‘Errors made’ in creating opioid guide, Mac says
Process failed to keep publication conflict-of-interest free, MP says
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.