Doctors in New Jersey were found to be overprescribing the powerful opioid fentanyl after they were prodded by pharmaceutical companies to do so.
According to a lengthy report from NJ.com, general practitioners across New Jersey were prescribing fentanyl at a much higher rate than in previous years, helping contribute to the massive opioid epidemic currently gripping both the state and country at large.
From 2013 to 2015, doctors in New Jersey were paid $1.67 million by pharmaceutical companies that were marketing several forms of fentanyl. Over the same time period, fentanyl-related deaths increased ten-fold.
"There's enough money going around that if you saw this in the abstract, you'd think there was a drug cartel happening," said Arthur Caplan, head of the Division of Bioethics at New York University. Companies would often take doctors out to dinner and funnel them monetary rewards in exchange for prescriptions of fentanyl.
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Fentanyl, a synthetic opioid, is a chemically-engineered painkiller that is often used to help soothe pain for cancer patients when all other painkillers have failed. The drug is so potent that a dose the size of a grain of sand is enough to kill a person.
"This should not be a first-line of defense, second-line of defense against pain," said Dr. Iqbal Jafri, a leader for the pain management program of a local New Jersey hospital. "Fentanyl is something to be used when you have exhausted all other options. I can think of no appropriate reason why the use of any kind of fentanyl should be increasing."
Prescriptions of fentanyl by oncologists, doctors who often deal with late-stage cancer patients for whom the drug was designed, ranked as the ninth-highest occurrence for fentanyl prescriptions in New Jersey. Prescriptions by general practitioners ranked first, being handed out ten times as often as those by oncologists, often for diseases far less severe.
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"It's unclear who's supervising these physicians' assistants," Caplan said. "And are these family doctors trained in pain medicine? Do they know of the alternative treatments?"
Fentanyl-related deaths rose from 42 in 2013 to 427 by 2015, a ten-fold rise some believe to be a direct correlation to the rising total of fentanyl prescriptions.
A potent applicator of fentanyl called Subsys was prescribed just 400 times in 2012, and the pharmaceutical company that distributed gave it to several New Jersey doctors with explicit instructions to prescribe it often. By 2014, the number of Subsys prescriptions filled was nearly 3,000.
"I need to see more response from the medical community, more vigilance," said Jafri. "We are losing people. Families are losing loved ones. So I'm concerned, not for me, but for the entire United States."