Intended for healthcare professionals


WHO opioid guidelines are “marketing materials for Purdue,” say US members of Congress

BMJ 2019; 365 doi: (Published 28 May 2019) Cite this as: BMJ 2019;365:l2343
  1. Owen Dyer
  1. Montreal

Key guidelines from the World Health Organization on prescribing opioids for adults and children are tainted by drug industry influence and peddle dangerous and discredited myths that understate the dangers of addiction, a report by two representatives of the US Congress has found.

Katherine Clark, a Massachusetts Democrat, and Hal Rogers, a Kentucky Republican, collaborated to produce the report, which uses flow charts to allege that the marketing message of Purdue Pharma was transmitted through influential physicians and pressure groups, often handsomely reimbursed, to the committees that wrote WHO’s guidance.1

The report singles out two current WHO guidelines—one from 2011 suggesting national policy approaches to controlled substances and one from 2012 on persistent pain in children.2,3 Although by then the evidence and expert consensus was tilted against wider opioid use, the report said, WHO guidelines continued to advance discredited claims from a decade earlier, when an industry campaign to redefine pain treatment was in full swing.

WHO’s 2011 guidance echoes a common industry claim—that fewer than 1% of patients taking opioids for chronic pain become dependent—declaring that “a systematic review of research papers concludes that . . . only 0.05% developed dependence syndrome.”

The 2012 WHO paediatric guidance argues that there should be no predetermined limit to maximum opioid dosage, even in children. It eliminated a second line of treatment using weak opioids mixed with non-opioid pain drugs, recommending an earlier switch to strong opioids when other pain control fails. This precise step had been a key marketing goal of Purdue Pharma, the report claimed.

The 2012 guideline also used a word that was popular with the industry, opiophobia, to describe clinicians’ “unreasonable fears” over dependence and adverse effects. “In order to change attitudes, a major effort should be made to educate them on the rational use of opioid medicines,” the WHO guidance said.

The US report said that the “problem” that WHO seems to be tackling “is not how to limit the use of these highly addictive drugs, but rather to limit barriers to their use.”

Eight of the 21 organisations that WHO consulted over the guidelines had known financial relationships with the industry, the report said. These included the American Pain Society and the International Children’s Palliative Care Network.

Several well known opinion leaders were also sponsored directly by industry or through support groups, the report alleged, citing Willem Scholten, the chairperson of the WHO steering group on pain treatment guidelines. Then a WHO employee, he is now a US consultant who works to resist tighter limits on prescribing, the report claimed, adding that “at least as early as 2015” he received speaking fees from Purdue’s international arm, Mundipharma.

In a statement, Purdue said that the congressional report “seeks to vilify the company through baseless allegations.” Purdue’s relations with third parties are “transparent, and any potential conflicts of interest are fully disclosed,” the company said.

WHO spokesman Christian Lindmeier said that the agency had just received the report and was “reviewing it point by point.”

Introducing their report, the members of Congress wrote that they had decided to investigate WHO after the agency failed to answer a letter they sent in 2017 “warning that Purdue was attempting to expand their sales to international markets using the same fraudulent marketing tactics that instigated the opioid crisis in the United States.”

But WHO’s spokesman said, “Our records show that then director general Dr Margaret Chan replied to Congress’s original letter on 17 May 2017.”


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