Policy and Practice of Opioid Agonist Treatment (OAT) in 23 Countries

Significant variations in opioid agonist treatment (OAT) practices and policy exist across different countries. We sought to understand these differences in the regulatory landscape, availability, and practices of OAT.

We distributed a survey designed according to the "Opioid Agonist Treatment Guiding Principles For Legislation And Regulations" developed by the Pompidou group and the Council of Europe to professionals working in mental health and addiction medicine for 2 international professional networks from January to June 2024. Twenty-six respondents from 23 countries representing all World Health Organization regions participated, all with over 10 years of experience in substance use disorder policy, service, and research. Data reliability was ensured by cross-referencing published literature and national-level policy documents. Each respondent had the chance to correct their country-level data 4 times.

We presented differences in international OAT coverage and regulations. Most respondents reported that methadone, buprenorphine, or a combination of buprenorphine/naloxone are registered as OAT in their countries, with 7 of the 23 countries having availability of long-acting depot buprenorphine. Six countries have telemedicine-based OAT dispensing. Take-home dosing occurs in 18 countries. Sixteen respondents reported full funding of OAT through public health or insurance schemes. Training in OAT for physicians is available in 13 countries, mainly from the global north. Eight of the 14 countries with a national essential medicines list include OAT.

Global disparities in OAT regulations persist, with limited coverage in low- and middle-income countries. Improving training, telemedicine access, and essential medicines inclusion can enhance global OAT accessibility and quality.