Startling news: Opioid agonist maintenance treatment (OAMT) is being reaffirmed as an essential health service, with fresh WHO guidance aimed at preventing service disruptions for those receiving opioid-dependence care.
The World Health Organization (WHO) has released new implementation guidance titled Mitigating disruption of services for treatment of opioid dependence, which outlines how to keep OAMT available even during crises or interruptions (see https://www.who.int/publications/i/item/B09543).
Global scope: In 2022, an estimated 60 million people worldwide used opioids for non-medical purposes, including heroin, morphine, codeine, fentanyl, methadone, and tramadol. WHO’s most recent data show opioids contribute to a large share of drug-related deaths, with about 450,000 of the roughly 600,000 global deaths linked to drug use. Infectious diseases such as HIV and viral hepatitis, along with opioid overdoses, are among the leading causes of mortality in this context.
What OAMT achieves: Treating opioid dependence with agonist maintenance medicines is a cost-effective strategy. It lowers mortality and illness, reduces non-medical opioid use, and cuts the transmission of HIV and hepatitis C virus (HCV). The approach also decreases risky behaviors, crime, and broader social costs while improving retention in treatment and overall quality of life for participants.
Access and integration: OAMT should be widely available, ideally free or covered by public health insurance, supported by solid governance. The goal is to integrate opioid dependence treatment into health systems fully, under a governance framework that ensures clear clinical accountability and maintains minimum quality standards across providers.
Planning for disruptions: When interruptions to OAMT are likely, proactive contingency plans are essential. Recommendations include engaging communities to discuss mitigation steps, expanding community-based naloxone distribution to curb overdoses, reinforcing take-home dosing options during staffing shortfalls, increasing psychosocial support, and coordinating across multiple stakeholders.
Safety in short supply: Sudden reductions in OAMT dosing can be life-threatening. If withdrawal cannot be avoided, patients should receive appropriate medical care following established pharmacological withdrawal protocols.
Call to action: WHO invites countries, health planners, service providers, policymakers, and all participants in treatment and overdose-prevention programs to prioritize uninterrupted delivery of life-saving OAMT.
Event notice: A global webinar featuring WHO, the International Network on Health and Hepatitis in Substance Users (INHSU), and Médecins du Monde (MdM) will discuss the new guidance on 17 December.
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