>>From today's local paper.
>>http://www.nj.com/healthfit/index.ssf/2017/06/doctors_raked_in_cash_to_push_powerful_fentanyl_as_nj_death_rate_soared.html
>>From 2013 to 2015, doctors in New Jersey were paid at least $1.67 million by pharmaceutical companies marketing various forms of fentanyl. In the same time period, fentanyl deaths in New Jersey increased from 42 in 2013 to 417 in 2015.

Unlike you, I'm not worried about subsidies for speaking engagements or meals with reps. What did concern me in your citation, was payments for sham "speaking engagements" occurring at restaurants rather than conferences or meetings. That needs to be stamped on hard.

As for fentanyl: 20 years ago it was an excellent anesthetic drug. We knew it was potentially highly addictive/destructive if self-administered: for a while, the death rate for anesthetists who got hooked on fentanyl, was 100%.

It used to be IV only, which meant unsupervised self-administration was almost always illicit. More recently, big pharma came up with easier delivery mechanisms such as sprays under the tongue.

Apart from anesthetics, a big use (and FDA approval) is for cancer pain. There's actually no excuse for cancer pain and fentanyl is one of the reasons.

My expectation is that problems arise from non-injected formulations being over-prescribed or self-overdosed. Even if your physician tells you that an extra spray or two can kill you, that's foreign to most of our experience and you can't make mistakes with drugs of this potency. Also worth noting that physician assistants and nurse practitioners have been heavy prescribers of fentanyl. You'd have to ask who was supervising that, or whether/why the pharma didn't formalize consumer education programs for narcotic drugs whose dangers have been known for decades.