Note: This article has been updated with statement from the Colorado Medical Society

A key source of information that found its way into a bill on opioid substitutes failed to disclose to lawmakers that he had been paid more than $122,000 by the manufacturer of one of the drugs, which he promoted in two committee hearings.

Dr. Jonathan Clapp was the source on the three drugs that are listed in the legislative declaration for House Bill 1276. As it applies to “atypical opioids,” it requires health insurers to pay for these drugs as a substitute for opioid prescriptions.

State Rep. Chris Kennedy, D-Lakewood, one of the sponsors of the measure, told Colorado Politics that he had gotten the names of the three drugs — Tapentadol, Buprenorphine and Tramadol — from Clapp, who is president of the Colorado Pain Society.

Those three drugs are also listed in a 2020 version that was vetoed by Gov. Jared Polis, who was opposed to additional insurance mandates.

Clapp’s source, according to Kennedy, was a 2018 article in Medicine Today, written by an Australian pain specialist, which said the three drugs were the most effective as a substitute and far less addicting.

Kennedy said that while Clapp was the original source of the idea on how to do a better job of covering atypical opioids, there were other sources with which he vetted Clapp’s ideas. That included Dr. Rob Valuck of the Colorado Consortium for Prescription Drug Abuse Prevention.

“We backed up the claims that these drugs are safer and less likely to lead to opioid abuse deaths,” Kennedy said. 

But Clapp never told the House Health & Insurance committee, where he testified on HB 1276 on May 7, that he has been paid more than $122,000 over a three-year period by Collegium Pharmaceutical, the manufacturer of Tapentadol.

The money that Clapp accepted from more than a dozen pharmaceutical companies between 2013 and 2019 was primarily for speaking fees, according to ProPublica‘s 2019 “Dollars for Docs” report and a database operated by the federal Centers for Medicare and Medicaid Services. The CMS database was last updated in early 2019. 

Jonathan Clapp response: Coverage slighted me — and a good bill

Those speaking fees are not OK with the U.S. Health & Human Services Administration, which issued a Special Fraud Alert last November on the “fraud and abuse risks associated with the offer, payment, solicitation, or receipt of remuneration relating to speaker programs by pharmaceutical and medical device companies.” Those could also violate federal law, the alert said. 

“This remuneration to [health care providers] may skew their clinical decision making in favor of their own and the company’s financial interests, rather than the patient’s best interests,” according to the alert. 

The way it works is that a company pays the health care provider an honorarium for a speech, and often pays remuneration, such as for meals, to the attendees, the fraud alert said, adding that “in the last three years, drug and device companies have reported paying nearly $2 billion to HCPs for speaker-related services.”

The American Medical Association also frowns on payments to doctors from pharmaceutical companies. The AMA Code of Medical Ethics says “subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for the physicians’ time.”

According to the CMS database, beginning in 2016, Clapp started receiving payments well above the national norm for speaking fees and other expenses, such as food and lodging, most of it from Collegium. He received $41,323 that year, well above the national mean of $3,383. In 2017, he received $74,306, when the mean was $3,434; in 2018, he received $48,556, when the national mean was $3,524.

In 2018, Collegium paid out almost $800,000 in “general payments” (i.e. not for research purposes) to doctors. Their number one recipient? Dr. Jonathan Clapp, according to the CMS database.

In those three years Clapp received a total of $164,185; Collegium Pharmaceuticals paid him $122,157. On average over that three years, 83% were for speaking fees, according to ProPublica.

Atypical opioids

HB 1276 doesn’t define what an atypical opioid is. Instead, it lists the three drugs that are classified that way. Kennedy told the House committee that he struggled with how to define an atypical opioid.

“We don’t want to name the specific drugs in statute,” he said, but then cited the Medicine Today study that identified the three that were particularly effective in treating opioid addiction and are now listed in the bill as “safer alternatives to conventional opioids.”

Dr. Clapp, “who knows a lot about these drugs,” can answer questions about them, Kennedy told the committee.

Clapp told the committee that he was there on behalf of the Colorado Medical Society and as president of the Colorado Pain Society, a multi-disciplinary organization for health care providers that deals with pain management.

This bill is unprecedented, Clapp said. The one entity in health care that has avoided the health crisis is the insurers, he told the committee, because the incentive and profit is in their favor.

“Legislation stepping into medicine is appropriate because it will even the playing field, because not one company will step up to limit prices at the expense of being less competitive,” he said.

In response to committee questions, however, the only drug Clapp talked about was Tapentadol. It’s the strongest of the atypical opioids in pain-relieving qualities, and one-10th as addicting as opioids, he told the committee.

Clapp was back on May 26 to testify when HB 1276 was reviewed by the Senate State, Veterans and Military Affairs Committee.

There is national attention on this bill, Clapp told the Senate committee last week. Alternatives to opioids would be instrumental in avoiding opioid prescriptions, he said, noting that 75% of heroin addicts get their first taste of it from opioids.

He told the committee that he had spoken with Collegium, and that the company has been partnering with Medicaid on discounts for Tapentadol.

“They are willing to do something similar for this [Colorado] endeavor,” Clapp said. “What they want is to be able to show they have a statewide study, and share data with the state to keep this cheap, and then show it off to 49 other states … they would love to jump on this opportunity to show how effective it is.”

Clapp told Colorado Politics Wednesday that he was not being paid by Collegium when he testified.

“Anything I gave was independent data, not issued by Collegium,” he said. He maintained that his testimony was on “efficacy as far as pain relief, and any drugs I talked about were better deterrents.”

Clapp said he ended his relationship with Collegium in early 2019. “I was just a naïve doc” trying to get information out to other doctors, he said. 

“I’m passionate about this bill and have been working with Kennedy for a long time on it.”

The Colorado Medical Society, on whose behalf Clapp testified, said in a statement Wednesday that “Dr. Clapp, who specializes in pain management, did testify on behalf of CMS on a bill addressing alternatives to opioids.” CMS President Dr. Sami Diab, continued that “We see alternatives to opioids as an important way to help care for patients with pain, while combatting potential addiction and continuing work to reverse the opioid epidemic. However, Dr. Clapp was not speaking for CMS when he singled out a specific drug. We are looking at our internal controls to ensure that any physician testifying on behalf of CMS does not promote any specific drug or treatment, but simply evidence-based best practice and CMS policy.”

Clapp also has a history with the state medical board, which put his license on probation in October 2016 for overprescribing drugs, including opiates, to patients who failed drug and alcohol tests. That probation was completed in November 2017, according to medical board records.

Sen. Brittany Pettersen, D-Lakewood, the Senate sponsor of HB 1276, said she was unaware of Clapp’s relationship with Collegium. She told Colorado Politics Wednesday people promote and advocate for things all the time.

“I’m happy to look at how we can bring transparency” to witness testimony, she said. “Everyone who testified, if they’re being paid, they should say how much and that there should be transparency.” 

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