BACKGROUND AND AIMS: OAT is a well developed and successful treatment strategy for opioid dependant patients in Europe, which contributed significantly to the fight against the HIV and HCV pandemic and contributed to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany and Switzerland and their model of care, the objective of this study is to analyze experiences and changes in patient structures to identify necessary adaptations for the system of care. ***METHODS: We analysed national register‐based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents. ***RESULTS: Across these three countries, the life expectancy of opioid users increased significantly. The mean age of OAT patients increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases) and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020. ***CONCLUSIONS: An integrated model of supports, reliable structures and internationally a comparable high coverage for treatment and flexible prescribing practices as well as a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy.