The World Health Organization has officially retracted its controversial guidelines on the use of opioid analgesics.
The agency’s move applies to two statements, issued in 2011 and 2012. Last June, WHO announced that it was “discontinuing” the guidelines in the wake of a critical report which said the documents were heavily tainted by commercial bias. According to a BMJ story published at the time:
The bipartisan report [by two members of Congress] accused the opioid manufacturer Purdue Pharma of working, through its international arm Mundipharma, to expand the indications for chronic opioid use and minimise concerns about risks of addiction.
Mundipharma paid physician opinion leaders and sponsored “astroturf” patients’ groups (set up by industry bodies) to demand easier access to opioids for pain treatment, the report alleged. Purdue Pharma faces extensive legal action in the US, where it has often been accused of leading a campaign to normalise opioid use.
Among the more controversial statements in the initial guideline was this line downplaying the potential risks of opioids:
It should be recognized that controlled medicines when used rationally for medical purposes are safe medicines. Opioid analgesics, if prescribed in accordance with established dosage regimens, are known to be safe and there is no need to fear accidental death or dependence.
In 2017, according to the U.S. Centers for Disease Control and Prevention, roughly 50,000 people in this country alone died from opioid abuse.
The WHO’s guidelines followed a declaration by the agency in 2010 that access to pain relief was a “human right”:
Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses.
The WHO’s retraction notice, published in the January 2020 issue of The Bulletin of the World Health Organization, reiterates its June 2019 statement, which begins:
WHO is discontinuing these guidelines in light of new scientific evidence that has emerged since the time of their publication. This will also address any issues of conflicts of interest of the experts that have been raised.
WHO remains fully committed to ensuring that people suffering severe pain have access to effective pain relief medication, including opioids. WHO is concerned that there is very low access to medication for moderate and severe pain, particularly in low and middle-income countries.
The retraction was the right move, according to G. Caleb Alexander, of the Center for Drug Safety and Effectiveness at Johns Hopkins University in Baltimore (who has testified against opioid makers and distributors in lawsuits against the companies). Alexander told Retraction Watch:
The bottom line is that there are grossly inaccurate scientific claims in the documents. These statements, some of which significantly misconstrue the safety of opioids and downplay the risks of dependence, addiction and overdose, create exactly the type of narrative that has allowed the opioid epidemic to take hold. The WHO did the right thing in retracting these documents, and they now have an incredibly important opportunity to set the record straight by ensuring that future guidelines are evidence-based and not corrupted by the commercial interests of opioid manufacturers or third party organizations who they support.
Like Retraction Watch? You can make a tax-deductible contribution to support our work, follow us on Twitter, like us on Facebook, add us to your RSS reader, or subscribe to our daily digest. If you find a retraction that’s not in our database, you can let us know here. For comments or feedback, email us at [email protected].
If only the leaders of companies that do despicable things would be punished for those actions, we would all be better off.
As a hospice and palliative care nurse I have mixed emotions. I see an awful lot of untreated pain, and have seen an immense amount of pain being inappropriately treated with narcotics by providers who lacked education in the assessment and treatment of nerve pain and bone pain. I and my patients have been “lucky” because they were dying and nobody was afraid to prescribe appropriate medications to them. Chronic pain patients find themselves in a vicious cycle of undertreated pain due to lack of the aforementioned education, leading to behaviors that get flagged as drug seeking – which is wrong, they are seeking relief. Being sidelined off to psychological therapy and disproven alternative treatments like accupuncture just reinforces the message that they are not believed. Which adds anxiety and depression to the mix, and you create an “overutilizer” of services. Which I have seen again and again. The answer is going to be a commitment once again to addressing pain rather than just asking for a number and ignoring the answer. And education of both providers (with emphasis on Emergency Room providers) and patients on pain pathways and the most effective ways to manage pain both with and without narcotics. Medications are tools, just like scalpels and stethoscopes. Narcotics are not evil, they can be literally lifesaving. And having folks dying from illegally sourced narcotics or simply killing themselves because their pain is not recognized or addressed are not good answers to a problem with prescribing. Radical idea – perhaps drug reps should not be the ones educating providers on new medications.
Thank you, ma’am. I am disabled retired veteran who was prescribed narcotics 14 years ago for chronic pain for spine injuries received in the service. I may be in a minority, but it works well for me. I have a very active lifestyle which had all but gone away until a pain management doctor recommended narcotics. The problem now is that while my treatments and condition have not changed, it is harder and harder to get prescriptions and as you point out, if a patient goes to more than one doctor looking for one who is willing to write scripts for narcotics, they are now drug seeking.
I actually place blame on the dentists and doctors that give out several weeks worth of narcotics for acute pain that would be better served with NSAIDs