RA: Trump says we should put the drug dealers in jail, but does that include all drug dealers? We have plenty right here in the United States hiding behind either a Big PhRMA corporate wall or a white coat. CNN and Harvard shed light on why we need to start with our own drug dealers and focus just as hard on them as we do on dealers crossing the border. 

CNN Exclusive: The more opioids doctors prescribe, the more money they make. Story by Aaron Kessler, Elizabeth Cohen and Katherine Grise, CNN

As tens of thousands of Americans die from prescription opioid overdoses each year, an exclusive analysis by CNN and researchers at Harvard University found that opioid manufacturers are paying physicians huge sums of money -- and the more opioids a doctor prescribes, the more money he or she makes. 

In 2014 and 2015, opioid manufacturers 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. 

From August 2013 through December 2016, Dr. Steven Simon of Overland Park, Kansas, was paid nearly $1.1 million by companies that make opioid painkillers, according to the federal Open Payments database. Most of the payments were fees for speaking, training and education.

Corey Ballou, currently suing him, says she remembers Simon bragging about how drug companies were flying him across the country to give lectures to other doctors. "He said he was going to Miami, and they were going to give him a convertible, and he was going to stay in the best hotel and eat the best Cuban food he'd ever had." Simon's lawyer, James Wyrsch, said he would not comment on pending litigation.

RA: Sure, they’re not being paid to prescribe. These are but a few of the voluminous examples out there – thousands of them.

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. Fifty-four percent of the doctors prescribing opioids -- 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% received payments. Among those in the top fifth percentile, 84% received payments. Among the very biggest prescribers -- those in the top 10th of 1% -- 95% received payments.

On average, doctors whose opioid prescription volume ranked among the top 5% 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% of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1%, on average, received nine times more money than the typical doctor.

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.

RA: How much did you really help, Dr. Stanos? Doesn’t seem like you can establish any evidence you did, but you made plenty of money by not doing so.

RA: Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. See Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. It’s expected that the opioid crisis will claim another 500,000 lives over the next decade.

RA: Dr. Patrice Harris, a spokeswoman for the American Medical Association, said that the data raised “fair questions” but that such analyses show only an association between payments and prescribing habits and that it’s “not a cause and effect relationship.” 

Come on, Dr. Harris, wake up.

"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."