Prescription rate and its effect on the opioid overdose death rate: implications of pharmaceutical financial incentives

Abstract

Objectives. To examine the effect of pharmaceutical incentives to physicians to write opioid prescriptions and its effect on opioid-related deaths by county urbanicity, industry, and demographic characteristics.

Methods. We estimated a linear regression model on opioid-related death rates, obtaining unbiased estimates by treating prescription rates as endogenous and adjusting for suppressed or missing county level opioid-related death rates.

Results. Pharmaceutical payments are positively associated with prescription rates; a 1% increase in the prescription rate results in 3 deaths per 100,000 persons; mining dependence is independently associated with an additional 7.4 deaths per 100,000 persons. Rural counties have lower death rates than urban counties but have significant spatial heterogeneity.

Conclusions. Pharmaceutical companies incentivizing physicians to write opioid prescriptions for their patients has a strong positive relationship with increased opioid prescribing. Legal prescriptions are an important driver of opioid-related overdose deaths. Finally, the mining industry in rural counties has the highest death rates in the opioid epidemic.

Public Health Implications. Given the positive empirical relationship between incentives and prescribing and its role in overdose deaths, opioid-related mortality prevention should target pharmaceutical companies