The World Health Organization (WHO) announces the revision process for two recently discontinued documents, “Ensuring balance in national policies on controlled substances: Guidance for availability and accessibility of controlled medicines” (2011) and “WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses” (2012). https://www.who.int/who-revision-of-pain-management-guidelines
As an intergovernmental organization comprised of 194 Member States, WHO must consider and balance the differing needs of all countries for public health advice. WHO is deeply concerned about the opioid overdose crisis in the USA and about the risks and harms that can arise anywhere in the world from the misuse of medicines for pain management, including opioids. At the same time, WHO is well aware that in low- and middle-income countries, access to medicines for moderate and severe pain control remains very low. The Organization is fully committed to ensuring that children as well as adults with severe pain have access to effective pain control medication, including opioids when needed.
WHO has in place robust procedures concerning the quality of its norms and standards. Both of the discontinued guidelines referenced above will be updated according to these standard procedures, as detailed in the “WHO Handbook for Guideline Development” (2nd edition). (http://apps.who.int/medicinedocs/en/m/abstract/Js22083en/).
The process for revision of the documents will include the following elements, among others:
- A Call for Experts will be issued, by 31 August 2019, as part of identifying potential members of the guideline development groups.
- All potential external contributors to the guideline development will be required to submit the standard WHO conflict of interest declarations. Any declared conflicts of interest will be assessed and managed according to WHO’s standard requirements.
- Two guideline development groups will be convened, one for each document.
- Members of the guideline development groups will be selected based on expertise, and regional and gender balance, after review and assessment of the declarations of interest.
The proposed scope of each guideline will be published for public comment. It is expected that the scopes will include a review of the latest evidence on: (i) safety and efficacy of use of medicines for pain in children, (ii) dependence and misuse potential, and (iii) the public health benefits and risks of different strategies for ensuring appropriate access.
Once the comments have been received, hearings, which will include the opportunity for civil society organizations to make statements, will be held. After the scope of each guideline has been finalized, the process of evidence retrieval, synthesis and review will be completed according to the defined scope.
Once the evidence has been identified and synthesized, the guideline development groups will then meet to assess the evidence and propose recommendations based on such evidence. Thereafter, public comment will be solicited on the implementation of the draft guidelines. Before they are finalized and published, the draft guidelines must also undergo external peer review.
Final documents are expected to be published and disseminated within the next 9-12 months.
Countries in need of guidance on pain management can: (i) use the list of resources below for advice concerning access to appropriate medicines for pain and palliative care, and/or (ii) contact WHO to request ad hoc technical support at painmedicines@WHO.int