Rep. Ray Ward sees a parallel.

As a state legislator and a physician, he likens the relationship between a doctor and a pharmaceutical rep to that of a politician and a lobbyist.

In the case of lobbying, the influence is subtle. At first a legislator may not even realize his views are being shaped.

“It’s the same way with drug company payments,” said Ward, a Bountiful Republican, adding doctors are often “groomed and selected” by pharmaceutical reps.

A review of the federal government’s Open Payments database by the Utah Investigative Journalism Project found that more than 600 Utah doctors received $718,000 in benefits from opioid manufacturers between 2013 and 2017. That included some 7,500 free meals and more than $374,000 for speaking fees. Those fees went to doctors who gave presentations to other doctors on opioid treatments. One pharmaceutical company handed out almost $200,000 during those years, and several doctors collected tens of thousands in benefits.

The money came at a time when Utah had one of the highest rates of opioid deaths in the country, and that is not a coincidence.

Here’s another part of that same parallel Rep. Ward spoke of: both the politicians and the doctors who receive benefits from lobbyists and drug companies always insist they weren’t influenced by the payments.

And in both cases, a collective look makes the opposite argument. The lunches, the free travel, the speaking fees actually do have an effect. In the years since the federal government started collecting and publishing this data, several studies have shown a connection between payments from drug companies and higher prescribing rates.

And now that connection is part of the lawsuits filed after years of rising overdose deaths.

"Utah’s opioid crisis stems directly from a callously deceptive marketing scheme that was spearheaded by certain opioid manufacturers and perpetuated by prominent doctors they bankrolled,” Salt Lake County says in its suit against several companies and doctors filed last spring.

Are all opioid prescriptions bad? No. In many cases patients need them and doctors are right to prescribe them. It’s also the nature of certain practices that some doctors will prescribe a lot more than others.

But Ward has diagnosed well. Doctors have to learn how to manage the world of influence peddling, or it will manage them. They have to figure out what politicians have known for a long time: There is no such thing as a free lunch.