The iatrogenic opioid crisis: an example of “institutional corruption
of pharmaceuticals”?
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.”