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Some GPs boycott new HSE opioid guidelines

The HSE guidelines, which were supposed to be published in 2011, were finally launched in late 2016 without approval from the National Clinical Effectiveness Committee (NCEC).

Dublin GPSSA Dr Garrett McGovern told the Medical Independent (MI) the HSE guidelines were not an acceptable standard for patients.

Dr McGovern said there was lack of input into the development of the guidelines from all relevant stakeholders, lack of sufficient peer review and no submission of the guidelines to the NCEC, which he said is a “requirement for guidelines which aspire to be national guidelines”.

The NCEC confirmed there is a requirement for its national clinical guidelines to have been reviewed by two expert reviewers.

However, the HSE guidelines were reviewed by one expert reviewer only.

Dr McGovern called on the HSE to submit the guidelines for review to the NCEC. He said he would continue to use the UK clinical guidelines on drug misuse and dependence, known as the ‘Orange Book’, until such time as the guidelines had been endorsed by the NCEC.

Dublin GPSSA Dr Cathal Ó Súilliobháin is also refusing to use the HSE guidelines.

However, Dublin GPSSA Dr Pat Troy told MI he had “absolutely no problem” with using the HSE guidelines and added that they were “well thought-out”.

A HSE spokesperson explained that NCEC evaluation criteria changed after work began on the guidelines and that the time frame for completion could not be estimated.

“As there was an imperative to have Irish guidelines developed, work continued and produced the current guidelines for use until such time as the NCEC guidelines can be developed. Relevant international guidelines, including the UK clinical guidelines (‘Orange Book’) were considered and adapted for the Irish system.”

A Department of Health spokesperson said NCEC criteria were updated in 2015 and that each evaluation process takes around six weeks to conduct.

“However, the guideline development process required to meet the NCEC criteria can take up to two years and depends on the topic under consideration.

“The NCEC has not received a Notice of Intent or a submission of a guideline related to substance misuse for consideration for endorsement as a national clinical guideline.”

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