prescription drug, be it benzos, opioids, or even the harmless cough syrup codeine, is associated with risks. So, while abuse of these is bad, even using the drugs with the doctor’s prescription without being aware of the side effects can be detrimental. Subsys for example was found to have a bad track record and ever since it was approved by the U.S. Food and Drug Administration (FDA), it has resulted in 63 deaths as per the Agency’s estimates. Therefore, when it comes to prescription drugs, it is better to ask the doctor about the consequences and ask if safer alternatives are available.

Medical Conditions Associated With Higher Risks of Opioid Use Side Effects

Some physicians prescribe more opioids for certain medical conditions and for longer durations compared to others. Paradoxically, the indiscriminate abuse of painkillers instead of providing a permanent cure has been found to increase the severity of the medical condition or cause unwanted side effects – the commonest being drug abuse, dependency and addiction.

Some of the disorders where painkillers are prescribed routinely ignoring the harmful consequences are listed below.

Sleep Apnea: Sleep disorders like sleep apnea are common occurrence in the United States, with an estimated 22 million Americans living with the condition. It is also estimated that a further 80 percent of instances of moderate or severe sleep apnea are undiagnosed. During sleep apnea, the individual suffers from pauses in the intake of breath. As the sleep cycle suffers from repeated interruption, the individual ends up feeling fatigue during the day. In many instances, people suffering from the condition are prescribed prescription painkillers to combat anxiety and pain. However, studies have proved that these drugs only make the condition worse. In a letter published in the Cleveland Journal of Medicine, author Aaron Geller points out the risks of opioid consumption. It caused the cessation of breathing, ultimately resulting in death. It also increased the number of episodes of obstructive and central sleep apnea per hour, as a result people were more likely to die in their sleep.

Anxiety: Sadly, while people with mood disorders and anxiety are more likely to abuse opioids, they are also the ones more likely to be prescribed these addictive medications for their pain and discomfort. Opioids, at best, can provide temporary relief from the pain. But they increase the risks of permanent damage to the brain manifold and up the risks of addiction. Anxiety-prone individuals who have resorted to opioids are known to experiment with drugs such as heroin at a later stage. Some of the common ameliorative strategies for coping with anxiety include therapies such as cognitive behavioral therapy, and behavioral modification strategies. In case of a comorbid disorder, which could arise after prolonged exposure to opioids, an integrated treatment module is considered worthwhile.

Depression: Depression is also associated with the increased abuse of opioid medications. It has become a practice for doctors to hand out opioids even when one has a case of minor blues. More so when the patient happens to be a woman. Though opioids could bring relief from pain initially, in the long run these only aggravate the condition. As the individual’s life revolves more around the drug, he/she has less inclination to participate in routine activities. The natural feel good hormones get depleted, and the individual takes a less positive view of life. He/she feels sad and sullen most of the time. Though prescription medications like antidepressants and opioids are required in case someone goes through a bereavement and finds it hard to cope on his/her own, these should never be used as a crutch. Instead, as soon as one feels even slightly better, these medications should be stopped (with doctor’s approval) and shift gears toward a healthier lifestyle. Proper exercise, healthy food and sound sleep provide long lasting relief and ensure the free flow of natural endorphins.

Obesity: Obesity is as much a psychological condition as a physiological one. While a person who is comfortable even when he/she is overweight is less likely to require help, someone who is obese and is not comfortable with it may go through cycles of depression or anxiety or both. Such patients might be prescribed opioids for the pain. However, it interferes with the natural production of endorphins, which are produced naturally when one walks briskly or does some exercise.

Fibromyalgia: Fibromyalgia is a chronic condition characterized by pain in all parts of the body, emotional distress and fatigue. People who suffer from this condition perceive more pain than others because of the faulty pain perception and processing. It is estimated that 4 percent of the American population lives with the condition. As the pain is for life and opioids at best provide relief only for a short duration, and have high risks of abuse and addiction, one could check with the doctor if alternate medications (off the label) are productive. While therapeutic measures such as CBT are extremely helpful for relieving emotional pain, muscle strengthening exercises, yoga, massage and good sleeping habit can deflect the physical pain considerably.

Addiction prevention

Though opioids should best be avoided, in case the person suffers from a condition where its use is relevant, it is necessary that he/she follows the doctor’s recommendations. Practices such as crushing medications or using more than the standard dosage must be avoided.

Intense Physical Activity Predisposes Teens to Substance Use Disorders

Regular physical activity is important for everyone as it boosts self-esteem, keeps active and energetic and lowers the propensity to serious illnesses. For teenagers, who go through a lot of hormonal changes and hence the issues related to mood and emotions, regular workouts help them deal with the physical and emotional challenges of everyday life. However, according to a new study, teens engaged in regular and vigorous physical activity are prone to develop substance abuse problems.

Members from the Royal Australian and New Zealand School of Psychiatrists (RANZCP) conducted a survey on nearly 3,500 teenagers and concluded that those who worked out for more than four days a week were susceptible to develop substance abuse problem. The researchers analyzed the physical activity of 14-year-old teens and then evaluated their mental health outcomes at 21 years.

Lead author Dr. Shuichi Suetani said that teens who engaged in high-intensity workouts were susceptible to drinking alcohol as young adults. This was found to be true especially for young girls.

Differing opinions

Dr. Matthew Dunn, senior lecturer in public health at Deakin University, and Dr. Mark Hutchinson, professor at Adelaide University’s Medical School, found that exposure to alcohol and drugs takes place because of environmental and societal pressures as well.

Dr. Dunn said that there is nothing new when it comes to sports and consequent exposure to harmful substances. He said that multiple sociocultural things could drive a teenager toward drug or alcohol abuse. As per him, if a teenager is a part of a club or a team that receives sponsorship from an alcohol company, there is an understated pressure to drink.

As per him, when an individual is around athletes and peers who abuse alcohol and other substances, one gets inevitably drawn to try these addiction-forming substances. However, when children are under supervision, they are less likely to go astray.

Dr. Hutchinson said that exclusive sports clubs and competitive environments could be the gateway to substance abuse. He is of the opinion that teens who follow the group mentality by mimicking other people’s unhealthy behavior could be damaging their future.

Children are impressionable and do not know how to say no to such advances or make sensible decisions. Moreover, their brains are still in a developing stage, so they can suffer from the consequences in a more serious way than adults. The affected teenagers may ultimately require affordable drug and alcohol treatment at good addiction facilities.

The RANZCP research also established that the serotonin release during an intense workout could be responsible for pushing the teens towards alcohol and other substances but the finding was refuted by Dr. Hutchinson because of dearth of data supporting the view.

Talking to teens about substance abuse

Teenage is a vulnerable time when many young boys and girls are not yet capable of making informed choices and are likely to feel disoriented later. Parents can play a pivotal role in guiding their children about the perils of alcohol and substance abuse. It is important to talk and keep the communication channels open.

Some ways in which parents can address this issue are:

Get involved in the child’s life without intruding. Set rules for partying, homecoming, friends’ time, play time and other activities. When children know that they are being monitored closely, they are less likely to indulge in substance abuse.
Parents should remind teens about the deleterious effects of alcohol and substances on physical health, academic and sports performance, social interactions as well as family and romantic relationships.
Parents should encourage their teens and show appreciation even when the achievement is small. Positive reinforcements can go a long way in keeping them away from negative influences.
Children should be encouraged to pursue a hobby, try a new activity and volunteer. Their screen time should be minimal and parents should know all the friends and acquaintances their child is mingling with.

Road to recovery

Use of alcohol and other substances can be detrimental to the functional and structural abilities of the brain, especially during the adolescence. It’s a phase full of emotional upheavals and physical transformations that increase the likelihood of indulging in wrong habits. Substance abuse can lead to legal troubles, financial woes, drop in grades, unsafe sexual practices and much more. It is therefore prudent to stay away from substances and seek immediate help when required.