Management of substance abuse

Treatment of opioid dependence

  • - Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence
    The Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence review the use of medicines such as methadone, buprenorphine, naltrexone and clonidine in combination with psychosocial support in the treatment of people dependent on heroin or other opioids. Based on systematic reviews of the literature and using the GRADE approach to determining evidence quality, the guidelines contain specific recommendations on the range of issues faced in organizing treatment systems, managing treatment programmes and in treating people dependent on opioids.

Opioid dependence is a complex health condition that often requires long-term treatment and care. The treatment of opioid dependence is important to reduce its health and social consequences and to improve the well-being and social functioning of people affected. The main objectives of treating and rehabilitating persons with opioid dependence are to reduce dependence on illicit drugs; to reduce the morbidity and mortality caused by the use of illicit opioids, or associated with their use, such as infectious diseases; to improve physical and psychological health; to reduce criminal behaviour; to facilitate reintegration into the workforce and education system and to improve social functioning. The ultimate achievement of a drug free state is the ideal and ultimate objective but this is unfortunately not feasible for all individuals with opioid dependence, especially in the short term.

As no single treatment is effective for all individuals with opioid dependence, diverse treatment options are needed, including psychosocial approaches and pharmacological treatment.

Relapse following detoxification alone is extremely common, and therefore detoxification rarely constitutes an adequate treatment of substance dependence on its own. However, it is a first step for many forms of longer-term abstinence-based treatment. Both detoxification with subsequent abstinence-oriented treatment and substitution maintenance treatment are essential components of an effective treatment system for people with opioid dependence. The following documents provide more details:

Development of Guidelines for psychosocially assisted pharmacological treatment of persons dependent on opioids

In response to the resolution of the UN Economic and Social Council 2004/40, inviting WHO "… to develop and publish minimum requirements and international guidelines on psychosocially assisted pharmacological treatment of persons dependent on opioids, taking into account regional initiatives in this field", the Management of Substance Abuse Team under the WHO Department of Mental Health and Substance Abuse, in collaboration with the UNODC Global Challenges Section, has started the process of developing Guidelines for psychosocially assisted pharmacological treatment of persons dependent on opioids. According to the recommended process for developing WHO practice guidelines, a Technical Guidelines Development Group (TDG) was established that consists of experts from different relevant areas of knowledge and expertise representing different WHO regions.


In 2005, methadone and buprenorphine were included in the WHO Model List of Essential Medicines, which has been updated every two years since 1977.