Prescription rate and its effect on the opioid overdose death rate: implications of pharmaceutical financial incentives

Michael C Wang, Charles B Moss, James Oehmke, Andrew Schmitz, Gail D'Onofrio, Lori Ann Post

Research output: Contribution to journalArticle


Objectives: To examine the effect of pharmaceutical incentives to physicians to write opioid prescriptions and its effect on opioid-related deaths by county urbanicity, industry, and demographic characteristics.

Methods: We estimated a linear regression model on opioid-related death rates, obtaining unbiased estimates by treating prescription rates as endogenous and adjusting for suppressed or missing county level opioid-related death rates.

Results: Pharmaceutical payments are positively associated with prescription rates; a 1% increase in the prescription rate results in 3 deaths per 100,000 persons; mining dependence is independently associated with an additional 7.4 deaths per 100,000 persons. Rural counties have lower death rates than urban counties but have significant spatial heterogeneity.

Conclusions: Pharmaceutical companies incentivizing physicians to write opioid prescriptions for their patients has a strong positive relationship with increased opioid prescribing. Legal prescriptions are an important driver of opioid-related overdose deaths. Finally, the mining industry in rural counties has the highest death rates in the opioid epidemic.

Public Health Implications: Given the positive empirical relationship between incentives and prescribing and its role in overdose deaths, opioid-related mortality prevention should target pharmaceutical companies
Original languageEnglish (US)
Number of pages13
JournalInternal Medicine Review
StatePublished - Mar 2019


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