Recommendations to improve opioid use disorder outcomes in countries of the Middle East

Background: Progress has been made in treatment of opioid use disorder (OUD) in the Middle East; current clinical practice often differs from standards of care elsewhere. Aim: describe treatment approaches in selected countries to inform recommendations for improving care. Methods: Evidence describing approaches to OUD care was collected and analyzed in a structured, comparative manner. Recommendations were developed based on experts' clinical experience in the region. Results: Care differs across countries assessed: Egypt, KSA, UAE, Oman, Kuwait, and Bahrain. Detoxification programs are the common treatment approach in Egypt, KSA, Oman, and Bahrain; integrated programs with opioid agonist therapy (OAT): UAE, Kuwait. Fear of misuse and diversion risk commonly limits access to OAT. Problems with sourcing medicines may limit treatment options. There is limited data on treatment needs or provision. Recommendations: develop effective policy and expert-led consensus on best practice for OUD in the region including integrated treatment programs, provide support for specialists and centers, include innovative medication choices with low diversion risk, promote collaborative work, coordinate data collection, and sharing. Conclusions: There is important unmet need for OUD in the region and opportunity to improve services through collaboration to support change. Therapy options with reduced diversion risk may address barriers to care.