County By County, Researchers Link Opioid Deaths To Drugmakers’ Marketing

Researchers sketched a vivid line Friday linking the dollars spent by drugmakers to woo doctors around the country to a vast opioid epidemic that has led to tens of thousands of deaths.

The study, published in JAMA Network Open, looked at county-specific federal data and found that the more opioid-related marketing dollars were spent in a county, the higher the rates of doctors who prescribed those drugs and, ultimately, the more overdose deaths occurred in that county.

For each three additional payments made to physicians per 100,000 people in a county, opioid overdose deaths were up 18 percent, according to the study. The researchers said their findings suggest that “amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted.”

And the researchers noted that marketing could be subtle or low-key. The most common type: meals provided to doctors.

Dr. Scott Hadland, the study’s lead author and an addiction specialist at Boston Medical Center’s Grayken Center for Addiction, has conducted previous studies connecting opioid marketing and opioid prescribing habits.

“To our knowledge, this is the first study to link opioid marketing to a potential increase in prescription opioid overdose deaths, and how this looks different across counties and areas of the country,” said Hadland, who is also a pediatrician.

Nearly 48,000 people died of opioid overdoses in 2017, about 68 percent of the total overdose deaths, according to the Centers for Disease Control and Prevention. Since 2000, the rate of fatal overdoses involving opioids has increased 200 percent. The study notes that opioid prescribing has declined since 2010, but it is still three times higher than in 1999.

The researchers linked three data sets: the Centers for Medicare & Medicaid Services Open Payments database that shows drugmakers’ payments to doctors; a database from the CDC that shows opioid prescribing rates; and another CDC set that provides mortality numbers from opioid overdoses.

They found that drugmakers spent nearly $ 40 million from Aug. 1, 2013, until the end of 2015 on marketing to 67,500 doctors across the country.

Opioid marketing to doctors can take various forms, although the study found that the widespread practice of providing meals for physicians might have the greatest influence. According to Hadland, prior research shows that meals make up nine of the 10 opioid-related marketing payments to doctors in the study.

“When you have one extra meal here or there, it doesn’t seem like a lot,” he said. “But when you apply this to all the doctors in this country, that could add up to more people being prescribed opioids, and ultimately more people dying.”

Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management, said these meals may happen at conferences or industry-sponsored symposiums.

“There are also doctors who take money to do little small-dinner talks, which are in theory, supposed to educate colleagues about medications over dinner,” said Kolodny, who was not involved in the study. “In reality this means doctors are getting paid to show up at a fancy dinner with their wives or husbands, and it’s a way to incentivize prescribing.”

And those meals may add up.

“Counties where doctors receive more low-value payments is where you see the greatest increases in overdose rates,” said Magdalena Cerdá, a study co-author and director of the Center for Opioid Epidemiology and Policy at the New York University School of Medicine. The amount of the payments “doesn’t seem to matter so much,” she said, “but rather the opioid manufacturer’s frequent interactions with physicians.”

Dr. G. Caleb Alexander, who is the co-director of the Johns Hopkins Center for Drug Safety and Effectiveness and was not affiliated with the study, said that the findings about the influence of meals aligns with social science research.

“Studies have found that it may not be the value of the promotional expenditures that matters, but rather that they took place at all,” he said. “Another way to put it, is giving someone a pen and pad of paper may be as effective as paying for dinner at a steakhouse.”

The study says lawmakers should consider limits on drugmakers’ marketing “as part of a robust, evidence-based response to the opioid overdose epidemic.” But they also point out that efforts to put a high-dollar cap on marketing might not be effective since meals are relatively cheap.

In 2018, the New Jersey attorney general implemented a rule limiting contracts and payments between physicians and pharmaceutical companies to $ 10,000 per year.

The California Senate also passed similar legislation in 2017, but the bill was eventually stripped of the health care language.

The extent to which opioid marketing by pharmaceutical companies fueled the national opioid epidemic is at the center of more than 1,500 civil lawsuits around the country. The cases have mostly been brought by local and state governments. U.S. District Judge Dan Polster, who is overseeing hundreds of the cases, has scheduled the first trials for March.

In 2018, Kaiser Health News published a cache of Purdue Pharma’s marketing documents that displayed how the company marketed OxyContin to doctors beginning in 1995. Purdue Pharma announced it would stop marketing OxyContin last February.

Priscilla VanderVeer, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, or PhRMA, said that doctors treating patients with opioids need education about benefits and risks. She added that it is “critically important that health care providers have the appropriate training to offer safer and more effective pain management.”

Cerdá said it is also important to consider that the study is not saying doctors change their prescribing practices intentionally.

“Our results suggest that this finding is subtle, and might not be recognizable to doctors that they’re actually changing their behavior,” said Cerdá. “It could be more of a subconscious thing after increased exposure to opioid marketing.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News


Change in the Old South: Gwinnett County Gets First Black Woman Democratic Party Chair

The South will rise again—but this time in a definite shade of blue rather than Confederate grey. At least that is the goal of newly-elected Democrats in Georgia. The midterm election was an exclamation point, underscoring a process of change that has been quietly underway for some time. Nationally, eyes are on Georgia, particularly Gwinnett County and the first black woman to chair the county’s Democratic party.

With a Bachelor of Political Science from Spelman College, Bianca Keaton has earned her spot at the political table. Upon graduation, she went to Washington, D.C., and served as an aide and adviser to U.S. Congressmen Robert Brady and Cedric Richmond for a combined six years. Keaton is well-versed in legislative policy, administration, and strategic planning. Her most recent political position before being voted in as Gwinnett County Democratic Chair has been assistant to Cobb County Commissioner Lisa Cupid where she served for nearly three years.

Keaton’s position is significant for a number of reasons. Gwinnett County has been a Republican stronghold for at least the last 30 years. It’s the second-most populous county in Georgia, and prior to 2016, had not voted for a Democrat since Jimmy Carter.

However, this all began to change in 2016, when Hillary Clinton won a majority of the county’s votes. Last year, two Democrats were elected to the County Commission and the county’s legislative delegation in the state capitol shifted from being majority Republican to majority Democratic.

Gwinnett County is located in the northeast quadrant of the greater Atlanta area. With population just shy of 1 million people, it is often hailed as one of the most diverse counties in the southeast.

The most common foreign languages in Gwinnett County are Spanish (144,073 speakers), Korean (19,938 speakers), and Vietnamese (15,614 speakers), compared to other places, Gwinnett has a relatively high number of Korean (19,938 speakers), Serbo-Croatian (3,767 speakers), and Gujarati (4,802 speakers). –

However, this diversity was not reflected in the county’s political leadership — prior to 2018, the  Gwinnett County Commission was all white and all Republican. Keaton, at 35-years-old, is set to play a critical role as the county’s political shift.

Change is not a scary word to Keaton. Growing up in Chicago, she struggled against poverty and uncertainty on a daily basis. She once went to 10 different schools in one year. Now, she is on a path to move Gwinnett from red to completely blue by the time of the 2020 elections.

Some of the key issues she is focused on include:

  • Fair elections – It’s no secret Gwinnett County had issues on election night with their precincts and ballot access. These issues could have been avoided with better planning and oversight. Absentee Ballots were thrown out and not enough voting machines were made available for the high voter turnout. This is a priority to fix for Keaton.


  • Making room for new voices and creating an expanded Democratic footprint throughout Gwinnett – At one time, the Democratic Party in Gwinnett was all but defunct. Keaton and her executive team are taking the reins and moving things forward, especially for groups that have been historically marginalized in the county.


  • Modernized operations – Keaton says it’s time to bring party operations into the 21st century. She has a clear idea on how she wants to achieve this. It’s more than just building a new website she says–it’s about brand and messaging as well as policy and procedures. She embraces technology and wants to utilize it to streamline the functions and work of the party.


The post Change in the Old South: Gwinnett County Gets First Black Woman Democratic Party Chair appeared first on Black Enterprise.

Lifestyle | Black Enterprise


Washington’s Chelan County PUD Plans Higher Electricity Costs For Crypto Mining

A rural Washington County Public Utility District, or PUD has proposed higher electricity costs for cryptocurrency miners, according to Central Washington radio station KPQ. The Chelan County PUD in north-central Washington has proposed a new electricity pricing structure, Schedule 36, for the mining activity, which generally takes enormous power.
RTT – Top Story


Devastating 72 hours for Ventura County with Thousand Oaks Shooting and Woolsey Fire

Ventura County has faced a devastating 72 hours, with the mass shooting Wednesday night in Thousand Oaks to hours later a brush fire sparked and quickly engulfed city after city. The community went from mourning to panic in a matter of hours. Our thoughts and prayers go out to friends and family affected by both tragedies.

Devastating 72 hours for Ventura County with Thousand Oaks Shooting and Woolsey Fire

To take action, there are multiple go fund me pages for those that have lost their homes. You can also drop off chapstick, bottled water, eye drops, energy drinks, gallon zip lock bags, beef jerky etc to your closest fire station. Our first responders have been incredibly grateful to receive these care packages. There will also be a fundraiser at Bandits in Thousand Oaks in December 1st, 2018 to raise money for friends and families affected by the senseless tragedy of the Borderline shooting. We extend our hearts and helping hands to anyone in need ❤️


The post Devastating 72 hours for Ventura County with Thousand Oaks Shooting and Woolsey Fire appeared first on .


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Pornhub offers free leaf removal in New York’s Dutchess County

Yard work never sounded so scandalous.

Residents of Dutchess County, N.Y., can apply to have leaves removed from their properties for free by a company hired by adult entertainment brand Pornhub.

The naughtily-named campaign, “Pornhub Blows America,” is in effect now through Friday in this Hudson…

Life Style – New York Daily News


County pays nearly $5M over heroin withdrawal death in jail

She collapsed and died after four days of heroin withdrawal in jail.
ABC News: Health

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Verne Troyer’s death ruled a suicide by L.A. County coroner

Actor Verne Troyer’s death has been ruled a suicide by the Los Angeles County Coroner.

The “Austin Powers” star’s cause of death was listed as “sequelae of alcohol intoxication” and the manner of death a suicide in a report released Wednesday.

Troyer, 49, died April 21, two weeks after he was admitted…

/entertainment – New York Daily News