Contribution to the update of WHO guidelines on opioid dependence treatment and overdose prevention

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Louisa Degenhardt

Scientia Professor

Postdoctoral Fellow

Professor

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Research Fellow (PhD candidate)

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Project Overview

In 2022, approximately 60 million people globally engaged in non-medical opioid use, comprising 1.2% of the adult population. Notably, 38% of individuals in drug treatment identified opioids as their primary drug of use. Opioids are also the most lethal drug group, responsible for 450,000 out of 600,000 deaths attributed to drug use, predominantly by overdose.

It is crucial that people with opioid dependence and those at risk of opioid overdose have access to prevention, harm reduction, treatment, and care that is of good quality, affordable, ethical and evidence based. While some 64 million people globally are estimated to live with drug use disorders, access to treatment remains very limited, with less than 10% having access to it.

To address this issue, WHO has published guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (2009) and community management of opioid overdose (2014). These guidelines now need to be updated and expanded to summarize and synthesize the large body of recent evidence. The announcement of this update can be found here: https://www.who.int/news/item/09-02-2025-who-updates-guidelines-on-opioid-dependence-treatment-and-overdose-prevention

The NDARC systematic review team, led by Professor Louisa Degenhardt, will be conducting 10 systematic reviews, preparing evidence for discussions by WHO Guidelines Development Group. These reviews are:

Overdose management with the use of naloxone, including doses of naloxone and CPR response for high affinity opioids
Distribution channels for naloxone
Training on opioid overdose prevention
Supervised overdose prevention sites (or supervised safe injection rooms) for opioid overdose prevention
Digital health interventions in the management of opioid overdose
Pharmacotherapies for the treatment of opioid dependence
Psychosocial interventions for the treatment of opioid dependence
Methods of opioid dependence treatment delivery such as digitally assisted services, take-home dosages and integrated treatment
Transfer between different pharmacological agents and discontinuation of treatment for opioid dependence
Opioid withdrawal management with different approaches

The aim of this work is to improve availability and access to treatment of opioid dependence and reduce the number of deaths from opioid overdose by providing evidence-based recommendations on the psychosocially assisted pharmacological treatment and interventions on prevention and management of opioid overdose.

Design and Method

Systematic reviews focus on people with opioid dependence or who may be at risk of an opioid overdose and include studies that present original data. Population, intervention/s, comparator/s and critical outcome/s are defined in advance by the WHO guideline development group.

Published PROSPERO details for each review can be found here:

Systematic literature review on overdose management with the use of naloxone, including doses of naloxone and CPR response for high affinity opioids. PROSPERO 2025 CRD420251029172. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251029172.
Systematic literature review on distribution channels for naloxone. PROSPERO 2025 CRD420251039362. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251039362.
Systematic literature review on training on opioid overdose prevention. PROSPERO 2025 CRD420251038640. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038640.
Systematic literature review on supervised overdose prevention sites (or supervised safe injection rooms) for opioid overdose prevention. PROSPERO 2025 CRD420251043910. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043910.
Systematic literature review of the role of digital health interventions in the management of opioid overdose. PROSPERO 2025 CRD420251043994. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043994.
Systematic literature review on the comparative effectiveness and safety of different medications for the treatment of opioid dependence. PROSPERO 2025 CRD420251043921. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043921.
Systematic literature review of psychosocial interventions for the treatment of opioid dependence. PROSPERO 2025 CRD420251043943. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043943.
Systematic literature review on the methods of opioid dependence treatment delivery such as digitally assisted services, take-home dosages of opioid agonist maintenance treatment, and integrated treatment. PROSPERO 2025 CRD420251043931. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043931.
Systematic literature on the transfer between different pharmacological agents and discontinuation of treatment for opioid dependence. PROSPERO 2025 CRD420251043982. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043982.
Systematic literature on opioid withdrawal management with different approaches (tapered opioid agonists, a2-adrenergic agonists, psychosocial support). PROSPERO 2025 CRD420251043950. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251043950.