WHO Issues New Global Guidance to Safeguard Opioid Dependence Treatment Services

In 2022, an estimated 60 million people worldwide engaged in non-medical opioid use, involving substances such as heroin, morphine, fentanyl, tramadol, methadone, and codeine.

The World Health Organization (WHO) has launched comprehensive new guidance aimed at ensuring continuity of Opioid Agonist Maintenance Treatment (OAMT)—a life-saving service for people living with opioid dependence. The document, “Opioid agonist maintenance treatment as an essential health service: implementation guidance on mitigating disruption of services,” outlines evidence-based measures countries must adopt to prevent interruptions in treatment and reduce opioid-related harm.

A Global Crisis Requiring Urgent Action

In 2022, an estimated 60 million people worldwide engaged in non-medical opioid use, involving substances such as heroin, morphine, fentanyl, tramadol, methadone, and codeine. Opioids accounted for 450,000 of the 600,000 global deaths related to drug use, according to WHO estimates.

These deaths are often linked to:

• HIV and hepatitis C transmission

• Overdose events

• Untreated dependence

• Barriers to accessing evidence-based care

The escalating crisis highlights the need for uninterrupted, accessible treatment services that reduce mortality, prevent overdose, and support long-term recovery.

Why OAMT Is Essential

OAMT—using medications such as methadone or buprenorphine—is one of the most effective, cost-efficient interventions for opioid dependence. Research shows it:

• Significantly reduces death rates, including from overdose

• Lowers HIV and HCV transmission

• Decreases risky injecting behaviours

• Improves treatment retention

• Reduces crime, stigma, and social costs

• Enhances overall quality of life

WHO emphasizes that OAMT should be:

• Widely available and accessible

• Provided free of charge or fully covered by public health insurance

• Supported by strong clinical governance and accountability structures

• Integrated into national health-care systems, not treated as a parallel service

Preventing Harm During Service Disruptions

Unplanned interruptions to OAMT—whether due to conflict, natural disasters, supply shortages, workforce disruptions, or public health emergencies—can pose severe risks. Abrupt dose reductions or forced withdrawal can be life-threatening.

WHO outlines several critical mitigation strategies:

1. Community Consultation and Planning

Engage people using OAMT, service providers, and affected communities early to design safe contingency measures.

2. Scaling Up Overdose Prevention

Expand the distribution and community use of naloxone, a medicine that rapidly reverses opioid overdose.

3. Increased Flexibility in Service Delivery

Strengthen take-home dosing schemes, especially when in-person visits are disrupted or staffing is limited.

4. Ensuring Medical Support for Withdrawal

If withdrawal cannot be prevented, proper medical care must follow evidence-based withdrawal management protocols.

5. Multi-Stakeholder Coordination

Health authorities, civil society, harm reduction organisations, and international partners must collaborate to maintain service continuity.

A Call to Action

WHO urges governments, policy-makers, service planners, treatment providers, and public health systems to prioritize OAMT as an essential health service, ensuring it remains available even in the most challenging circumstances. Maintaining OAMT is not only a clinical necessity—it is a human rights imperative that protects lives, dignity, and community well-being.

Global Webinar for Stakeholders

WHO, the International Network on Health and Hepatitis in Substance Users (INHSU), and Médecins du Monde (MdM) will host a global webinar on 17 December to introduce the new guidance and discuss implementation strategies.

The event will bring together health professionals, policymakers, researchers, and harm reduction practitioners to share best practices on safeguarding OAMT services globally.