Industry payments to doctors drive surge in gabapentinoid prescribing, study finds

Managing the misuse potential and risk of psychological harm from gabapentinoids in primary care in New Zealand

Gabapentinoid prescribing is increasing in New Zealand. International evidence suggests that this prescribing trend is followed by increasing harms, including misuse, dependence, overdose, and psychological harms including suicidal thoughts or behaviours. However, there is limited guidance for prescribers on how to manage these potential harms. Here, we summarise the current international literature and identify three main risk factors that can be used for screening purposes when considering prescribing a gabapentinoid, to identify patients that may be at greater risk of harm. Based on current knowledge of harms, we provide guidance to prescribers on monitoring patients taking gabapentinoids. Finally, we summarise the evidence regarding tapering, and highlight key knowledge gaps including other interventions, referral, and data from primary care populations.

Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing? : A Systematic Review

BACKGROUND

Financial payments from the drug industry to U.S. physicians are common. Payments may influence physicians' clinical decision making and drug prescribing.

PURPOSE

To evaluate whether receipt of payments from the drug industry is associated with physician prescribing practices.

DATA SOURCES

MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science, and EconLit were searched without language restrictions. The search had no limiting start date and concluded on 16 September 2020.

STUDY SELECTION

Studies that estimated the association between receipt of industry payments (exposure) and prescribing (outcome).

DATA EXTRACTION

Pairs of reviewers extracted the primary analysis or analyses from each study and evaluated risk of bias (ROB).

DATA SYNTHESIS

Thirty-six studies comprising 101 analyses were included. Most studies (n = 30) identified a positive association between payments and prescribing in all analyses; the remainder (n = 6) had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association. Payments were associated with increased prescribing of the paying company's drug, increased prescribing costs, and increased prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association; 25 assessed and found evidence of a dose-response relationship.

LIMITATION

The design was observational, 21 of 36 studies had serious ROB, and publication bias was possible.

CONCLUSION

The association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.

PRIMARY FUNDING SOURCE

National Cancer Institute.