Association between Opioid Prescribing in Medicare and Pharmaceutical Company Gifts by Physician Specialty

BACKGROUND: The association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown. OBJECTIVE: To examine the relationship between opioid-related gifts to physicians and opioid prescribing in the subsequent year across 7 physician specialties. DESIGN: Panel study using data from 2014 to 2016. PARTICIPANTS: 236,103 unique Medicare Part D physicians (389,622 physician-years) who received any gifts from pharmaceutical companies measured using Open Payments and prescribed opioids in the subsequent year. MAIN MEASURES: Amounts paid by pharmaceutical companies for opioid-related gifts including meals and lodging; quartile of opioid prescribing as a percent of total prescribing compared with other same-specialty physicians. KEY RESULTS: In 2014-2015, 14.1% of physician received opioid-related gifts from the industry with 2.6% receiving > $100. Gifts varied by specialty and were concentrated among two pharmaceutical companies responsible for 60% of the value of opioid-related gifts. Receiving opioid-related gifts was associated with greater prescribing of opioids compared with same-specialty physicians in the next year. Primary care physicians are nearly 3.5 times as likely to be in the highest quartile of prescribing versus the lower quartiles if they were paid >= $100. Psychiatrists and neurologists were 7 to 13 times as likely to be in a higher quartile of opioid prescribing compared with colleagues who were paid $0 in the preceding year. CONCLUSIONS: The value of opioid-related gifts given to physicians varies substantially by provider specialty, as does the relationship between payment amounts and prescriber behavior in the following year.