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The iatrogenic opioid crisis: an example of “institutional corruption of pharmaceuticals”?
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  • Michael Makhinson,
  • Shashikant Seshia,
  • Bryan Young,
  • Preston Smith,
  • Kent Stobart,
  • Neil Guha
Michael Makhinson
David Geffen School of Medicine at the University of California
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Shashikant Seshia
University of Saskatchewan
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Bryan Young
Western University Schulich School of Medicine and Dentistry
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Preston Smith
University of Saskatchewan College of Medicine
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Kent Stobart
University of Saskatchewan College of Medicine
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Neil Guha
Nottingham University Hospitals NHS Trust
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Abstract

Rationale Prescribed opioids are major contributors to the current international public health opioid crisis. Such iatrogenic calamities usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future tragedies. In this exploratory study, we report on such an analysis. Methods Root cause analysis, incorporating recent suggestions for improvement, was used to retrospectively identify possible causal factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. Results The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were: pharmaceutical, political and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and all other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables. Limitations Our analysis suggests associations not causality. Conclusions The iatrogenic crisis has multiple intricately linked interacting roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most of the other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis exemplifies widespread “institutional corruption of pharmaceuticals.”

Peer review status:Published

18 Oct 2020Submitted to Journal of Evaluation in Clinical Practice
21 Oct 2020Submission Checks Completed
21 Oct 2020Assigned to Editor
22 Oct 2020Reviewer(s) Assigned
05 Feb 2021Review(s) Completed, Editorial Evaluation Pending
07 Feb 2021Editorial Decision: Revise Minor
09 Mar 20211st Revision Received
10 Mar 2021Submission Checks Completed
10 Mar 2021Assigned to Editor
12 Mar 2021Review(s) Completed, Editorial Evaluation Pending
12 Mar 2021Editorial Decision: Accept
24 Mar 2021Published in Journal of Evaluation in Clinical Practice. 10.1111/jep.13566