‘Er­rors made’ in cre­at­ing opi­oid guide, Mac says

Process failed to keep pub­li­ca­tion con­flict-of-in­ter­est free, MP says

The Hamilton Spectator - - LOCAL - JOANNA FRKETICH jfr­ketich@thes­pec.com 905-526-3349 | @Jfr­ketich

McMaster Univer­sity ad­mits “er­rors were made” in the process that was sup­posed to keep a new na­tional opi­oid guide­line-con­flict-of-in­ter­est free.

“Th­ese er­rors should not have oc­curred and we apol­o­gize that they did,” said McMaster pro­fes­sor Dr. Gordon Guy­att in a let­ter dated May 19 to fed­eral Health Min­is­ter Jane Philpott.

“We are re­view­ing our ad­min­is­tra­tive poli­cies and prac­tices to en­sure that er­rors of this type do not oc­cur again.”

Guy­att rec­og­nizes the sig­nif­i­cance of the mis­take say­ing, “Min­i­miz­ing the in­flu­ence of con­flict of in­ter­est is an im­por­tant as­pect of en­sur­ing a sound and cred­i­ble guide­line.”

The 2017 Cana­dian Guide­line for Opi­oids for Chronic Non-Can­cer Pain pub­lished in May de­clared no one with “overt fi­nan­cial or in­tel­lec­tual con­flicts of in­ter­est” was al­lowed to vote.

The let­ter ac­knowl­edges this is not true.

“The ad­min­is­tra­tive process to re­view the con­flict-of-in­ter­est forms was not prop­erly fol­lowed,” said Guy­att, who was chair of the guide­line steer­ing com­mit­tee. “As a re­sult, the fi­nan­cial con­flicts iden­ti­fied by one mem­ber were not brought to the at­ten­tion of the steer­ing com­mit­tee un­til af­ter the rec­om­men­da­tions had been com­pleted and the guide­line was be­ing pre­pared for pub­li­ca­tion.”

The let­ter does not iden­tify which of the 15 vot­ing mem­bers had the con­flict.

How­ever, Oakville physi­cian Dr. Sol Stern is iden­ti­fied as re­ceiv­ing hon­o­raria for con­tin­u­ing med­i­cal education pre­sen­ta­tions from pre­scrip­tion opi­oid maker Pur­due Pharma in the Cana­dian Med­i­cal As­so­ci­a­tion Jour­nal pub­li­ca­tion of the guide­line May 8.

The same pub­li­ca­tion re­ports ad­vo­cate Chris Cull re­ceived per­sonal fees from In­di­v­ior, which makes opi­oid ad­dic­tion treatment drugs.

The con­flict-of-in­ter­est forms were com­pleted in De­cem­ber 2015 and Jan­uary 2017 and the mis­take was made in both sub­mis­sions. The forms also only cov­ered 36 months in­stead of the five years in­tended by the com­mit­tee.

Guy­att, who is con­sid­ered a founder of ev­i­dence-based medicine, says the steer­ing com­mit­tee stands by the guide­line, which was ap­proved by a panel of ex­perts from around the world.

“We sought in­put from a wide range of groups to en­sure that all views were taken into ac­count as the panel con­ducted its work,” Guy­att said in the let­ter.

The univer­sity re­ceived more than $430,000 from the fed­eral gov­ern­ment in 2015 to over­haul the guide­line, which had last been up­dated in 2010.

“Now we learn that one of the mem­bers of that panel was a paid ad­viser for phar­ma­ceu­ti­cal com­pa­nies, in­clud­ing Pur­due, a ma­jor opi­oid pro­ducer,” NDP Van­cou­ver Kingsway MP Don Davies said dur­ing ques­tion pe­riod in the House of Com­mons on Thurs­day. “Given the record of mis­rep­re­sen­ta­tion by the drug in­dus­try that fed this cri­sis, how did the gov­ern­ment al­low an in­di­vid­ual with a clear con­flict of in­ter­est to help draft new pre­scrip­tion guide­lines?”

Canada is in the midst of a deadly opi­oid ad­dic­tion epi­demic caused in part by the over-pre­scrib­ing of the pain med­i­ca­tion.

“I in­deed was con­cerned when I heard th­ese al­le­ga­tions of po­ten­tial con­flict of in­ter­est,” Philpott replied to Davies.

“As a re­sult, I want to make sure that the guide­line will have the con­fi­dence of physi­cians and other pre­scribers who ex­pect to use them.”

Philpott asked McMaster to do a thor­ough in­ves­ti­ga­tion of what took place and re­port back to her.

“We are con­fi­dent in the guide­line and its rec­om­men­da­tions and look for­ward to shar­ing a full ac­count as you have re­quested,” states the let­ter from Guy­att. “Let me em­pha­size that we be­lieve the guide­line is sound, un­bi­ased and a crit­i­cally im­por­tant tool to help Cana­dian physi­cians and their pa­tients bet­ter man­age chronic pain.”

The let­ter de­scribes the guide­line as rec­om­mend­ing “ex­tremely cautious pre­scrib­ing of opi­oids for pa­tients with chronic pain, which is a dra­matic change form how th­ese drugs have been pre­scribed across Canada for nearly 20 years.”

The ac­cept­abil­ity of the guide­line will now be reviewed as Philpott has re­quested the Cana­dian In­sti­tute for Health In­for­ma­tion con­vene a meet­ing to have ex­perts ad­vise on whether there is still con­fi­dence in the rec­om­men­da­tions.

“We are con­fi­dent in the sci­ence that un­der­pins the guide­line rec­om­men­da­tions and the method­ol­ogy used was ex­plicit and trans­par­ent and the best avail­able to link ev­i­dence with clin­i­cal rec­om­men­da­tions,” Guy­att said.

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