29 January 2026
“Opioid agonist maintenance treatment (OAMT) is not optional, not peripheral, and not a temporary intervention to be scaled back in times of crisis. It is a core lifesaving health service that must be protected and sustained during emergencies and during funding transitions.”
These were the opening words from Dr Tereza Kasaeva, Director of the Department for HIV, TB, Hepatitis and STIs at the World Health Organization, at a recent webinar launching WHO’s new guidance on maintaining OAMT during emergencies, including conflict, economic crisis, pandemics, and funding transitions.
The webinar was co-hosted by INHSU and Médecins du Monde and brought together speakers presenting modelling, epidemiological data, lived experience, and country case studies. Together, they examined why uninterrupted OAMT must be treated as an essential health service, what happens when continuity is disrupted, and how health systems respond when access to treatment is under threat.
The importance of OAMT cannot be overstated.It is not only a highly effective treatment for opioid dependence. It is also a very powerful tool for preventing HIV and viral hepatitis transmission, improving treatment adherence, and reducing avoidable morbidity and mortality.
Across the discussions, speakers rallied around a clear set of priorities:
- Treat OAMT as an essential health service in all contexts
- Integrate OAMT into national health systems and budgets
- Advocate for OAMT to be included on national essential medicines lists
- Protect medication supply chains and workforce capacity
- Develop emergency protocols before crises occur
- Expand flexible delivery models, including take-home dosing where appropriate
- Strengthen naloxone access and peer-led services
- Use WHO guidance to advocate for continuity during emergencies
Below, we summarise the key takeaways from each speaker.
Anja Busse, Team Lead, Drugs, Alcohol and Addictive Behaviours, World Health Organization
Anja set out the global evidence base for opioid agonist maintenance treatment and the rationale behind WHO’s new guidance.
- In 2023, an estimated 61 million people worldwide used opioids for non-medical purposes
- Opioids account for approximately 450,000 of the estimated 600,000 drug-related deaths annually, largely due to overdose and infections such as HIV and viral hepatitis
- Globally, less than 10 percent of people with drug use disorders have access to any form of treatment
- OAMT, such as methadone and buprenorphine, has strong evidence of effectiveness for opioid dependence
- Methadone and buprenorphine are included on the WHO Model List of Essential Medicines, recognising them as life-saving treatments
- OAMT should be offered to most people with opioid dependence and continued as long as clinically indicated
- Involuntary interruptions increase risks of withdrawal, relapse, overdose, HIV, and hepatitis
- Health systems must plan for resilience, including medication supply, workforce capacity, and early contingency measures to avoid involuntary service interruptions
Methadone and buprenorphine are life-saving medicines that are included on the WHO Model List of Essential Medicines. Opioid agonist maintenance treatment should be fully integrated into national health systems and not treated as optional.
Anton Basenko, Executive Director of the International Network of People Who Use Drugs (INPUD)
Anton presented findings from a rapid multi-language survey conducted by INPUD following the recent global funding crises and US funding withdrawal.
- The survey collected 101 responses from across 51 countries during the emergency period
- 65 percent of respondents were drug user-led organisations, often the first to see service disruption and the last to be consulted in funding decisions
- 63 percent reported severe financial impact due to US funding withdrawal
- Almost half lost between 26 and 100 percent of their total budget and 23 percent lost between three quarters to 100 percent of all their funding
- 25 percent reported reduced access to opioid agonist maintenance treatment
- 43 percent reported disruptions to needle and syringe programs (NSPs)
- Disruptions to naloxone distribution were associated with increased overdose risk
- Peer-led outreach services were the most disrupted, despite being foundational to linking people to OAMT and retaining them in care
- Services for women who use drugs were disproportionately affected, with 68 percent reduced or halted
- Funding-related disruptions intersect with other crises, including conflict, natural disasters, drug policy changes, procurement reforms, and donor transitions
This is not about abstract budget lines. It is about people forced off treatment, peer workers losing jobs, clinics reducing hours, and communities facing rising overdose risk. OAMT is not optional, not experimental, and not a luxury. It is essential medicine recognised by WHO and relied upon by millions of people worldwide. When OAMT is disrupted, people die.
Professor Peter Vickerman, University of Bristol
Peter presented modelling that puts numbers to a growing concern: what happens when funding cuts interrupt harm reduction services such as OAMT and needle and syringe programs. The modelling reflects the PEPFAR funding cuts alongside wider declines in international support.
- Across nine countries modelled (including South Africa, Ukraine, Kyrgyzstan and India) service disruption was projected to have resulted in approximately:
- 3,600 additional HIV infections
- 6,500 additional hepatitis C infections
- …in 2025 alone
- Overall increases in new infections were estimated at around 8 percent, rising to 17–19 percent in countries with disruption to both NSP and OAMT
- Most of the projected increase was driven by NSP disruption, since NSP services reach more people than OAMT
- OAMT coverage was only 3.3 percent (just over 46,000 people) limiting its population-level impact
- Of those, just over 40,000 were on PEPFAR-funded OAT, which is 87 percent of the overall provision in those nine countries
- Low impact reflects low coverage, not lack of effectiveness
- Scaling up OAMT would substantially strengthen HIV and hepatitis C prevention
We need to replace not only PEPAR funds but we also need to diversify funding to increase the coverage of OAMT which has always been historically low.
Tatyana Sleiman, Executive Director, Skoun Lebanese Addictions Center, Lebanon
Tatyana presented a case study of how OAMT was disrupted in Lebanon during a 2021–2022 economic and humanitarian crisis, and the emergency measures taken to prevent treatment collapse.
- OAMT was legalised in Lebanon in 2011 and managed centrally by the Ministry of Public Health.
- Lebanon had only buprenorphine (no methadone), procured through one accredited pharmaceutical agent
- At the time of the crisis, medication was dispensed through just three government hospital pharmacies
- Access required accredited psychiatrists, periodic urine testing, and mandated psychosocial follow-up
- A national medication shortage linked to currency devaluation, COVID-19, and the Beirut port explosion left only one to one-and-a-half months of stock remaining
- Around 1,000 people were enrolled nationally at the time
How services maintained access
- An ad hoc national coordination group was rapidly reactivated involving civil society organisations, government pharmacies, the Ministry of Health, and accredited psychiatrists
- Doses were reduced to 8 mg per day for all patients to preserve stock (as it was more dangerous for people to have no access at all, than a reduced dose)
- New enrolments were paused during the emergency period
- The Ministry approved use of buprenorphine expired by two to three months, following endorsement from the Lebanese Psychiatric Society and informed consent from service users
- Psychosocial and mental health support was intensified, alongside emergency naloxone distribution
- Cash and medication donations were secured to procure new stock and provide treatment free for a limited period
- The crisis exposed the lack of flexibility in Lebanon’s highly centralised OAMT system
Post the emergency, one of the key reflections was the need for flexible procurement processes. At the time, we were already in an emergency, and while many agencies were able to procure other medications, they could not help us procure buprenorphine because of the layers and layers of complexity involved in procuring a controlled substance. The cross-sectoral collaboration between public health, community groups, mental health agencies, and harm reduction actors was essential, and it was something we were able to build on later, including during the war in Lebanon, when there were further disruptions to access to OAMT.
Michel Kazatchkine, Global Commission on Drug Policy
Michel praised the much-needed WHO guidance within a broader global policy failure to deliver opioid agonist maintenance treatment at scale, despite overwhelming evidence of its effectiveness.
- A huge global treatment gap persists, with an estimated 50–60 million people living with opioid-related drug use disorders worldwide, and fewer than 10 percent accessing treatment
- That includes only one-in-five people in need accessing treatment in the US, and below 5 percent in many countries in Eastern Europe and Central Asia, where HIV and hepatitis C epidemics continue to be driven by unsafe injection practices
- OAMT must be understood as maintenance, meaning long-term treatment that supports health, stability, and social integration, not short-term or crisis-only care
- Methadone and buprenorphine are already on the WHO Model List of Essential Medicines, yet are still missing from many national essential medicines lists, creating barriers to access and affordability
- Highly centralised and monopolistic procurement systems inflate costs and restrict supply
- COVID-19 demonstrated that more flexible delivery models, including take-home doses and community involvement, are both feasible and effective
- Governments must integrate OAMT fully into national health systems and move away from punitive, enforcement-led drug policies
OAMT. Each of these four letters is important. The ‘M’ is for maintenance, and maintenance means maintaining treatment for as long as needed, and maintaining people in good health and fully integrated in society. The ‘T’ is for treatment, but OAMT is also part of an effective harm reduction intervention complex, protecting people against overdose, against HIV and hepatitis C, and against the harms associated with procuring illicit opioids every day.
Service continuity is not optional, says WHO
OAMT is one of the most evidence-based interventions to improve the health and wellbeing of people who use drugs. It reduces overdose, prevents HIV and hepatitis C transmission, and supports long-term engagement with health services. Yet in many countries, OAMT remains fragile, routinely disrupted during crises, funding cuts, and health system shocks.
Dévora Kestel, Director, Noncommunicable Diseases and Mental Health at the World Health Organization closed the session, saying:
Opioid agonist maintenance treatment is a proven, lifesaving intervention that reduces mortality and supports health and stability for people who use opioids. The WHO guidance provides clear, practical recommendations to maintain uninterrupted OAMT even during emergencies, whether conflict, crisis, or funding disruptions. Service continuity is not optional. It is essential to prevent overdose, protect health, and uphold human rights.
