A nexus between pharmaceutical companies and rogue doctors has been alleged for a long time despite both of them denying it. However, a recent study has established that doctors who got payments from the pharmaceutical companies for meals, travel and other non-research activities are more likely to prescribe opioids in comparison to others. The study, led by Scott E. Hadland from Boston Medical Center, explored how unscrupulous opioid marketing practices intensified the opioid nuisance that continues to affect millions of Americans every year. The researchers found that the doctors who prescribed the largest volume of painkillers were the ones receiving maximum attention from the drug manufacturing companies. Their research letter was published in JAMA Internal Medicine on May 14, 2018. The researchers explored open payment database and Medicare database before reaching the conclusion. They found that nearly 370,000 doctors had written opioid prescriptions for Medicare part D patients and nearly 7 percent (26,000) of them had received certain benefits other than cash in 2014. They also found that nearly 436 doctors received equal to or more than $1,000 in cash. Hadland shared that doctors who prescribed more opioids were approached frequently by the pharma companies. As per the report, Insys Therapeutics spent maximum ($4.5 million) on such payoffs and now it is under the scanner of federal investigation agencies. The marketing fees included payments for speaking, honorariums, meals, education, travel, etc. The researchers wrote that in an effort to combat the opioid crisis, marketing activities should be minimum and the benefits must be curtailed for the prescribers. They also emphasized that the state agencies and federal government should keep a limit on the amount and number of such payments being disbursed in such a critical situation. Regulation of prescribing behavior The U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, recently wrote in a blog post that opioid crisis is the biggest challenge faced by the agency currently. In 2017, he had set up Opioid Policy Steering Committee to develop new approaches in confronting the crisis. FDA is now considering a strategy to develop “evidence-based guidelines on appropriate prescribing for different acute medical indications” and how to assess the impact of prescribing behavior. They also intend to make treatment services more accessible so that people are encouraged to seek help from a certified drug abuse clinic or an addiction help center at the earliest. According to the Centers for Disease Control and Prevention (CDC), opioids claimed 42,000 lives in 2016, out of which 40 percent were linked to prescription opioids. Many doctors have contributed to the worsening opioid epidemic by prescribing opioids to too many patients, in high doses and for a period longer than required. Doctors often get swayed by marketing gimmicks of the pharma companies and do not realize the harm they are causing to innocent people. A past study showed that doctors who accepted even a single free meal from drug companies were more likely to prescribe their brand later. The Pharmaceutical Research and Manufacturers of America has issued a voluntary code of conduct to stop the companies from handing out prescription pads, mugs and other articles with their branding to the physicians. Some states have sued certain drug companies for fueling opioid addiction through their deceptive promotional practices. In the past, Hadland and colleagues had reported that one out of 12 doctors in the United States received something in the form of lunch or payment to prescribe a company’s opioids. Last year, the federal prosecutors took legal action against five doctors from Manhattan who charged more than $800,000 as speaker fee for promoting opioids. The prosecutors shared that these speaker meetings were actually gatherings where plenty of alcohol was served and Subsys (a fentanyl sublingual spray marketed by Insys) was being promoted. Things have improved at Insys with the new management team focusing on ethical standards. The company has also stopped organizing speaker programs for Subsys and reduced the honorariums as well. Live life free from prescription drug abuse Meanwhile, the FDA is working towards promoting alternatives to opioids that are non-addictive and as effective as opioids. Those who are already experiencing the side effects of misusing opioids, must seek help at the earliest.