Free Drug Samples and the Opioid Crisis

Abstract

To the Editor: Malpractice on the part of some pharmaceutical companies has been established as a key driver of the opioid crisis.1 Powerful painkillers are offered under attractive condi- tions to poorly educated patients who are not aware of the risk of addiction and who eventu- ally die from drug overdose. The practice of providing “starter coupons” that give patients incentives to try a new drug with a free prescrip- tion for a limited time deserves special consider- ation, as the General Accounting Office under- lined in its report on the abuse of OxyContin (oxycodone).2 The provision of free drug samples for pro- motional purposes is common in the United States. Pharmaceutical companies argue that this practice facilitates early initiation of treatment and helps physicians provide better care to low- income, uninsured patients. However, there is evidence that free samples often do not reach the intended patient population, reduce patients’ adherence to their treatment plans, and eventu- ally increase health care costs.3 Indeed, free samples tend to provide support for the prescrip- tion of expensive brand-name medications at the expense of the prescription of generics.4 In the case of prescription opioids, free sam- ples can lead to even more dramatic consequenc- es. Opioids are potent stimulators of the reward system of the brain, so getting a free “taste” of these medications can precipitate compulsive and long-lasting seeking of substances that re- produce their effects — a phenomenon typically exploited by drug dealers. In the European Union, opioids are subject to specific legal measures introduced in 1992 (well before the onset of the opioid crisis). A 2001 European Parliament and Council of the Euro- pean Union Directive (Directive 2001/83/EC) on medicinal products for human use clearly speci- fied that member states must prohibit both di- rect advertising to the general public of narcotic drugs and psychotropic substances and their provision as free samples to prescribers.5 The implementation of these provisions is supported by the European Federation of Pharmaceutical Industries and Associations in its code on the promotion of prescription-only medicines to and interactions with health care professionals (www.efpia.eu/media/24302/3a_efpia-hcp-code -2014.pdf ). Although the divergent drug-advertising and free-sample policies in the United States and Europe can be understood in light of the differ- ent health care systems, we believe the opioid crisis should lead U.S. policymakers to address the specific case of addictive drugs as their Euro- pean counterparts have done. In order to con- tain the current epidemic and prevent its recur- rence, we suggest that a ban on the practice of providing free starter coupons for narcotic and psychotropic substances be urgently considered.