WMA Resolution on the Revocation of WHO Guidelines on Opioid Use

Adopted by the 70^th WMA General Assembly, Tbilisi, Georgia, October 2019 and
reaffirmed with minor revisions by the 227^th WMA Council, Helsinki, Finland, October 2024

1. The World Medical Association remains concerned 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.”
2. This revocation, which took place in June 2019 without consulting the medical community, will deprives 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.
3. 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 the 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.
4. 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.
5. The WMA demands that the announced revision process by WHO for the two discontinued guidelines be promptly completed in an open and transparent process, including a reliable mechanism to ensure the disqualification of experts with conflicts of interest.