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The more money doctors received, the more opioids they prescribed, report finds

New York State doctors who got payments from opioid makers prescribed more of the narcotic painkilling drugs than those who received no payments from 2013 to 2015, as opioid use reached epidemic proportions.

Those payments also were concentrated in the hands of physicians who tended to write the most prescriptions.

These are among the key findings released Tuesday in a report by the New York State Health Foundation titled "Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing Patterns in New York State."

"We've found there is an absolutely clear association between opioid-related payments to doctors and the amount of opioid prescriptions that are being written. The more money you get, the more opioids you prescribe," David Sandman, president and CEO of the foundation, told The Buffalo News.

The foundation analyzed prescribing activity for Medicare enrollees, as well as payments physicians received from opioid drug makers during the same period.

“It's the financial relationship that creates either the perception or the reality of a potential conflict of interest,” says David Sandman, CEO of the New York Health Foundation.

More than $3.5 million in payments were made by drug companies to nearly 3,400 doctors in the state who wrote opioid prescriptions for Medicare patients, according to the report. Roughly one in 10 physicians who prescribe opioids received a payment.

In Western New York, Sandman said:

290 doctors received $506,802 in opioid-related payments from August 2013 to December 2015, accounting for 14.2 percent of the state total.

213 of those doctors identified themselves as practicing in Erie County, and were paid $483,901.

Those figures include one doctor, who the foundation would not identify, who received $422,019. No other doctor from the region was in the top 1 percent in terms of payments received, Sandman said.

Four doctors from the region, including three practicing in Erie County, received at least $10,000 in payments.

Most of the money came from speaking fees and honoraria, but most of the payments were made to cover the cost of meals.

"We were able to use a comparison group of doctors who did not receive money," Sandman said of the foundation report. "Those who got money really began upping their prescriptions of opioids whereas those who didn't get money did not. That is more suggestive of an association."

Five New York City doctors who were among those to receive the highest payments were indicted in March by federal prosecutors on charges that they set up a sham speakers bureau to receive payments, one that met several times at high-end Manhattan restaurants with no apparent educational purpose.

It is unclear whether any of the doctors in the top payment echelon in Western New York include a small number from the region who also have run afoul of the law as a result of their opioid prescription writing practices.

Dr. Pravin Mehta, of Niagara Falls, was sentenced to two years in prison in 2016 after he pleaded guilty to writing painkiller prescriptions with inadequate reasons, in some cases without a medical examination.

Dr. Eugene Gosy, of Amherst – who at one point earlier this decade wrote more narcotic painkiller prescriptions than any physician in the state – awaits trial this year on federal charges that he illegally wrote prescriptions for six patients, leading to their deaths. He also is accused of unlawful distribution of narcotics, health care fraud and conspiracy to commit health care fraud.

Dr. Thomas Madejski, president of the Medical Society of the State of New York, said in an email that doctors who face prosecution are outliers in a state that has the second-lowest rate of opioid prescribing in the nation, after Hawaii.

“Any physician that chooses to prescribe any medication for reasons other than patient need faces threat of significant sanction from the New York State Office of Professional Medical Conduct," he said, "as well as potentially criminal and civil penalties."

Madejski also said the total number of prescriptions prescribed by doctors in the state has fallen by 20 percent since 2013.

"Certainly more needs to be done to address New York’s heroin and opioid abuse epidemic," Madejski said, "including increased insurance coverage to respond to those facing addiction, and addressing barriers that limit the ability of physicians and others to prescribe Suboxone to address addiction. However, these recent statistics showing a significant drop in opioid prescribing are the result of a multi-pronged and multi-year effort by many to assure greater caution in the prescribing of opioids.”

The New York State Health Foundation was created a little more than a decade ago to boost health in communities and among state consumers.

The foundation study found that:

· Doctors who got payments of $20 or less – the cost of a lunch – wrote opioid prescriptions for Medicare patients worth $34,000, on average, from 2013 through 2015, based on the average opioid costs during this time period.

· Doctors who received between $20 and $50 prescribed almost $50,000 worth of of opioids.

· A small group of physicians paid more than $10,000 worth of benefits prescribed more than $1.24 million worth of opioids.

"A small number of physicians did get the majority of payments but there are over 3,000 doctors who did receive opioid payments," Sandman said. "For many of them, the amount is not great but other research shows it doesn't necessarily take a lot to influence physician behavior."

The report comes as New York State and hundreds of municipalities across the nation – including Erie County, Amherst and Cheektowaga – have filed lawsuits seeking to recoup costs they've borne during the opioid crisis as a result of doctors and drug companies working together to promote their improper use.

The report also comes several weeks after a Siena College poll showed that more than three in four New Yorkers blame drug companies and doctors overprescribing opiates as key causes for the opioid epidemic.

Researchers with the foundation also reported that pharmaceutical companies gave nearly $200 million in payments during the three years studied when it came to drugs of all kinds – spurring larger concerns about how doctors and drug makers interact.

"It would raise fewer eyebrows if the financial element was not part of it," Sandman said. "The perception of a conflict of interest would be less, say, if doctors had participated in an educational seminar but they didn't receive any money for doing that. It's the financial relationship that creates either the perception or the reality of a potential conflict of interest."

Dr. Gosy faces new charges tied to six deaths

The Pharmaceutical Research and Manufacturers of America (PhRMA) responded to the report with a statement that underlined the important relationships between doctors and drug companies when it comes to providing accurate, up-to-date information on medications to assure patients use them safely and appropriately.

"Any communications between biopharmaceutical companies and health care professionals are highly regulated by state and federal governments and informed by industry guidelines," the organization said in a statement.

The organization, which represents research-based pharmaceutical and biotechnology companies, assures that its members follow a Code of Interactions with Health Care Professionals, the statement said. It continued, "We do not want our interactions with health care professionals to be perceived as inappropriate by patients or the public at large, and the Code is to reinforce that these interactions are professional exchanges designed to benefit patients and enhance the practice of medicine."

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