0944 GMT October 15, 2019
Representatives of the hospice and palliative care community said they were stunned by the Congress members’ report, which they said made false accusations and would affect people suffering in countries where almost no opioids were available, the Guardian reported.
“At least five billion people live in countries where there is limited or no availability of opioids for pain treatment,” according to the International Association for Hospice and Palliative Care (IAHCP). More than 18 million people a year worldwide die with “untreated, excruciating pain”, the organization said.
The report by the Democratic congresswoman Katherine Clark and the Republican congressman Hal Rogers, published in May, has undermined efforts to encourage governments to buy generic morphine or other appropriate opioids and doctors to prescribe them, dealing a severe blow to the struggle to help people dying in acute pain from cancer, Aids, injuries and other conditions, the IAHPC said.
The palliative care experts say low- and middle-income countries need cheap morphine, not patented opioid drugs such as OxyContin, at the center of the US opioids crisis.
According to the UN’s International Narcotics Control Board (INCB), only 10 percent of the world’s morphine is used for palliative care. Almost all of the remainder is converted into codeine and used in cough medicine for sale in wealthy nations.
“That makes it difficult for countries with fewer resources to procure any of the limited amount of morphine available for palliative care,” said a 2018 INCB report on access to controlled drugs for medical use.
There is anxiety in many countries about the potential for opioid addiction, which has been heightened by events in the US.
The Congress members accused WHO and the palliative care community of being influenced by funding from Purdue Pharma, the company accused of precipitating the disaster in the US. Two sets of WHO guidelines on the prescribing of opioids wrongly claim the drugs are safe, says the report, supporting Purdue’s claim that dependence occurs in less than one percent of patients and talking of the need to tackle “opiophobia”, which stops doctors prescribing the medications.
“The web of influence we uncovered, combined with the WHO’s recommendations, paints a picture of a public health organization that has been manipulated by the opioid industry,” says the Congress members’ report.
WHO and palliative care organizations have denied taking money or being influenced by Purdue Pharma’s global offshoot, Mundipharma. But the decision of WHO to withdraw the guidelines immediately after the criticism dismayed the palliative care community. The move will further discourage countries from trying to buy the drugs, they say.
Dr. Lukas Radbruch, the chair of the IAHPC, said the opioid crisis in the US had caused global alarm before the attack on WHO.
“Stakeholders are getting more reluctant to advocate for easy access to opioids,” he said, citing India as one of the countries that had slowed down. He said he had seen morphine locked in a small safe labeled “poisonous drugs cupboard” in one of the largest hospitals in the world, in Johannesburg. In sub-Saharan Africa, people still die in agony as a result of Aids.
“We were really shocked about the withdrawal of the guidelines from WHO in response to that report,” said Radbruch, a professor of palliative medicine at the University of Bonn. The two sets of guidelines, from 2011 and 2012 — Ensuring Balance in National Policies on Controlled Substances, and Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses — provided vital information and guidance to governments and doctors on what was safe and necessary for pain relief.
“This wasn’t influenced by any of the pharmaceutical companies,” said Radbruch, who was involved in drawing up the guidelines. The IAHPC, which was also attacked in the report, has published a detailed refutation of the allegations, saying claims it took pharma money are false. “The IAHPC has never served the interests of Purdue or any other pharmaceutical company to influence WHO or any other agency, government, institution or entity,” it says.
Professor Felicia Knaul of the University of Miami, chair of a recent Lancet commission on palliative care, said the Congress members’ report was not evidence-based. “Actions that are not based in evidence will do harm,” she said.
The stakes were high, she said. “I believe that policies that work to deny access to necessary pain relief medication in low- and middle-income countries because of the situation in the United States are akin to denying food to people suffering from malnutrition because there is an obesity epidemic in the United States.
“More than 60 million people every year require pain relief and palliative care and we know that more than 80 percent get virtually nothing. The vast majority of those individuals live in low- and middle-income countries. I consider it despicable from an ethical point of view and completely antithetical to the goals of global health and sustainable development to have children and adults living and dying in extreme pain when we have very inexpensive safe medications that we could offer them. Poor policies in the United States are not an excuse for allowing that to continue to happen.”