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Why Some Doctors’ Groups Blocked Opioid Reform

A new study finds doctors’ and patients’ groups that receive funding from opioid manufacturers were more likely to oppose a major national effort to reduce opioid prescribing.
Close-up photo of a pile of round pills

The American Cancer Society describes itself as a “health organization dedicated to eliminating cancer.” So it might come as a surprise that the society’s Cancer Action Network has a pretty strong stance on recommended guidelines for prescribing painkillers for people without cancer. “We cannot endorse the proposed guidelines in any way,” Cancer Action Network President Christopher Hansen wrote in a letter addressed to the Centers for Disease Control and Prevention (CDC) in October of 2015.

At the time, the CDC had just released rough-draft recommendations it was writing for doctors prescribing opioid painkillers for pain unrelated to cancer. Officials hoped the guidelines would decrease the number of Americans who became dangerously hooked on opioids — a class of drugs including various painkillers and heroin — after taking their prescribed medicines. In the year before the draft guidelines’ release, nearly 29,000 Americans died of opioid overdoses, according to CDC data. Their deaths have led to an ongoing debate among doctors and scientists about when to treat people with chronic pain, such as back pain, with opioids. Giving people opioids to ease the pain of cancer, cancer treatment, and those with terminal illnesses, however, is less controversial.

So why would the American Cancer Society step into the fray? “We injected ourselves into the debate because we did not want cancer patients to not be able to have access to their medication,” Theodore Morrison, a one-time lobbyist for the Cancer Action Network, told the Associated Press. But a new study suggests another possible reason the network — which counted opioid-makers Purdue Pharma, Endo, and Johnson & Johnson among its “Corporate Heroes” in 2015 — might be interested in opioid policy generally. After systematically analyzing the letters that 158 organizations sent to the CDC, a team of scientists found that those groups that had funding from opioid manufacturers were more likely to oppose the opioid-prescribing guidelines than groups that had received no health-industry funding at all. The organizations included doctors’ associations and patient advocacy groups.

“Opposition to the guidelines was much higher among organizations that had financial relationships with opioid manufacturers.”

“We found that most organizations that we examined supported the CDC’s draft guidelines, about 80 percent. But opposition to the guidelines was much higher among organizations that had financial relationships with opioid manufacturers,” says Caleb Alexander, one of the study scientists and a co-director of Johns Hopkins’ Center for Drug Safety and Effectiveness.

“I think when you have tens of thousands of people dying from these products in a given year, it’s time to take pause and reconsider the role that these lobbying efforts may be playing,” Alexander adds. He and one of his study co-authors, rehab-center executive Andrew Kolodny, submitted a letter to the CDC last January, declaring their “unqualified support” for the guidelines.

In recent years, several investigative news stories have revealed various doctors’ and patients’ organizations’ opioid industry funding. They’ve noted such groups tend to support policies that would bolster drug sales. But few stories or studies have looked for that pattern in a comprehensive way, according to Barbara Mintzes, a drug policy researcher at the University of Sydney who was not involved in Alexander’s study. “What this study adds is that it’s more systematic,” she says. “It looks at every group that made a submission on a policy.”

Alexander wants organizations to make their funding information easier to find. He and his co-authors argue in their paper for the CDC to request or require letter-submitters to state their industry ties. “Our study underscores the importance of greater transparency regarding these financial relationships,” he says. “Listen, in no cases were we able to easily identify the relationships between opioid manufacturers and patient advocacy and professional organizations. It’s very opaque.”

It’s not a cure-all for undue bias in policy decisions, but funding transparency is a “step in the right direction,” as researchers Sara Gorman and Jack Gorman (a father-daughter team) recently argued in Psychology Today.

What about divesting from the health-care industry altogether? That may severely hamper some organizations. A survey published today found that many patient advocacy organizations are on the smaller side; two-thirds of surveyed groups received industry funding; and seven percent reported they got at least half their budget from health companies. Pacific Standard contacted several doctors’ and patients’ groups who receive opioid manufacturer funding, and all of whom responded negatively to the CDC’s prescribing guidelines, including the Cancer Action Network. None returned requests for comment before this story published.

Mintzes has a suggestion to keep cash-strapped groups representing patients going, while minimizing industry influence: Create a pool of money into which health-care companies donate to be distributed anonymously among charities. Building such a system would take some work, but it’s not an unprecedented idea. Some have proposed a similar solution to the outsize industry backing of nutrition science.

Less industry funding could mean patients’ groups are able to better represent their constituents’ interests. Patients often really do want more access to medicines; just because they say so doesn’t mean they’re mouthpieces for the industry. But industry funding may be keeping some voices from making the news as much as others. Patients should also be invested in knowing more about ill side effects from drugs, but patients’ groups don’t seem to take as strong as a stance about that, Mintzes says.