Substance use disorders
Also known as: addiction · alcohol use disorder · AUD · opioid use disorder · OUD · SUD
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The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder
American Society of Addiction Medicine (ASAM) · 2020 · 2020 Focused Update
ASAM's national guideline on treating opioid use disorder, covering all FDA-approved medications for opioid use disorder and opioid overdose in one document. The 2020 focused update was adopted by the ASAM Board in December 2019 and developed with an independent expert committee using a RAND/UCLA appropriateness process. Note that this guideline addresses opioid use disorder specifically; ASAM issues separate guidelines for alcohol withdrawal management and stimulant use disorder.
- Updates and replaces the 2015 ASAM National Practice Guideline, with major revisions to 35 recommendations and 13 new ones. source
- Developed using the RAND/UCLA Appropriateness Method with independent research support. source
- ASAM maintains separate current guidelines for alcohol withdrawal management and stimulant use disorder. source
Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence
WHO · 2009
The World Health Organization's guidance on treating opioid dependence with medication alongside psychological and social support. It covers which medicines to use, how treatment services should be organised and managed, and how individual care should be delivered. Recommendations were graded using GRADE on the basis of systematic reviews. WHO announced revised recommendations in 2025, with the full replacement document expected in 2026-27.
- Medication and psychosocial support are framed as two halves of one treatment, not alternatives to each other. source
- The pharmacological options assessed are methadone, buprenorphine, naltrexone and clonidine, with agonist maintenance favoured over detoxification alone. source
- The guidance addresses system-level questions — how treatment programmes should be organised and governed — as well as individual clinical care. source
- A 2025 WHO update reaffirmed maintenance treatment with methadone and oral buprenorphine and added a conditional recommendation covering long-acting injectable buprenorphine. source
US vs EU key differences
- Currency is the single biggest difference: the WHO guidance was issued in 2009 and has not been replaced, while the US ASAM National Practice Guideline was reworked as a 2020 focused update that majorly revised 35 existing recommendations and added 13 new ones - an eleven-year gap in evidence base. source
- The medication menus differ because of that gap: ASAM 2020 includes long-acting formulations such as monthly extended-release injectable buprenorphine and extended-release injectable naltrexone, whereas the 2009 WHO document is built around oral methadone liquid, sublingual buprenorphine tablets and oral naltrexone at 50 mg daily. source
- WHO supplies explicit prescribing numbers, citing an average effective methadone dose of 60-120 mg daily and buprenorphine maintenance of 8-24 mg daily up to a 32 mg maximum, plus stepwise induction and tapering schedules. The US guideline is organised around clinical decision-making within US federal regulation rather than a single universal dose table. source
- Psychosocial care is positioned differently: WHO frames the entire document as psychosocially assisted pharmacological treatment, while ASAM explicitly states that a patient declining psychosocial treatment, or its absence locally, must not preclude or delay medication for opioid use disorder. source
- Delivery-setting constraints are US-specific in the ASAM document, which works within rules confining methadone to opioid treatment programs while allowing office-based buprenorphine prescribing; the WHO guidance is written for varied national treatment systems rather than one regulatory regime. source
What changed recently
- US2015 → 2020 Focused Update2020-01-01
The 2020 focused update substantially revises 35 recommendations from the 2015 guideline and adds 13 new ones, reflecting newly approved buprenorphine formulations and a targeted evidence review. Among the additions is explicit guidance that all FDA-approved medications for opioid use disorder be available to people in criminal justice settings, with medication choice driven by the individual treatment plan.
source ↗curation confidence 90%
See the full update feed for changes across every system.