Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention (a UN/UNODC/UNAIDS position paper)


Produced by: World Health Organization (WHO) (2004)
This position paper, produced by the WHO, UNODC, and UNAIDS, is based on a review of scientific evidence of the effects of substitution maintenance therapy (SMT) for the management of opioid dependence and HIV/AIDS prevention. Aimed at policy makers, the paper begins with a joint statement on SMT and establishes the epidemiology, nature
and possible treatments of opioid dependence. It then examines a range of issues concerning SMT, including the rationale for this treatment, its impact and cost-effectiveness, and specific considerations regarding its provision for people with HIV/AIDS.

The paper finds that SMT is effective, safe and cost-effective. Evidence is highlighted which shows that improved outcomes form opioid SMT arise from timely entry into treatment, longer duration and continuity of treatment, and adequate doses of medication. The authors argue that society as a whole benefits from SMT through reductions in criminal behaviour, health costs and reduced transmission of HIV. The paper concludes that the provision of SMT for opioid dependence is an effective HIV/AIDS prevention strategy that should be implemented for injecting drug users (IDU) as soon as possible. However, it should be guided by research evidence, and supported by adequate training and evaluation. [adapted from author] Available online at: