January 22, 2020
By Will Boggs MD
NEW YORK (Reuters Health) - The amount of money spent by the pharmaceutical industry on marketing stimulants to physicians nearly doubled between 2014 and 2018, researchers report.
"What alarmed us was the high percentage of physicians in practice that we estimated may have received marketing during the 5-year study period," Dr. Scott E. Hadland of Boston Medical Center and Boston University School of Medicine told Reuters Health by email. "We estimated that as many as nearly 1 in 5 pediatricians received stimulant marketing."
The use of prescription stimulants in the United States doubled from 2006 to 2016, and, in 2013, stimulants accounted for more pharmaceutical expenditures for children than any other medication class.
Dr. Hadland and colleagues used data from the Centers for Medicare and Medicaid Services' Open Payments database to characterize stimulant marketing to physicians from 2014 through 2018.
During this period, there were close to 592,000 payments to physicians totaling more than $20 million, the team reports in JAMA Pediatrics.
Annual marketing increased from $2.4 million in 2014 to a peak of $4.8 million in 2016 and declined to $3.9 million in 2018.
An estimated 5.6% of physicians received payments during this interval, but rates were highest among pediatricians (19.2%), psychiatrists (17.6%) and family physicians (12.5%).
The total dollar amount of payments was highest for psychiatrists ($11.4 million), followed by pediatricians ($5 million) and family physicians ($2.1 million).
The most heavily marketed product was Vyvanse (lisdexamfetamine), with 274,502 payments amounting to $7 million.
"Vyvanse has a tamper-proof design that makes it less susceptible to misuse," Dr. Hadland explained. "It is a prodrug to be swallowed and converted into its active form by the digestive tract and liver. This makes it less susceptible to misuse through snorting or injection. So, it may be used in circumstances in which physicians want to ensure that someone does not misuse a stimulant, such as when someone has a stimulant use disorder. Nonetheless, it can still be misused (e.g., if someone takes additional or higher doses in a manner different from how it is prescribed) and has street value - albeit less than other prescription stimulants."
"Nationally, stimulant prescribing rates - as well as rates of diversion and misuse - are rising dramatically," he said, "and it will be important to study the extent to which these phenomena may be linked in future research."
"There are, of course, many patients with ADHD for whom stimulants are extremely effective treatment, and I don't advocate against continuing to prescribe stimulants," Dr. Hadland said. "Rather, it is critical that physicians prescribe stimulants in an appropriate manner that does not contribute to excessive or unnecessary prescribing."
"These data highlight that there may be a need for limits on the extent to which physicians can receive direct marketing from drug companies," he said. "Such laws have been instituted in some states in the U.S."
Dr. Hadland added, "When individuals do have a stimulant use disorder, it is important that we ensure that they be offered effective drug treatment."
Dr. Hadland reports support from the National Institute on Drug Abuse.
SOURCE: https://bit.ly/2TSpGlA JAMA Pediatrics, online January 21, 2020.(c) Copyright Thomson Reuters 2020. Click For Restrictions - https://agency.reuters.com/en/copyright.html