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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


Autoři: Sheryl Spithoff aff001;  Pamela Leece aff002;  Frank Sullivan aff002;  Nav Persaud aff002;  Peter Belesiotis aff007;  Liane Steiner aff008
Působiště autorů: Department of Family and Community Medicine, Women’s College Hospital, Toronto, Canada aff001;  Department of Family and Community Medicine, University of Toronto, Toronto, Canada aff002;  Dalla Lana School of Public Health, University of Toronto, Toronto, Canada aff003;  Public Health Ontario, Toronto, Canada aff004;  Medical School University of St Andrews, St Andrews, Scotland, United Kingdom aff005;  Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada aff006;  Faculty of Health Sciences, McMaster University, Hamilton, Canada aff007;  St. Michael’s Hospital Centre for Urban Health Solutions, Toronto, Canada aff008
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227045

Souhrn

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.

Klíčová slova:

Drug discovery – Finance – Industrial organization – Opioids – Pain management – Physicians – Systematic reviews – Treatment guidelines


Zdroje

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