ArticlePloS one2020
Drivers of the opioid crisis: An appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations.The Cochrane database of systematic reviews · 2020Pooled it
- Conflicts of Interest Reporting in Trials and Guidelines Addressing Glucocorticoid Injections for Knee Osteoarthritis.Arthritis care & research · 2026Review
- The NHS and the pharmaceutical industry: High risk of harmful interactions.Future healthcare journal · 2025Article
- Conflicts of Interest in the Assessment of Chemicals, Waste, and Pollution.Environmental science & technology · 2023Review
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- A critical appraisal of Evicore's guidelines for advanced diagnostic imaging of the spine for lower extremity pain with neurological features.Journal of spine surgery (Hong Kong) · 2023Article
- Secrecy, Spin, and Seeding: Should Medical Trainees Learn About Industry Influence in the Medical Literature?Journal of general internal medicine · 2023Article
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- Sponsorship of Australian and New Zealand medical societies by healthcare companies: an observational study.JRSM open · 2022Article
- Associations Between Aggregate NLP-Extracted Conflicts of Interest and Adverse Events by Drug Product.Studies in health technology and informatics · 2022Article
- Industry involvement in clinical practice guidelines.Canadian family physician Medecin de famille canadien · 2021Article
- Self-reported Financial Conflict of Interest in Nephrology Clinical Practice Guidelines.Kidney international reports · 2021Article
- Centralised Full Access to Clinical Study Data Can Support Unbiased Guideline Development, Continuing Medical Education, and Patient Information.Journal of European CME · 2021Article
- [How long does a long-term therapy last?]Schmerz (Berlin, Germany) · 2020Article
- Increased risk of adverse events in non-cancer patients with chronic and high-dose opioid use-A health insurance claims analysis.PloS one · 2020Article
- The Evidence Driving Policy for the Implementation of Virtual Rehabilitation Is Riddled With Conflicts of Interest.Sports healthArticle
- Estimating the prevalence and correlates of pain among people living with HIV who use unregulated drugs in a Canadian setting.Journal of opioid managementArticle
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStarting 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.
methodsWe 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.
resultsWe 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.
conclusionOur 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.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.