Scaling up opioid dependence treatment in low- and middle-income settings

Abstract

Opioids (i.e. opium, heroin and prescription pain relievers) rank third in the world among drug classes in terms of the number of users. Opioid dependence has a worldwide prevalence that ranges from 0.6 to 0.8% and opioid consumption and the demand for treatment for dependence are highest in Europe and Asia.1 Opioid users are at particularly high risk of death from overdose. Those who inject opioids also face the risk of infection with the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) as a result of unsafe injecting behaviour.2,3 In this issue, Mathers et al. present the results of a meta-analysis of mortality rates among 67 cohorts of people who injected illicit drugs, including 14 from low- and middle-income countries. Their results clearly show higher rates of death in low- and middle-income country cohorts and in HIV-positive people who use opioids, as well as during off-treatment periods.4 There is good evidence that opioid agonist maintenance treatment can greatly reduce harm by preventing HIV and HCV infection5 and reducing the risk of death from these infections and drug overdose.6 Thus, strategies for scaling up opioid agonist maintenance treatment in low- and middle-income countries should be prioritized.