Opioid agonist maintenance treatment as an essential health service: Implementation guidance on mitigating disruption of services for treatment of opioid dependence

Key messages

1. WHO recommends opioid agonist maintenance treatment (OAMT) as the intervention to be offered to most patients with opioid dependence, in view of its proven safety and effectiveness in addressing broad range of health and social issues.

2. OAMT must be maintained without interruption, even during periods of instability. It is an essential health service that should be prioritized in the same way as other life-saving health services to protect those who rely on it.

3. OAMT should be an integral, embedded part of national health systems, ideally included within national strategies and not reliant on fluctuating funding or considered as an optional intervention.

4. When unplanned interruptions of OAMT are expected, contingency measures must be implemented early to minimize harm. These include community consultations on mitigation measures, scaling up community management of opioid overdose with naloxone, reinforcing take-home opioid agonist schemes in case of workforce shortages, increasing psychosocial support and ensuring multi-stakeholder coordination.

5. Unplanned reductions in OAMT dosage can be life-threatening. If opioid withdrawal is unavoidable, people must receive adequate medical support in following established protocols for pharmacologically assisted withdrawal management.