SAMRC contributes to WHO guidelines on the treatment of opioid dependence and the community management of opioid overdose
The World Health Organization (WHO) has announced updated recommendations for its forthcoming guidelines on the treatment of opioid dependence and the community management of opioid overdose, responding to the substantial global burden of opioid-related morbidity and mortality.
The South African Medical Research Council, through its Mental health, Alcohol, Substance use and Tobacco Research Unit (MASTRU), played a key role in the development of these guidelines as the guidelines methodologist responsible for ensuring the scientific rigour of the methods used to formulate these new guidelines.
Opioids are a group of substances which affect the brain by blocking pain signals, creating feelings of wellbeing and slowing down brain activity. Opioids occur naturally and are derived from the poppy plant, but they can also be manufactured in laboratories. When properly prescribed by medical doctors, opioids can be effectively used to manage pain. However, inappropriate or prolonged use of opioids can lead to dependence with many health complications. Overdoses can also lead to death.
Approximately 61 million people worldwide engage in non‑medical opioid use and opioids account for roughly 450 000 of the 600 000 annual drug‑related deaths.
Opioid use in South Africa has increased over the past decade, driven primarily by illicit heroin use, locally known as nyaope or whoonga, particularly in urban and socio‑economically marginalised communities.
Improving access to effective treatments for opioid use and overdoses is a public health priority.
Treatment surveillance data from SACENDU suggest that South Africa may be experiencing a moderate downward trend in opioid-related admissions to treatment centres over the past 18 months.
According to the 2024 and 2025 United Nations Office on Drugs and Crime World Drug Report , there has been a significant decline in global opium production, driven mainly by the 2022 opium cultivation ban in Afghanistan which was historically the world’s leading producer of opium. Nonetheless opioid use remains an important public health concern.
The updated WHO treatment recommendations were developed through a rigorous WHO guideline process that considered benefits and harms, values and preferences, cost‑effectiveness, equity, acceptability and feasibility, informed by comprehensive quantitative and qualitative systematic reviews.
In the updated guidelines, the WHO reaffirms strong recommendations for opioid agonist maintenance treatment using methadone and oral buprenorphine and now conditionally recommends new long‑acting injectable buprenorphine formulations.
Associate Professor Nandi Siegfried, a Chief Specialist Scientist at MASTRU who worked on this project said the guidelines represent a major step forward in expanding treatment for people who are dependent on opioids.
“I am privileged to have assisted the WHO with this rigorous process and thank the experts involved who paid such close attention to ensuring these recommendations are based on the best available evidence,” she said.
The full guidelines, including detailed rationale, evidence profiles, implementation considerations and identified research gaps, are under peer review and are expected to be published later this year or in early 2027.
For more information, please contact:
Yolanda Phakela
Public Relations Manager
Yolanda.phakela@mrc.ac.za