Abstract
Educational activities for physicians sponsored by opioid manufacturers are implicated in the over- and mis-prescribing of opioids. However, the implications of promotion to nurses are poorly understood. Nurses play a key role in assessing pain, addressing the determinants of pain, and administering opioid medications. We sought to understand the nature and content of pain-related educational events sponsored by opioid manufacturers and to compare events targeting physicians and nurses. We conducted a cross sectional, descriptive analysis of pharmaceutical company reports detailing 116,845 sponsored educational events attended by health professionals from 2011 to 2015 in Australia. We included events that were sponsored by manufacturers of prescription opioid analgesics and were pain related. We compared event characteristics across three attendee groups: (a) physicians only; (b) at least one nurse in attendance; and (c) nurses only. We coded the unstructured data using iteratively generated keywords for variables related to location, format, and content focus. We identified 3,411 pain-related events sponsored by 3 companies: bioCSL/CSL (n = 15), Janssen (n = 134); and Mundipharma (n = 3,262). Pain-related events were most often multidisciplinary, including at least one nurse (1,964/3,411; 58%); 38% (1,281/3,411) included physicians only, and 5% (166/3,411) nurses only. The majority of events were held in clinical settings (61%) and 43% took the form of a journal club. Chronic pain was the most common event topic (26%) followed by cancer pain and palliative care (18%), and then generic or unspecified references to pain (15%); nearly a third (32%) of event descriptions contained insufficient information to determine the content focus. Nurse-only events were less frequently held in clinical settings (32%; p < .001) and more frequently were product launches (17%; p < .001) and a significantly larger proportion focused on cancer or palliative care (33%; p < .001), generic pain topics (27%; p < .001), and geriatrics (25%; p < .001) than physician-only or multidisciplinary events. Opioid promotion via sponsored educational events extends beyond physicians to multidisciplinary teams and specifically, nurses. Despite lack of evidence that opioids improve outcomes for long-term chronic non-cancer pain, hundreds of sponsored educational events focused on chronic pain. Regulators should consider the validity of distinguishing between pharmaceutical companies' "promotional" and "non-promotional" activities.
Highlights
Opioid-related overdoses and deaths constitute a contemporary public health crisis in several countries including the United States, Canada and Australia
The majority of events were held in clinical settings (61%) and 43% took the form of a journal club
In 2015, 12 opioid analgesics were available in Australia; 9 of these were approved for subsidy by the Australian Government under the Pharmaceutical Benefits Scheme, including buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, tapentadol and tramadol [27]
Summary
Opioid-related overdoses and deaths constitute a contemporary public health crisis in several countries including the United States, Canada and Australia. While the United States and Canada continue to lead in terms of prescribing and utilisation of opioid analgesics [1], and the burden of opioid-related mortality [2], Australia appears to be following a similar pattern [3]. Purdue Pharma introduced a sustained-release oxycodone preparation (OxyContin) in the United States in 1996, which quickly reached blockbuster status with combined sales of nearly $3 billion (over 14 million prescriptions) by 2002 [7]. Compared with other available opioid preparations, Purdue Pharma’s formulation offered no clinical benefits; the explosion in sales of oxycodone was attributed to the company’s aggressive promotional and marketing campaign [7]. We sought to understand the nature and content of pain-related educational events sponsored by opioid manufacturers and to compare events targeting physicians and nurses
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