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Good practices

Guidelines canceled after opioid crisis

The World Health Organization (WHO) has announced the retraction of two guidelines on the use of opioids—synthetic drugs that have a similar effect to opium derivatives—for pain control. The guidelines, released in 2011 and 2012, were criticized for underestimating the risks of dependency and death by overdose or suicide among users of the drugs, therefore promoting what became known as the “opioid crisis.” In 2017 alone, opioid abuse killed 70,000 people in the USA, directly contributing to a drop in the country’s life expectancy to 78.6 years—from 78.7 years in 2016.

The official retraction announcement was made in January’s Bulletin of the World Health Organization, although health services had already stopped following the recommendations in mid-2019 after a report by US Congress accused Purdue Pharma, owner of Mundipharma, of minimizing the risks of the drugs and influencing the drafting of the WHO guidelines. Mundipharma is one of the manufacturers of oxycodone, an opioid developed in the early 2000s that became a popular pain-relief medication. The company, according to the document, paid doctors to publicly defend the use of opioids and sponsored patients groups who pressured health officials into providing easy access to painkillers.

In 2010, the WHO classified access to pain medications as a “human right” and the guidelines it released in the following years categorized opioids as “safe medications,” which if used in the proper dosage, pose no risk of dependency or accidental death. In practice, the mild tone of the guidelines led to loopholes that allowed pharmaceutical companies to aggressively market opioids and doctors to prescribe them to patients who may benefit from other drugs.

In April last year, the US Center for Disease Control (CDC) launched its own guidelines on the use of opioids, recommending that physicians prescribe these painkillers sparingly, assessing individual risks and benefits, and opting for other drugs whenever possible. It also suggested that they closely monitor patients taking high dosages to decrease the risk of overdose.

For epidemiologist Caleb Alexander of Johns Hopkins University, the WHO did the right thing by retracting the guidelines. “They now have an incredibly important opportunity to set the record straight by ensuring that future guidelines are evidence-based and not corrupted by commercial interests,” he told Retraction Watch. Last August, Purdue Pharma offered to pay somewhere between US$10 billion and US$12 billion to settle more than 2,000 lawsuits filed against the company in the US related to the opioid crisis.