A Global Perspective on Treatment Service Provision for Opioid Use Disorders
Background: Opioid use disorder is a chronic relapsing disorder with an immense public health burden globally. Despite the global increase in misuse and overdose of opioids and their derivatives, there is a gap on our understanding of available treatment and harm reduction services worldwide.
Methods: A global survey was designed within the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN) with the involvement of 43 addiction medicine societies/organizations representing 40 countries worldwide (15 in Europe, 15 in Asia/Oceania, 6 in North/South America, 4 in Africa). The participating societies/organizations responded to the survey between December 2022 till May 2023 and provided an overview to their country’s current situation regarding opioids availability, treatment facilities, and harm reduction services.
Results: Over 88% of the countries reported the illicit prescription opioids followed by heroin (82%) as the most frequently misused opioids across their countries. Community level outpatient clinics are the most reported available treatment setting across the world (93%) while shelters are least common setting (25%) for providing treatment for opioid use disorder. Methadone (75%) and buprenorphine (70%) were reported as most available medications followed by morphine (11%) while 16% of countries reported of none of these medications available. 77% of the countries reported short term medically-managed inpatient withdrawal as the most available type of treatment program. Long-acting Naltrexone maintenance treatment (23%), cold turkey detoxification (20%), and rapid/ultra rapid opioid detoxification (16%) are reported as least available treatment options worldwide. 69% of the countries reported availability of treatment services in their custodial settings. Compared to HIV antiretroviral therapy (93%) and HIV testing (91%), naloxone distribution (36%), safe-injection/drug-consumption rooms (23%), and ingredient testing for safe consumption (14%) are least available opioid harm reduction services world wide. Less than 35% of the countries reported the nationwide availability of 12-step programs.
Conclusions:
This global report on opioid use disorder, treatment services, and harm reduction programs can inform international policies regarding treatment service provision on a global scale. Our results warrant further development of ecologically valid measures and guidelines to fill the gap in the available opioid use disorder treatments across the world especially in areas related to available facilities and harm reduction services
