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Drivers of the opioid crisis: An appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing

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  • Sheryl Spithoff
  • Pamela Leece
  • Frank Sullivan
  • Nav Persaud
  • Peter Belesiotis
  • Liane Steiner

Abstract

Background: Starting in the late 1990s, the pharmaceutical industry sought to increase prescribing of opioids for chronic non-cancer pain. Influencing the content of clinical practice guidelines may have been one strategy industry employed. In this study we assessed potential risk of bias from financial conflicts of interest with the pharmaceutical industry in guidelines for opioid prescribing for chronic non-cancer pain published between 2007 and 2013, the peak of opioid prescribing. Methods: We used the Guideline Panel Review (GPR) to appraise the guidelines included in the 2014 systematic review and critical appraisal by Nuckols et al. These were English language opioid prescribing guidelines for adults with chronic non-cancer pain published between July 2007 and July 2013, the peak of opioid prescribing. The GPR assigns red flags to items known to introduce potential bias from financial conflicts of interest. We operationalized the GPR by creating specific definitions for each red flag. Two reviewers independently evaluated each guideline. Disagreements were resolved with discussion. We also compared our score to the critical appraisal scores for overall quality from the study by Nuckols et al. Results: We appraised 13 guidelines, which received 43 red flags in total. Guidelines had 3.3 red flags on average (out of a possible seven) with range from one to six. Four guidelines had missing information, so red flags may be higher than reported. The guidelines with the highest and second highest scores for overall quality in the 2014 critical appraisal by Nuckols et al. had five and three red flags, respectively. Conclusion: Our findings reveal that the guidelines for opioid prescribing chronic non-cancer pain from 2007 to 2013 were at risk of bias because of pervasive conflicts of interest with the pharmaceutical industry and a paucity of mechanisms to address bias. Even highly-rated guidelines examined in a 2014 systematic review and critical appraisal had many red flags.

Suggested Citation

  • Sheryl Spithoff & Pamela Leece & Frank Sullivan & Nav Persaud & Peter Belesiotis & Liane Steiner, 2020. "Drivers of the opioid crisis: An appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    • Handle: RePEc:plo:pone00:0227045
    DOI: 10.1371/journal.pone.0227045
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    References listed on IDEAS

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    1. Paul Campsall & Kate Colizza & Sharon Straus & Henry T Stelfox, 2016. "Financial Relationships between Organizations That Produce Clinical Practice Guidelines and the Biomedical Industry: A Cross-Sectional Study," PLOS Medicine, Public Library of Science, vol. 13(5), pages 1-16, May.
    2. Lisa A Bero & Quinn Grundy, 2016. "Why Having a (Nonfinancial) Interest Is Not a Conflict of Interest," PLOS Biology, Public Library of Science, vol. 14(12), pages 1-8, December.
    3. Van Zee, A., 2009. "The promotion and marketing of oxycontin: Commercial triumph, public health tragedy," American Journal of Public Health, American Public Health Association, vol. 99(2), pages 221-227.
    4. Paul T E Cusack, 2020. "On Pain," Biomedical Journal of Scientific & Technical Research, Biomedical Research Network+, LLC, vol. 31(3), pages 24253-24254, October.
    5. Susan L Norris & Haley K Holmer & Lauren A Ogden & Brittany U Burda, 2011. "Conflict of Interest in Clinical Practice Guideline Development: A Systematic Review," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-6, October.
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    1. Jakob M Burgstaller & Ulrike Held & Andri Signorell & Eva Blozik & Johann Steurer & Maria M Wertli, 2020. "Increased risk of adverse events in non-cancer patients with chronic and high-dose opioid use—A health insurance claims analysis," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-14, September.

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