Opioid ball rolling down hillCabell County, West Virginia, received 32 times more dollars inprescription opioid marketing than the nationalaverage–and saw the most prescription opioid overdosedeaths during the months surveyed. (Image: Shutterstock)

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As pharmaceutical companies face hundreds of lawsuits over their role in theU.S. opioid epidemic, new research suggests a linkbetween their marketing practices and overdose-related deaths.

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U.S. counties where doctors received high volumes of opioid marketing saw more prescriptions and, inturn, more overdose deaths, according to a study funded inpart by the National Institute on Drug Abuse and published by theGrayken Center for Addiction at Boston Medical Center. Almost $40million was spent on opioid marketing — including speaking fees,travel costs and lunches — that was distributed to 67,507 U.S.physicians between August 2013 and December 2015.

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Related: Opioids now kill more people than carsdo

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But those marketing dollars weren't distributed equally, leavingsome counties more vulnerable than others, the study found.

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“Areas in this country hardest hit by the prescription opioidcrisis were the same areas targeted by drug companies marketingopioids,” said Scott Hadland, a pediatrician and researcher at theGrayken Center who was the lead author of the study.

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Cabell County, West Virginia, for example, received 32 timesmore dollars in prescription opioid marketing than the nationalaverage. Opioid manufacturers spent $11,676 on marketing per everythousand residents living in the region at the foothills of theAppalachians.

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That money had an impact, Hadland said. Cabell County saw themost prescription opioid overdose deaths in the U.S. during themonths surveyed.

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Across the state line, doctors in Salem City and WinchesterCity, Virginia, experienced the most frequent marketinginteractions. Frequency of marketing had a stronger correlation toprescription opioid overdose deaths than the amount spent, thestudy found.

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“These small, frequent interactions are really the potentialdriver of this public health crisis — and yet it's legal,” Hadlandsaid. “There needs to be tighter regulation.” Under Scrutiny

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The study analyzed county-level marketing data from the Centersfor Medicare and Medicaid Services and compared it with overdosemortality data from the Centers for Disease Control and Preventionfrom the following year. While researchers examined the outcomes ofdeaths related to prescription opioid overdoses, many of thefatalities also involved heroin, fentanyl and other illicitopioids.

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Manufacturers have come under scrutiny for their marketingtactics amid the national opioid overdose epidemic, which was tiedto about 50,000 deaths in 2017. More than 1,500 suits have sincebeen filed by state attorney generals, cities and counties againstcompanies including Purdue Pharma LP, Endo International Plc andJohnson & Johnson. The governments contend the companiesdownplayed painkillers' health risks and oversold their benefitsthrough hyper-aggressive marketing campaigns.

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Lawyers for state attorneys general and local governments havebeen in settlement talks for more than a year with makers anddistributors of opioids, without reaching a deal.

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A handful of manufacturers have voluntarily halted marketingtheir opioids since the study was conducted. Endo stopped promotingpain products to health-care professionals and eliminated its375-person salesforce in December 2016, while Purdue endedpromotion of opioids to physicians in February 2018. Legal expertshave said that halting marketing could build goodwill with judgesin ongoing litigation.

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“We recognize we have a role to play to help address this publichealth crisis and have taken action to do so,” said Purduespokesman Robert Josephson in an emailed statement. He noted thecompany has also distributed CDC guidelines to opioid prescribersand funded efforts to make the opioid overdose antidote naloxonemore accessible to the public.

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