Did Doctors Help Create the Opioid Crisis?
In 2005, the FDA approved a new treatment for pain, administered through a patch on the patient’s skin. The drug’s approval coincided with a movement in the medical profession towards treating pain as the “fifth vital sign,” leading doctors to take more aggressive steps to deal with pain. By 2012, doctors were prescribing the drug, called fentanyl, over 255 million times a year throughout the U.S. For millions of Americans, these legal prescriptions intended to help their chronic pain had already pulled them into opioid dependency. The role of doctors in creating the current national crisis cannot be ignored.
Fentanyl is now one of the most infamous drugs of America’s opioid epidemic, which claimed more than 30,000 lives by accidental overdose in 2016 alone. While about half of those deaths were from heroin and other illegally obtained opiates, most opiate-users started taking opiates prescribed by their doctors. Troublingly, many of these doctors — one in 12, according to Boston Medical Center researchers — received money from opioid manufacturing companies.
Opiate prescriptions have fallen steadily since their peak in 2012, but nothing has fundamentally changed about the incentives doctors are offered for prescribing opiates. The Chicago Tribune reported that just last year, 28,000 Illinois doctors accepted more than $74 million from pharmaceutical companies. In another report from CNN, more than 200,000 doctors throughout the U.S. admitted to taking payments from opioid manufacturers for prescribing their drugs, and made more money the more they prescribed.
But convincing doctors to prescribe more opiates takes a lot less than nefarious kickback schemes. The Journal of the American Medical Association recently demonstrated that doctors who received a free meal from an opioid company were more likely to prescribe opioids than doctors who didn’t get free meals. Moreover, doctors’ persistent use of opioids for long-term treatment, despite the FDA’s well-publicized warnings against using opioids this way, shows a disturbing trend in the way doctors write prescriptions.
Since the beginning of the opioid epidemic, nothing has legally altered these incentives.
Early this year, all the legal action against parties to the opioid epidemic was rolled into a single federal court case in the Northern Ohio U.S. District Court called the National Prescription Opiate Litigation MDL (multi-district litigation). The omnibus litigation includes suits from across the country against nearly everyone in the health-care industry. Pharmaceutical manufacturers, insurance companies, pharmacies, and distributors are all under investigation for the role they continue to play in America’s opiate problem. But none of these legal efforts will pursue an important source of over-prescribed opioids: doctors.
While multiple factors have contributed to the opioid epidemic, in the end, it was doctors who wrote too many prescriptions for drugs they knew were dangerous. If the MDL does not address the role doctors and irresponsible prescription-writing played in the opioid epidemic, the court will have failed to adequately address the problem. The relationship between doctors and patients is essential to resolving health problems. So ensuring that doctors are incentivized to behave responsibly when prescribing treatments should be a top priority in medical law.
Even if the MDL accomplishes everything the judge hopes to with suppliers, and distributors stop paying doctors, manufacturers stop advertising opiates irresponsibly, and pharmacy counters stop turning a blind eye to addiction, doctors will not change the way they write prescriptions. While opiates may become less widely available, the root of the opioid epidemic would remain: doctors would not face new incentives about the level of care and research they put into writing prescriptions.
Until the law addresses physicians’ role in the opioid epidemic and their incentives for writing prescriptions, the crisis of prescription drugs will never truly end.
Albert Gustafson is an economics and public policy contributor for Young Voices. Follow him on Twitter @apgustafson.