Consensus building on access to controlled medicines: a four-stage Delphi consensus procedure.

Area of Science:

• Public Health Policy
• Pharmaceutical Access
• Harm Reduction Strategies

Background:

• The World Health Organization (WHO) published updated policy guidelines in 2011 for national controlled substances, revising the 2000 edition.
• These guidelines focus on ensuring the availability and accessibility of controlled medicines.

Purpose of the Study:

• To detail the consensus-building process employed in revising the WHO's controlled medicines policy guidelines.
• To describe the methodology used to achieve agreement among international experts.

Main Methods:

• A four-stage revision process involving 29 international experts in palliative care, public health, and harm reduction.
• Utilized a qualitative inventory, a two-round online Delphi consensus process, and a WHO advisory meeting to address controversies and finalize revisions.

Main Results:

• The revision process yielded a significantly improved draft of the guidelines with a broader scope and enhanced evidence base.
• Operationalization was strengthened through specified measures, procedures, and responsibilities.
• The Delphi process and advisory meeting facilitated consensus on wording and addressed remaining disagreements.

Conclusions:

• A substantial revision of the WHO guidelines was achieved through a rigorous four-stage multimethod consensus process.
• The updated guidelines incorporate advancements in knowledge regarding opioid medication since the initial publication.
• The process highlighted the inherent complexity in balancing medication accessibility with control measures.