The WHO has conceded that pharmaceutical makers may have influenced the original drafting of guidlines on opioid use for pain management
The WHO has retracted two of its guidelines after accusations that their development was unduly influenced by opioid manufacturers was found to be true.
The retracted guidelines include Ensuring Balance in National Policies on Controlled Substances (2011) and WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses (2012).
US congressional papers in 2019 tied scientists involved in drafting the guidelines to Mundipharma, the international subsidiary of Purdue Pharma, which develops, licenses, and markets opioids.
In response to the allegations of conflicts of interest, Dr Tedros Adhanom Ghebreyesus (PhD), the WHO director-general, ordered an internal review into the guidelines.
In a recent statement confirming the retraction, the WHO said it took concerns about pharmaceutical influence in the guidance documents very seriously. And, while the WHO said the decision was made in light of new scientific evidence, the retraction would also address any concerns about conflicts of interest.
“Recent research in the fields of palliative care and pain management has identified many strategies for managing pain, beyond drug treatment alone. Evaluating this new evidence and establishing best strategies for alleviating pain—both acute and chronic—is an important area of work for WHO,” it said.
The retracted guidelines used the term “opiophobia,” a term often used in the marketing campaigns of pharmaceutical companies in the late 1990s to describe doctors’ hesitancy to prescribe opioids.
The guidelines also cited that less than 1% of patients became addicted to opioids, a figure not supported by clinical evidence.
But despite admitting the guidelines were invalid, the WHO also said it remained fully committed to ensuring that people suffering severe pain had 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,” WHO said.
This need for equitable access now must be balanced with concerns from experts about the harm arising from the misuse of medications prescribed for pain management.
The WHO has already begun the process of reviewing and updating its remaining guidelines on pain management and plans to produce guidance for managing pain in different age groups.
More information about the guideline revision process can be found here.
