Bibliographic Info
GuidelineConsolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations
Year of Publication2022
Issuing InstitutionWHO
Recommendation
Status
Maintained
Recommended in favor
Strong
Certainty of evidence
Low
All people from key populations who are dependent on opioids should be offered opioid substitution therapy in keeping with WHO guidance, including those in prison and other closed settings
Notes and Remarks
- 1)To maximize the safety and effectiveness of OST programmes, policies and regulations should encourage flexible dosing structures, without restricting dose levels or duration of treatment (50). Usual methadone maintenance doses should be in the range of a minimum of 60–120 mg per day, and average buprenorphine maintenance doses should be at least 8 mg per day (50). Take-home doses can be offered when the dose and social situation are stable and when there is little risk of diversion for illegitimate purposes (50). OST is most effective as a maintenance treatment for longer periods of time (treatment for years may be necessary). Detoxification or opioid withdrawal (rather than maintenance treatment) results in poor outcomes in the long term. However, patients should be helped to withdraw from opioids if it is their informed choice to do so (50).
- 2)OST should be used for the treatment of opioid dependence in pregnancy rather than attempt opioid detoxification.
- 3)Psychosocial support should be available to all opioid-dependent people, in association with pharmacological treatments of opioid dependence. At a minimum this support should include assessment of psychosocial needs, supportive counselling and links to family and community services (50).
- 4)For opioid-dependent people with TB, viral hepatitis B or C or HIV, opioid agonists should be administered in conjunction with medical treatment. There is no need to wait for abstinence from opioids to start treatment for these conditions (50).
- 5)Treatment services should offer hepatitis B vaccination to all opioid-dependent patients (whether or not they are participating in OST programmes) (50).
- 6)Care settings that provide OST should initiate and maintain ART for eligible people living with HIV (4).
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations
Year2014
InstitutionWHO
Guideline
Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations
Year2016
InstitutionWHO