As public health officials combat the opioid overdose epidemic, in part by reducing unnecessary prescribing, a study shows that drug manufacturers paid more than $46 million to more than 68,000 doctors over a 29–month period.

In a new study published in the American Journal of Public Health, Marshall, lead author Scott Hadland of Boston Medical Center and colleagues report for the first time on the tens of millions of dollars that drug companies are paying doctors through meals, honoraria and other marketing and education programs.

In this national study, the researchers used data from the Centers for Medicare and Medicaid Services (CMS) to track payments related to an opioid medication from the pharmaceutical industry to physicians. Under the recently implemented Physician Payments Sunshine Act, drug companies are now required to report all “transfers of value” – payments – to U.S. physicians. What they found was astounding: between August 2013 and December 2015, more than 375,000 opioid–related payments were made to more than 68,000 physicians in the U.S. Although the average payment to physicians was $15, the top 1 percent of physicians reported receiving more than $2,600 annually in payments related to the promotion of opioid products.

Although most disbursements were small – for activities such as industry–sponsored meals – previous research suggests that pharmaceutical company payments result in increased prescribing of marketed medications, even when these payments are of low monetary value. As such, it is possible that these payments – particularly such a large number of payments – have led to the high level of opioid prescribing we continue to see today. At a minimum, they are probably counterproductive to nationwide efforts to reduce excessive opioid prescribing.

In fact, one in 12 physicians (and one in five family doctors) accepted a payment related to a prescription opioid product during in the study period. These figures demonstrate the extent to which pharmaceutical companies are broadly marketing these medications to physicians in almost every part of the country.