How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis
Sud A, Strang M, Buchman DZ, Spithoff S, Upshur REG, Webster F, Grundy Q. How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis. BMJ Open. 2022 Jul 12;12(7):e059561. doi: 10.1136/bmjopen-2021-059561. PMID: 35820738; PMCID: PMC9277368.
Objectives: Pharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the ‘Suboxone Education Programme’, developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada.
Setting: These documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry’s role in driving the overprescribing of opioid analgesics and contributing to population-level harms.
Design: A critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007-2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument.
Results: Documents characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority.
Conclusions: Addressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.