- From 2021 to 2023, stimulant marketing payments doubled and tripled for physicians and advanced practice clinicians, respectively.
- The increases were driven in large part by growth in marketing to psychiatrists (a 250% increase) and nurse practitioners (a 300% increase).
- The increasing use of stimulants for ADHD has raised concerns about overprescribing and misuse, the researchers noted.
Total marketing payments for stimulants to physicians and advanced practice clinicians (APCs) sharply increased in recent years, researchers found.
From 2021 to 2023, stimulant marketing payments to physicians doubled from $1.8 million to $3.6 million, and tripled from $0.5 million to $1.6 million for APCs, reported J. Travis Donahoe, PhD, MPH, of the University of Pittsburgh, and colleagues.
The increases were driven in large part by growth in marketing to psychiatrists (by $1.2 million from 2021 to 2023, representing a 250% increase) and nurse practitioners (by $0.8 million, representing a 300% increase), they noted in JAMA Pediatrics.
Marketing growth was highest for serdexmethylphenidate/dexmethylphenidate (Azstarys), which increased by $2.4 million, or 580%.
"Stimulant prescribing has increased in recent years, particularly since the COVID-19 pandemic," Donahoe told MedPage Today. "The reasons for these trends are not fully understood. Our study describes recent patterns in pharmaceutical marketing of stimulants to provide context on a factor that may be relevant to these trends and worthy of further study."
"One finding that stood out is that marketing payments to advanced practice clinicians have been increasing at a faster rate than for other professionals," he added. "This aligns with evidence from other sources showing that they are playing a growing role in prescribing stimulants."
Donahoe and colleagues noted that stimulants are an effective treatment for attention deficit-hyperactivity disorder (ADHD), but "rising use has raised concerns about overprescribing and misuse."
"Post-pandemic telehealth expansions might partly explain these trends by reducing barriers to obtaining ADHD medications, but pharmaceutical marketing is another potential contributor," they wrote.
A recent analysis of industry payment data showed that more than $12 billion in payments were made to physicians from 2013 to 2022, with those researchers noting that financial conflicts of interest are prevalent in medicine, despite evidence that they influence prescribing practices and harm patient-doctor relationships.
In this study, psychiatrists and pediatricians, including those in adolescent-focused subspecialties, had the highest percentages of clinicians -- 5.9% to 10.5% -- receiving any payment. The frequency of clinicians receiving payments exceeding $5,000 annually, total payments, and average individual payments were highest for adolescent psychiatrists and psychiatrists.
Meanwhile, nurse practitioners had the highest number of unique clinicians receiving payments, at 18,676.
"At this stage, we don't know how marketing payments affect stimulant prescribing appropriateness, and more research is needed on the clinical implications of this," Donahoe said. "In the meantime, it may be helpful for patients and families to know about any financial relationships that their clinicians have with pharmaceutical companies. This information is publicly available through the CMS Open Payments database."
For this study, Donahoe and colleagues obtained data on pharmaceutical industry marketing payments, such as meals and speaking fees, from the CMS Open Payments Program. Payments were identified as related to at least one stimulant medication.
The numbers of active clinicians by specialty or subspecialty were obtained from the National Plan and Provider Enumeration System.
Donahoe and colleagues noted the importance of including APCs in their analysis through new data first available in 2021, "given recent state laws expanding their authority to prescribe controlled substances."
Limitations of the study included a reliance on industry-reported payments and the inability to identify APCs with pediatric or psychiatric subspecialties, as well as a lack of data on free medication samples.
Disclosures
The study was funded by a grant from the National Institute on Aging.
Donahoe reported receiving personal fees from Greylock McKinnon Associates.
Co-authors reported relationships with the American Medical Student Association, the National Institute on Aging, the American Heart Association, the American Medical Association, and the Patient-Centered Outcomes Research Institute.
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