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Comments on proposed CDC guidelines lack transparency for conflicts of interest

While the CDC did not require organizations to disclose their financial conflicts of interest in their public comments on its guidelines for prescribing opioids for chronic pain, researchers found that significantly more organizations with funding from opioid manufacturers opposed the guidelines, according to a research letter published in JAMA Internal Medicine.

“An increase in opioid prescribing for chronic, noncancer pain has been associated with large increases in addiction and overdose deaths in the United States,” Dora H. Lin, MHS, from the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “In response, the [CDC] developed guidelines for prescribing opioids for chronic pain. When the draft guidelines were released, there was criticism. Some organizations argued that the development of the guidelines was not transparent and the recommendations were based on weak evidence.”

Due to the criticism, the CDC postponed the release of the guidelines and allowed the public to formally submit comments for a duration of 30 days. The CDC received comments from 158 organizations. Lin and colleagues evaluated the comments to identify levels of support for the guidelines (supportive, generally supportive with recommendations, generally not supportive with recommendations and not supportive), and whether financial associations with opioid manufacturers were related to opposition of the guidelines. The investigators, blinded to level of support, used each organizations’ self-reported relationships, public websites, annual reports and federal tax returns to classify their association to opioid manufacturers.

Lin and colleagues found that 28.5% of organizations received funding from opioid manufacturers, 15.8% had funding relations to other companies in the life sciences, 40.5% received no funding from the life sciences industry and 15.2% had unknown funding. However, none of the organizations that received funding from opioid manufacturers disclosed that they had such funding sources in their comments. Funding was disclosed by 24% of the organizations that received funding from the life sciences industry.

Furthermore, 32.9% of organizations were supportive of the guidelines, 47.5% were generally supportive with recommendations, 11.4% were generally not supportive with recommendations and 8.2% were not supportive. Compared with organizations without funding from the life sciences industry, those with funding from opioid manufacturers more frequently opposed the guidelines.

The researchers noted that the CDC did not prompt or require organizations to disclose their financial relationships as part of their comments; thus, they suggest that the CDC do so in the future to manage conflicts of interest.

“A major concern is that opposition to regulatory, payment, or clinical policies to reduce opioid use may originate from groups that stand to lose financially if sales of opioids decline,” Lin and colleagues concluded. “Our findings demonstrate that greater transparency is required about the financial relationships between opioid manufacturers and patient and professional groups.” – by Alaina Tedesco

Disclosure: Lin reports no relevant financial disclosures. Please see full study for complete list of all other authors’ disclosures.