Approach The rapid spread of human immunodeficiency virus (HIV) infection among people using heroin led to a shift from a drug-free
approach to the treatment of opioid dependence to one focused on harm reduction. A substantial change in legislation made it possible
to meet public health needs and offer OAMT as part of harm reduction programmes in the public health system, including prisons.
Local setting Legislative changes were made throughout the country, although at a different pace in different regions.
Relevant changes Legal changes facilitated the expansion of OAMT, which has achieved a coverage of 60%. A parallel reduction in the
annual incidence of HIV infection has been reported. Reductions in morbidity and mortality and improved health-related quality of life
have been described in patients undergoing OAMT.
Lessons learnt The treatment of opioid dependence has been more heavily influenced by moral concepts and prejudices that hinder
legislation and interfere with the implementation of OAMT than by scientific evidence. To fulfil public health needs, OAMT should be
integrated in harm reduction programmes offered primarily in public facilities, including prisons. Longitudinal studies are needed to detect
unmet needs and evaluate programme impact and suitability.