Marketing promotion initiated by pharmaceutical manufacturers of medications for opioid use disorder (OUD) is less likely to occur in rural counties in the United States, according to results published in JAMA Network Open. Access to OUD medications is lower in rural areas than in urban areas, with only 29% of rural counties having a publicly listed prescriber.
The study used demographic and economic data from 3140 US counties separated into metropolitan, micropolitan, and rural categories. The researchers reviewed all reported direct-to-physician pharmaceutical payments from manufacturers of medications prescribed for OUD from January 2014 through December 2017. Data were made available as a result of the 2010 Sunshine Act. The researchers looked at reception of OUD medication-related payments as well as the value of promotion, in dollars, for each county by year. OUD medications included buprenorphine hydrochloride, buprenorphine/naloxone, Suboxone, Probuphine, Zubsolv, and naltrexone.
Researchers looked at data for 18,318 physicians who received OUD medication promotions, totaling $9.6 million during the study period. The majority went to physicians (n=16,740; 91.4%) in metropolitan counties (n=1166 counties; 37.1%). There were more total rural counties (n=1333; 42.5%), but far fewer physicians there (529 physicians; 2.9%) to receive promotions.
Rural physicians had an 8.98% likelihood of receiving a promotion vs 58.7% for physicians located in a county with a population ≥1 million. Physicians in rural counties had reduced odds of receiving any promotion (adjusted odds ratio, 0.57; 95% CI, 0.44-0.74; P <.001) and received lower payments (adjusted incidence rate ratio, 0.24; 95% CI, 0.17-0.34; P <.001) than metropolitan-based providers. In sensitivity analyses, the researchers found that rural counties received fewer payments per 100,000 residents when compared with their metropolitan counterparts (incidence risk ratio, 0.51; 95% CI, 0.36-0.72; P <.001).
The study was limited by a lack of data on promotion to nurse practitioners and physician assistants, who can both prescribe medications and receive payments.
Researchers suggested that pharmaceutical promotion may be less likely in rural areas because of smaller population sizes, greater travel distances, lower profitability of promotion, and fewer prescribers with buprenorphine waivers. The researchers noted, “policy makers, prescribers, and patients may feel uncomfortable with pharmaceutical promotion, especially given the association of opioid analgesic marketing with the ongoing opioid overdose crisis.” The training of prescribers by academics or public health workers might reduce concerns, but this approach is limited in its capacity to reach clinicians.
“Technology-assisted promotion, such as with distance-learning technology, is 1 approach to expanding both academic and pharmaceutical promotion in rural areas,” the researchers concluded.
Disclosures: a study author reported funding from a pharmaceutical company. Please see the original paper for a full list of disclosures.
Nguyen T, Andraka-Christou B, Simon K, Bradford WD. Comparison of rural vs urban direct-to-physician commercial promotion of medications for treating opioid use disorder. JAMA Netw Open. 2019;2(12):e1916520.