Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019
The World Medical Association expresses concern about the abrupt discontinuation of WHO 2011 guidance “Ensuring balance in national policies on controlled substances: Guidance for availability and accessibility of controlled medicines”, as well as its 2012 “WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses”.
This revocation, which took place last Summer without consulting the medical community, will deprive many physicians of support and regulation in countries without related national legislation, thus endangering their medically justified use of such substances. Ultimately, suffering patients will not have access to proper medication.
The WMA notes that the withdrawal was decided unilaterally, without providing any supporting evidence and without including any replacement or substitution. Moreover, the discontinued guidelines were fully removed from WHO online publications portal, thus impeding the ability of physicians to justify and validate retrospectively the use of controlled substances, exposing them potentially to criminal prosecution.
Without further information, the WMA considers it necessary to reinstate the mentioned guidelines until they are replaced by new or amended ones.
The WMA demands the adherence to the principle of evidence-based development of treatment guidelines. This should apply to the definition, amendment and discontinuation of such guidance in addition to the application of a precautionary principle. Evidence supporting the revocation of the opioid-guidelines must be published and made available for scientific scrutiny.
The WMA welcomes the efforts to assemble a new team of experts and strongly recommends an open and transparent process, including a reliable mechanism to ensure the disqualification of experts with conflicts of interest.