7 ms·

The more opioids doctors prescribe, the more money they make

177 points by fahd777 9y ago

ta76567656 9y ago
https://www.theguardian.com/commentisfree/2017/nov/07/truth-us-opioid-crisis-too-easy-blame-doctors-not-prescriptions https://www.theguardian.com/commentisfree/2017/nov/07/truth-...
gesman 9y ago
I've done study of these exact datasets with Splunk and applied machine learning to detect anomalies in prescribed drugs comparing each doctor/provider behavior to his peer group. Doing this on a past HHS/CMS datasets - i was able to discover anomalies that was proven to be actual fraud/crime: Was interesting to discover anomaly in 2015 provider behavior data and then read about that same provider just being raided by DEA in 2018. Interesting data! https://imgur.com/a/eIySC https://imgur.com/a/eIySC https://imgur.com/a/5BTo6 https://imgur.com/a/5BTo6
- teej 9y ago
  Did you publish your findings? How do I get my hands on the data?
  - gesman 9y ago
    Data is available on data.cms.gov I published initial research (with 2014 datasets) on splunkbase.com Search “Splunk security essentials for fraud detection” app. (Free app with anonymized data embedded into it. You need to download/install free Splunk to use it). Latest discovery for 2015 datasets (for which I attached snapshots) are not published yet - I plan to do it. Also - I’ll be speaking about it next week (Splunk for fraud detection seminar)
- btown 9y ago
  Do you have any papers or writeups on your methodology and dataset? Would be very interesting to see whether this could direct law enforcement (or, barring that, making it public knowledge so consumers can choose to avoid doctors where there is evidence of questionable behavior).
  - gesman 9y ago
    Yes. Here was initial write up: https://www.splunk.com/blog/2017/09/28/building-a-60-billion-data-model-to-stop-us-healthcare-fraud-with-splunk-and-machine-learning.html https://www.splunk.com/blog/2017/09/28/building-a-60-billion... https://www.splunk.com/blog/2017/10/03/building-a-60-billion-data-model-to-stop-us-healthcare-fraud-part-2.html https://www.splunk.com/blog/2017/10/03/building-a-60-billion... Also I combined prescription dataset with provider payment dataset and it allows to discover potential conflict of interest where provider got compensated by drug manufacturer (speaking fees, stock, conferences). Good idea to make this data publicly searchable. It’s not that difficult. So anyone could search for his favorite doctor name and find how much and for which drugs the doctor billed Medicare for. And how often, how much and when he was compensated by drug manufacturers.
- tshanmu 9y ago
  why cant this be used by the law enforcement as probable cause for shutting down dodgy providers?
  - openasocket 9y ago
    Because some statistical analysis showing a particular entity is an outlier isn't sufficient evidence to prove they are drug dealers. It is enough to start an investigation, of course.
  - Spooky23 9y ago
    They do! Similar approaches are used to identify Medicare and Medicaid fraud.
Mononokay 9y ago
Related: https://news.brown.edu/articles/2017/08/opioids-influence https://news.brown.edu/articles/2017/08/opioids-influence
snowpanda 9y ago
You can look up your doctor here to see if they've "Received Drug or Device Company Money" https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/
cf498 9y ago
>As tens of thousands of Americans die from prescription opioid overdoses each year The number of people apparently come from the CDC https://www.cdc.gov/nchs/data/databriefs/db294.pdf https://www.cdc.gov/nchs/data/databriefs/db294.pdf Is there some data about the circumstances? I was formerly under the impression, that overdoses can generally be categorized into two. Cut drugs and this no information about the dosage and intentional overdoses. How are tens of thousands of people overdosing with a product with a known content? Are all of those first time users?
- Erlangolem 9y ago
  People mix and match drugs, they lose track of dosing (easy to do when you’re wrecked on opioids), and as their tolerance increases they up their dose. They also frequently take a prescribed drug in unsafe ways, such as insufflation or injection.
  - cf498 9y ago
    The part of mixed consume patterns is something I missed. With the high number I disregarded poly drug use. I expected them to be negligibly in the number of death. But apparently with availability comes the category of occasional consumers. Up until now my picture of opioid addicts was people with daily consumption patterns. Even with an increasing tolerance I didnt think accidental overdose deaths were a common phenomenon for an addict. I thought the matter of unsafe consumption in form of injection and co is a matter for first time users of a specific product. Otherwise an addict know the dosage quite well. That said, it will be a problem of hard to dose substances. Changing the ingestion method of for example transdermal fentanyl gets you killed quickly if you cant measure the dosage for the extremely small margin of error with improper measurement tools. I assume it will be similar with the other products on the list. Thanks a lot for the input and the different perspective.
    - Erlangolem 9y ago
      My pleasure, and I’d just add two more things; sometimes Rx users will venture into the world of the black market, and get more than they bargained for. More commonly though, a disproportionate number of overdoses are found among people who had been in recovery. Their tolerance is reduced, they chase their dragon at old doses, and it levels them.
gt_ 9y ago
I can’t help but wonder about the overlap between US regions with high opioid use rates and US regions with high suicide rates. I don’t doubt the incentives in the article contribute to the issue, but I wonder how we can account for the regional discrepancies.
- lsc 9y ago
  I would assume there's a high correlation between experiencing long term pain and opioid use. It also seems there would be a large degree of overlap between people experiencing difficult to treat long-term pain and people who commit suicide. therefore, while it's certainly not an advertisement for the effectiveness of opioids for the treatment of long term pain, it seems unsurprising that there would be a great deal of correlation between opioid use and suicide, even if opioid use didn't cause suicide. I mean, there are several mechanisms wherein opioid use could be the causative factor, sure; I'm just saying that even if opioids mostly worked as designed and never made anything worse, I would expect there to be a lot of overlap between the people who are prescribed opioids over long periods of time and people who commit suicide.
- DanBC 9y ago
  Reducing access to methods is a key part of suicide prevention work. In the US the main methods are guns and opioid medication. Reducing access is politicially difficult, but would save tens of thousands of lives each year. If you have a stockpile of medication please either keep it locked away, or give it back to the pharmacist. A disturbing number of children die after taking their grandparent's medication that's been left out because "we don't have children around".
cassowary37 9y ago
Apparently we can only have one conflict-of-interest story on the front page at once per mods, but some readers might be interested in further reading on the topic from last year: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155474 http://journals.plos.org/plosone/article?id=10.1371/journal.... (Methods may also be useful to folks wondering how/where to get the data, and what a pain it is to link it...!) We were interested in how physician payments drive prescribing costs across specialties, rather than for specific meds.
rsbartram 9y ago
The focus needs to be shifted to education and recovery and funds should be pumped into those channels to see more effective results on the issue. https://latechnews.org/we-support/ https://latechnews.org/we-support/
throwa_way_ 9y ago
The more wet streets that doctors walk through, the more it rains.
sova 9y ago
"Do no harm! unless of course you can sedate your clients forever... then it's a gray enough area that we'll just all get rich!" My heart curls into strange shapes when I think of all the friends I've lost to opiates.
dahdum 9y ago
Outside of the top few, the amounts those doctors are receiving from drug companies is barely consequential (<25k) compared to the stable, huge incomes they can pull from their “patients” in a pain clinic.
md224 9y ago
Really curious how previous societies dealt with opioid misuse when opium and related products (e.g. laudanum) were far less regulated. I’m just confused why a substance that’s been a cornerstone of medicine for centuries (millennia?) is causing so many problems now. Is it less about the drug itself and more about the state of society? The cultural or legal context?
- BigJono 9y ago
  How many opiate addicts does the average person know today (sans internet access)? I know for me it's 0, and I don't exactly run in the most wholesome friend groups. My guess is it's always been a problem to the same extent, but the extent is exaggerated today, due to increased visibility (internet and media), and fairly recent (since the start of the war on drugs in the U.S.) incentives for bad news to spread.
  - mirimir 9y ago
    A close friend has used oxycodone for back pain, for many years. But this is under a doctor's care. So are they an addict? I don't know. It has been years since they went without it, however.
  - tdurden 9y ago
    interesting anecdote
  - notjtrig 9y ago
    In a Massachusetts suburb it's pretty rare to find some who doesn't know an opiate addict. Some of my neighbors, family, co-workers, classmates and friends have been addicted. Most towns have a Suboxone/Methadone clinic.
  - toomanybeersies 9y ago
    Opiate addiction isn't related to how wholesome your friends are. I also don't run in the most wholesome group of friends (at least by traditional standards) and also don't know any opoid users. However, every time I walk to the supermarket I walk past a park where there's about half a dozen heroin addicts shooting up. They just do it in plain sight. There's also needle deposit boxes in all the public toilets and alleyways. Just the other day I saw a dead addict being wheeled into an ambulance. Opiate abuse isn't related to how wholesome you are. There are plenty of god-fearing addicts. Overdose death rates have increased massively over the past 20 years (https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/related-topics/trends-statistics/o...) It's definitely a growing problem. Fentanyl and other synthetic opioids are making it even worse.
ScottBurson 9y ago
It occurred to me, reading a few days ago that Trump had suggested that some drug dealers should face the death penalty, that maybe that should apply to some of these pharma executives. I don't actually support the use of the death penalty, at least not in cases like this, but it is astonishing that we allow thinly-disguised kickbacks to doctors for prescribing addictive drugs. That's as much pushing as what the neighborhood drug dealer does — and more effective. This scam needs to be shut down yesterday.
- deleted 9y ago
  [deleted]

177 points by fahd777 9y ago

https://www.theguardian.com/commentisfree/2017/nov/07/truth-us-opioid-crisis-too-easy-blame-doctors-not-prescriptions https://www.theguardian.com/commentisfree/2017/nov/07/truth-...

gesman 9y ago

I've done study of these exact datasets with Splunk and applied machine learning to detect anomalies in prescribed drugs comparing each doctor/provider behavior to his peer group. Doing this on a past HHS/CMS datasets - i was able to discover anomalies that was proven to be actual fraud/crime: Was interesting to discover anomaly in 2015 provider behavior data and then read about that same provider just being raided by DEA in 2018. Interesting data! https://imgur.com/a/eIySC https://imgur.com/a/eIySC https://imgur.com/a/5BTo6 https://imgur.com/a/5BTo6

teej 9y ago
Did you publish your findings? How do I get my hands on the data?
- gesman 9y ago
  Data is available on data.cms.gov I published initial research (with 2014 datasets) on splunkbase.com Search “Splunk security essentials for fraud detection” app. (Free app with anonymized data embedded into it. You need to download/install free Splunk to use it). Latest discovery for 2015 datasets (for which I attached snapshots) are not published yet - I plan to do it. Also - I’ll be speaking about it next week (Splunk for fraud detection seminar)
btown 9y ago
Do you have any papers or writeups on your methodology and dataset? Would be very interesting to see whether this could direct law enforcement (or, barring that, making it public knowledge so consumers can choose to avoid doctors where there is evidence of questionable behavior).
- gesman 9y ago
  Yes. Here was initial write up: https://www.splunk.com/blog/2017/09/28/building-a-60-billion-data-model-to-stop-us-healthcare-fraud-with-splunk-and-machine-learning.html https://www.splunk.com/blog/2017/09/28/building-a-60-billion... https://www.splunk.com/blog/2017/10/03/building-a-60-billion-data-model-to-stop-us-healthcare-fraud-part-2.html https://www.splunk.com/blog/2017/10/03/building-a-60-billion... Also I combined prescription dataset with provider payment dataset and it allows to discover potential conflict of interest where provider got compensated by drug manufacturer (speaking fees, stock, conferences). Good idea to make this data publicly searchable. It’s not that difficult. So anyone could search for his favorite doctor name and find how much and for which drugs the doctor billed Medicare for. And how often, how much and when he was compensated by drug manufacturers.
tshanmu 9y ago
why cant this be used by the law enforcement as probable cause for shutting down dodgy providers?
- openasocket 9y ago
  Because some statistical analysis showing a particular entity is an outlier isn't sufficient evidence to prove they are drug dealers. It is enough to start an investigation, of course.
- Spooky23 9y ago
  They do! Similar approaches are used to identify Medicare and Medicaid fraud.

Mononokay 9y ago

Related: https://news.brown.edu/articles/2017/08/opioids-influence https://news.brown.edu/articles/2017/08/opioids-influence

snowpanda 9y ago

You can look up your doctor here to see if they've "Received Drug or Device Company Money" https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/

cf498 9y ago

>As tens of thousands of Americans die from prescription opioid overdoses each year The number of people apparently come from the CDC https://www.cdc.gov/nchs/data/databriefs/db294.pdf https://www.cdc.gov/nchs/data/databriefs/db294.pdf Is there some data about the circumstances? I was formerly under the impression, that overdoses can generally be categorized into two. Cut drugs and this no information about the dosage and intentional overdoses. How are tens of thousands of people overdosing with a product with a known content? Are all of those first time users?

Erlangolem 9y ago
People mix and match drugs, they lose track of dosing (easy to do when you’re wrecked on opioids), and as their tolerance increases they up their dose. They also frequently take a prescribed drug in unsafe ways, such as insufflation or injection.
- cf498 9y ago
  The part of mixed consume patterns is something I missed. With the high number I disregarded poly drug use. I expected them to be negligibly in the number of death. But apparently with availability comes the category of occasional consumers. Up until now my picture of opioid addicts was people with daily consumption patterns. Even with an increasing tolerance I didnt think accidental overdose deaths were a common phenomenon for an addict. I thought the matter of unsafe consumption in form of injection and co is a matter for first time users of a specific product. Otherwise an addict know the dosage quite well. That said, it will be a problem of hard to dose substances. Changing the ingestion method of for example transdermal fentanyl gets you killed quickly if you cant measure the dosage for the extremely small margin of error with improper measurement tools. I assume it will be similar with the other products on the list. Thanks a lot for the input and the different perspective.
  - Erlangolem 9y ago
    My pleasure, and I’d just add two more things; sometimes Rx users will venture into the world of the black market, and get more than they bargained for. More commonly though, a disproportionate number of overdoses are found among people who had been in recovery. Their tolerance is reduced, they chase their dragon at old doses, and it levels them.

gt_ 9y ago

I can’t help but wonder about the overlap between US regions with high opioid use rates and US regions with high suicide rates. I don’t doubt the incentives in the article contribute to the issue, but I wonder how we can account for the regional discrepancies.

lsc 9y ago
I would assume there's a high correlation between experiencing long term pain and opioid use. It also seems there would be a large degree of overlap between people experiencing difficult to treat long-term pain and people who commit suicide. therefore, while it's certainly not an advertisement for the effectiveness of opioids for the treatment of long term pain, it seems unsurprising that there would be a great deal of correlation between opioid use and suicide, even if opioid use didn't cause suicide. I mean, there are several mechanisms wherein opioid use could be the causative factor, sure; I'm just saying that even if opioids mostly worked as designed and never made anything worse, I would expect there to be a lot of overlap between the people who are prescribed opioids over long periods of time and people who commit suicide.
DanBC 9y ago
Reducing access to methods is a key part of suicide prevention work. In the US the main methods are guns and opioid medication. Reducing access is politicially difficult, but would save tens of thousands of lives each year. If you have a stockpile of medication please either keep it locked away, or give it back to the pharmacist. A disturbing number of children die after taking their grandparent's medication that's been left out because "we don't have children around".

cassowary37 9y ago

Apparently we can only have one conflict-of-interest story on the front page at once per mods, but some readers might be interested in further reading on the topic from last year: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155474 http://journals.plos.org/plosone/article?id=10.1371/journal.... (Methods may also be useful to folks wondering how/where to get the data, and what a pain it is to link it...!) We were interested in how physician payments drive prescribing costs across specialties, rather than for specific meds.

rsbartram 9y ago

The focus needs to be shifted to education and recovery and funds should be pumped into those channels to see more effective results on the issue. https://latechnews.org/we-support/ https://latechnews.org/we-support/

throwa_way_ 9y ago

The more wet streets that doctors walk through, the more it rains.

sova 9y ago

"Do no harm! unless of course you can sedate your clients forever... then it's a gray enough area that we'll just all get rich!" My heart curls into strange shapes when I think of all the friends I've lost to opiates.

dahdum 9y ago

Outside of the top few, the amounts those doctors are receiving from drug companies is barely consequential (<25k) compared to the stable, huge incomes they can pull from their “patients” in a pain clinic.

md224 9y ago

Really curious how previous societies dealt with opioid misuse when opium and related products (e.g. laudanum) were far less regulated. I’m just confused why a substance that’s been a cornerstone of medicine for centuries (millennia?) is causing so many problems now. Is it less about the drug itself and more about the state of society? The cultural or legal context?

BigJono 9y ago
How many opiate addicts does the average person know today (sans internet access)? I know for me it's 0, and I don't exactly run in the most wholesome friend groups. My guess is it's always been a problem to the same extent, but the extent is exaggerated today, due to increased visibility (internet and media), and fairly recent (since the start of the war on drugs in the U.S.) incentives for bad news to spread.
- mirimir 9y ago
  A close friend has used oxycodone for back pain, for many years. But this is under a doctor's care. So are they an addict? I don't know. It has been years since they went without it, however.
- tdurden 9y ago
  interesting anecdote
- notjtrig 9y ago
  In a Massachusetts suburb it's pretty rare to find some who doesn't know an opiate addict. Some of my neighbors, family, co-workers, classmates and friends have been addicted. Most towns have a Suboxone/Methadone clinic.
- toomanybeersies 9y ago
  Opiate addiction isn't related to how wholesome your friends are. I also don't run in the most wholesome group of friends (at least by traditional standards) and also don't know any opoid users. However, every time I walk to the supermarket I walk past a park where there's about half a dozen heroin addicts shooting up. They just do it in plain sight. There's also needle deposit boxes in all the public toilets and alleyways. Just the other day I saw a dead addict being wheeled into an ambulance. Opiate abuse isn't related to how wholesome you are. There are plenty of god-fearing addicts. Overdose death rates have increased massively over the past 20 years (https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/related-topics/trends-statistics/o...) It's definitely a growing problem. Fentanyl and other synthetic opioids are making it even worse.

ScottBurson 9y ago

It occurred to me, reading a few days ago that Trump had suggested that some drug dealers should face the death penalty, that maybe that should apply to some of these pharma executives. I don't actually support the use of the death penalty, at least not in cases like this, but it is astonishing that we allow thinly-disguised kickbacks to doctors for prescribing addictive drugs. That's as much pushing as what the neighborhood drug dealer does — and more effective. This scam needs to be shut down yesterday.

deleted 9y ago
[deleted]