The Chronicles March 2018

National news

Doctors who prescribe most opioids, make the most money

Federal databases show payments from opioid manufacturers


A direct link has been exposed between physicians prescribing opioids and drug manufacturers paying out huge sums of money.

Analysis by CNN and researchers at Harvard University found that the more opioids a doctor prescribes, the more money he or she makes, amid tens of thousands of American deaths every year from prescription opioid overdoses.

Opioid manufacturers in 2014 and 2015 paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid over $25,000 during that time.

Physicians who prescribed particularly large amounts of the drugs were the most likely to get paid.

“This is the first time we’ve seen this, and it’s really important,” said Dr. Andrew Kolodny, a senior scientist at the Institute for Behavioral Health at the Heller School for Social Policy and Management at Brandeis University, where he is co-director of the Opioid Policy Research Collaborative.

“It smells like doctors being bribed to sell narcotics, and that’s very disturbing,” said Kolodny, who is also the executive director of Physicians for Responsible Opioid Prescribing.

The Harvard researchers said it’s not clear whether the payments encourage doctors to prescribe a company’s drug or whether pharmaceutical companies seek out and reward doctors who are already high prescribers.

“I don’t know if the money is causing the prescribing or the prescribing led to the money, but in either case, it’s potentially a vicious cycle. It’s cementing the idea for these physicians that prescribing this many opioids is creating value,” said Dr. Michael Barnett, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health.

CNN spoke with two women who’ve struggled with opioid addiction, and they described the sense of betrayal they felt when they learned that their doctors had received large sums of money from the manufacturers of the drugs that had created such havoc in their lives.

Carey Ballou said she trusted her doctor and figured that if he was prescribing opioids, it must be because they were the best option for her pain.

Then she learned that opioid manufacturers paid her doctor more than a million dollars over two years

“Once I found out he was being paid, I thought, ‘was it really in my best interest, or was it in his best interest?’ “ she said.

To do the analysis, CNN — along with Barnett and Harvard’s Dr. Anupam Jena — examined two federal government databases. One tracks payments by drug companies to doctors, and the other tracks prescriptions that doctors write to Medicare recipients.

The CNN/Harvard analysis looked at 2014 and 2015, during which time more than 811,000 doctors wrote prescriptions to Medicare patients. Of those, nearly half wrote at least one prescription for opioids.

Fifty-four percent of those doctors — more than 200,000 physicians — received a payment from pharmaceutical companies that make opioids.

Doctors were more likely to get paid by drug companies if they prescribed a lot of opioids — and they were more likely to get paid a lot of money.

Among doctors in the top 25th percentile of opioid prescribers by volume, 72 percent received payments. Among those in the top fifth percentile, 84 percent received payments. Among the very biggest prescribers — those in the top 10th of 1 percent — 95 percent received payments.

On average, doctors whose opioid prescription volume ranked among the top 5 percent nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1 percent of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1 percent, on average, received nine times more money than the typical doctor.

“The correlation you found is very powerful,” said David Rothman, director of the Center on Medicine as a Profession at the Columbia University College of Physicians and Surgeons. “What’s amazing about the findings is not simply that money counts but that more money counts even more.”

Paying doctors for speaking, consulting and other services is legal. It’s defended as a way for experts in their fields to share important experience and information about medications, but it has long been a controversial practice.

Pharmaceutical company payments to doctors are not unique to opioids. Drug companies pay doctors billions of dollars for various services. In 2015, 48 percent of physicians received some pharmaceutical payment.

It’s illegal, however, for doctors to prescribe the drug in exchange for kickback payments from a manufacturer.

Dr. Steven Stanos, president of the American Academy of Pain Medicine, said he wasn’t surprised that doctors who frequently prescribe a drug are often chosen and paid to give speeches about the drug to other doctors.

“They know those medicines, and so they’re going to be more likely to prescribe those because they have a better understanding,” Stanos said, adding that some of the money paid to doctors may have been to teach other doctors about new “abuse-deterrent” opioid drugs.

Stanos’ group accepted nearly $1.2 million from five of the largest opioid manufacturers in the United States between 2012 and 2017, according to a recent report by the Senate Homeland Security and Governmental Affairs Committee.

Stanos said the money was used for various projects, including courses on safe opioid prescribing.

“I would obviously hope that a physician would not prescribe based on some type of kickback or anything like that, that they’d obviously be prescribing (in) the best interest of the patient,” he said.

But Dr. Daniel Carlat, former director of the Prescription Project at the Pew Charitable Trusts, said the CNN and Harvard findings are in line with other studies suggesting that money from drug companies does influence a doctor’s prescribing habits.

“It’s not proof positive, but it’s another very significant data point in the growing evidence base that marketing payments from drug companies are not good for medicine and not good for patient care,” said Carlat, a psychiatrist who blogs about conflicts of interest. “It makes me extremely concerned.”

Barnett, one of the Harvard researchers who worked with CNN, said pharmaceutical companies pay doctors for a reason.

“It’s not like they’re spending this money and just letting it go out into the ether,” he said. “They wouldn’t be spending this money if it weren’t effective.”

According to a statement by the Pharmaceutical Research and Manufacturers of America, drug companies support mandatory and ongoing training for prescribers on the appropriate treatment of pain.

“PhRMA supports a number of policies to ensure patients’ legitimate medical needs are met, while establishing safeguards that prevent overprescribing,” according to the statement from the group.


State news

Icon Foods targets cannabis industry with launch of CannaSweet

Proprietary blend offers clean-label sugar reduction for medicinal, recreational edibles

PORTLAND — A new sweetener formulated for the growing industry in edible cannabis products also is ideal for consumers following low-sugar, low-carb and ketogenic diets.

CannaSweet’s proprietary blend relies largely on allulose, a low-calorie sweetener balanced with stevia and monk fruit for optimum sweetness in reduced-calorie, low-calorie and calorie‐free foods and beverages. Naturally occurring in wheat, figs, raisins, jackfruit and other plants, allulose has the same molecular formula as fructose and glucose.

“CannaSweet is a game changer,” said Thom King, president and chief executive officer of Icon Foods, the creator of CannSweet. “It is specifically designed for the cannabis industry to employ clean-label sugar reduction in the medicinal and recreational edible category.”

Adult consumption of cannabis is on the rise in the United States, where more than a fifth of Americans reside in a state where recreational use of cannabis is legal. The plant is legal in some fashion in 30 states and the District of Columbia.

“Today’s consumers are looking for products made from nature, while at the same time limiting sugar intake to reduce calorie consumption and manage the glycemic response, but they aren’t willing to compromise on flavor,” said King. “CannaSweet delivers exceptional flavor, while also allowing developers to achieve clean-label sugar reduction.”

Because it is not rapidly digested and absorbed, CannaSweet is safe for diabetics and suitable for people who follow low-sugar or low-carb diets and even those who have adopted a ketogenic lifestyle. It behaves similarly to erythritol and does not have a laxative effect. It already is used in a number of product formulations, including the Icon Foods KetoseSweet product line, and it holds Generally Recognized as Safe status as a sugar substitute from the Food and Drug Administration.

“As the market for edible cannabis products continues to expand, regulators must identify and control food safety and quality concerns,” said King.

Available in crystalline and liquid forms, CannaSweet is geared toward a wide range of products including carbonated and noncarbonated beverages, frostings, baked goods, such as cakes, pies, pastries, biscuits and rolls; frozen dairy desserts, jams and jellies, sweet sauces, syrups, chewing gum, confectionery, such as hard and soft candies; gummies, puddings and fillings. It is certified organic and kosher and is free of genetically modified organisms (GMOs), soy, corn and allergens.

The calorie savings in products formulated with CannaSweet are significant when compared with full-sugar versions. Sugar has 4 calories per gram. CannaSweet has only 0.2 calories per gram, and it doesn’t affect blood glucose or insulin levels, critical to those with diabetes. The American Heart Association considers high blood glucose a factor in metabolic syndrome and increased risk of heart disease, stroke and other health problems.

For more information, visit


Consumer news

Condoms, breath mints … CBD tinctures

Impulse buys could include therapeutic cannabis

Sample-sized CBD edibles, topicals and tinctures could be available at corner markets with this month’s debut of the Benihemp brand.

Marijuana Company of America Inc. (MCOA) is targeting Convenient Hemp Mart for convenience stores, smoke shops, gas stations and similar types of retail businesses where CBD has a greater likelihood of purchase, on impulse, at the register. Consumers can find Benihemp packaged in one-day, two-day and 30-day supplies. CBD — cannabidiol — is the chemical compound in cannabis primarily responsible for therapeutic effects.

Convenient Hemp Mart plans the official Benihemp product-line launch at ASD Market Week, July 19 through Aug. 1, in Las Vegas. The comprehensive business-to-business trade show for retail merchandise annually hosts 45,000 buyers from over 90 countries, representing major department stores, convenience stores, gift shops, grocery stores and other retail stores. Among 45,000 attending the show, the average buyer spends a total of $82,500 on product orders.

“With the ever-growing convenience-store marketplace hitting a new record of over $140 billion in annual sales last year, we believe this is the perfect place to present the first industrial hemp-derived products developed specifically for this market,” said Sam Girges of Benihemp, which will be located in the lower south hall at ASD, booth SL2449.

Headquartered in Escondido, Calif., MCOA invested $100,000 into Benihemp in exchange for a 25-percent equity stake in Convenient Hemp Mart.