Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Humanist Voices, and The Good Men Project. This interview in Canadian Atheist does mean pro- or anti-religion/pro- or anti-non-religion. It amounts to a specific topical interview. Here we talk about national pharmacare.
Scott Douglas Jacobsen: These opioid guidelines were the national ones. What was your own work here?
Professor Gordon Guyatt: There have been an over prescription of chronic non-cancer pain and a use of excessive doses of opioids for chronic non-cancer pain. And, this has led to narcotic dependency. It has led to the narcotic associated deaths.
Everybody knows this is a problem. An earlier Canadian guideline in the days before people were really waking up to this, basically, did not say when to use opioids. It said, “If you decide to use opioids, what are the best ways? What are the guides for giving out the opioids?”
That might have been reasonable at the time. But, perhaps if anything, it contributed to the opioid overprescribing. So, a couple of years ago, and a few months ago produced, a national guideline for opioid use.
It starts out saying, “Before you use opioids, try non-steroidal, try drugs like Acetaminophen, try a number of other drugs such as those in the anticonvulsant class that have analgesic properties. Some antidepressants have analgesic properties. Bottom line: do not use opioids as your first, second, or third option. Try other things before you move to opioids.”
That was the first thing. The second thing we found out. Somewhat to our surprise: opioids were great for acute pain. If you give them for acute pain, they have substantial effects. But unfortunately, people get used to the opioids’ effects.
When you give opioids chronically, the effect is actually quite limited. On a visual analogue scale, where 0 is no pain and 10 is the worst pain that you have, chronic opioids lower your pain by only 1 unit: 6 to 5, 5 to 4.
Very modest effect, it has lots of side effects. So, the guidelines say, “Do not give large doses of opioids. No extra benefits, extra risks, if you are going to give opioids, first try everything else, then when you try this make the dose modest.”
It also gave guidelines for people currently stuck on opioids to help them reduce their opioid use, maybe get off opioids altogether. A whole set of recommendations for dealing with the over prescription of opioids.
That will hopefully lead to much better prescribing.