According to a new report, most criticisms of the CDC’s guidelines for opioid management of chronic noncancer pain did not include disclosures of any potential conflicts of interests with opioid manufacturers.
Interviews with Caleb Alexander, MD, and Daniel B. Carr, MD
In March of last year, the Centers for Disease Control and Prevention (CDC) released its guidelines for primary care physicians prescribing opioids to patients suffering from chronic noncancer pain conditions.1
Since then, the guidelines have come under scrutiny from a number of professional organizations and patient advocacy groups, many of which raised concerns over aspects of the guideline’s recommendations.
A new report now suggests that some of the opposition to the CDC guidelines expressed by professional groups may have been influenced by existing financial interests with opioid manufacturers and other stakeholders. The report, recently published in JAMA Internal Medicine,2 raises the topic of whether financial associations between prescription drug manufacturers and professional organizations may influence clinical policy.
According to Caleb Alexander, MD, an associate professor at the Johns Hopkins Bloomberg School of Public Health and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, financial ties between prescription drug manufacturers and professional organizations is a subject that can lack transparency.
“There was vocal opposition to the [CDC] guidelines by some groups and we thought it was important to examine whether or not this opposition was associated with funding from opioid makers,” Dr. Caleb told Practical Pain Management. “Unfortunately, there’s a remarkable lack of transparency regarding the flow of dollars from opioid makers to a variety of advocacy groups and other professional organizations, and I think this lack of transparency is important because we know that such funding can be influential an organization policy and platforms.”
Analyzing Professional Criticism of the CDC Guidelines
During the CDC’s allotted 30-day period, over 150 groups published public statements and criticisms concerning the guidelines. However, none of the groups were required to include a statement divulging any possible conflicts of interest (financial disclosure statement).
Dr. Alexander and his team extracted all publicly available comments submitted to the CDC’s docket by 158 different professional organizations and advocacy groups, organizing the comments into 4 varying levels of support towards the CDC guidelines:
- Generally supportive with recommendations
- Generally not supportive with recommendations
- Not supportive
“I think it’s important to emphasize that a majority of organizations supported the guidelines, whether or not they had funding relationships with opioid manufacturers,” Dr. Alexander noted.
Indeed, approximately 80% of the organizations were supportive of the CDC guidelines, regardless if they chose to also publish recommendations for revising the guidelines in some way. However, Dr. Alexander and his team also found that general opposition to the CDC guidelines was more common among organizations with financial ties to opioid manufacturers.
Of the 158 organizations evaluated, 45 (28.5%) had received funding from opioid manufacturers, and 25 (15.8%) had funding tied to various other companies in the life sciences industry. Another 24 (15.2%) organizations’ funding information could not be determined, at all.
“In hindsight, it’s remarkable the CDC did not require organizations to provide financial conflicts of interest, since so many organizations had them,” Dr. Alexander noted. And while conflicts of interest statements aren’t exactly a “panacea” for stopping speical interests from infringing on clinical policies, they should be more readily required by the CDC in the future, Dr. Alexander said.
“The bottom line is that there are many potential conflicts of interest in this area. We need greater transparency regarding the financial relationships between drug makers and the organizations that advocate for their positions.”
Daniel B. Carr, MD, who serves as president of the American Academy of Pain Medicine (AAPM), was in agreement with this sentiment, stating that AAPM is “scrupulous in [requiring disclosure] in all of its educational programming and publications.”
The AAPM was one of the organizations that was critical of the guidelines and had submitted a research letter back in January 2016 to CDC director Thomas Frieden, MD, MPH. While the letter was in general support of the CDC’s aims to reduce opioid morbidity in the national population, it expressed a variety of concerns over specific and systemic aspects of the guideline’s recommendations and evidence-review. The AAPM did not include a conflicts of interest statement within this letter to the CDC.
None of the organizations that had received funding from opioid manufacturers chose to disclose such information, something that may not be seen as surprising, said Dr. Alexander, who now believes future submissions to the CDC should be required to include full disclosure of revenue sources.
“Listen, if there wasn’t something to hide, then why wouldn’t there be greater transparency. That is, if there wasn’t some strategic benefit to keeping the information private, then why wouldn’t it be shared and see the light of day?” Even if organizations feel such information would undermine the credibility of their professional opinions on topics of clinical policy, conflicts of interest statements should be something commonly required in the public discourse, Dr. Alexander said.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. JAMA. March 15, 2016. [Epub ahead of print].
Lin DH, Lucas E, Murimi IB, et al. Financial conflicts of interest and the Centers for Disease Control and Prevention’s 2016 guideline for prescribing opioids for chronic pain. JAMA Intern Med. Published online January 17, 2017. doi:10.1001/jamainternmed.2016.8471