Does over-prescribing of opioids lie at the heart of the addiction crisis? Some members of Philadelphia City Council along with many public health experts think so. Last week, a bill came before City Council to limit the activities of pharmaceutical sales representatives, also known as detailers, who promote prescription drugs to physicians.
The bill would have required detailers to register with the city for a fee of up to $250, wear identification badges, refrain from giving even small gifts like free lunches to doctors and their staffs, and submit their sales materials to the city for review.
Philadelphia is fertile ground for selling pharmaceuticals. It is home to several major academic health systems and physician organizations, and the region contains the headquarters of numerous pharmaceutical and biotechnology companies. It also plays host to a large number of medical conventions that generate business for local restaurants and hotels. Opponents of the bill warned that it would have encouraged convention sponsors to look elsewhere, taking away this business, and the jobs and tax revenue that go with it.
In the end, opponents carried the day, and the bill was defeated by a vote of 9-5.
Would the bill have worked? Recent research suggests that it could have.
A study published in 2017 by researchers at UCLA and Carnegie Mellon examined the effects of limits on drug detailing at 19 academic medical centers around the country. It found that the restrictions resulted in fewer prescriptions for brand-name drugs that detailers promoted. The reduction in prescriptions was modest, but clear.
There is every reason to believe that the proposed limits on sales reps in Philadelphia would have had a similar effect. And fewer patients receiving prescriptions for opioids could have led to fewer becoming addicted. For a plague as serious as opioid addition, even a small reduction in the number of new victims would prevent a tremendous amount of human suffering, not to mention medical and law enforcement costs that go with it.
With the bill’s defeat, the risk of losing convention business has faded. At the same time, the opioid epidemic continues unabated. We are left to wonder which threat is the greatest.