For the first time, the European Court of Human Rights in Strasbourg has addressed the issue of whether persons with a heroin dependence syndrome in custodial settings are entitled to receive opioid agonist treatment (OAT). The court relied on Article 3 of the European Convention on Human Rights, which prohibits torture as well as inhuman or degrading treatment. It concluded that member states of the Council of Europe that refuse access to OAT have the burden of proving that an alternative medical approach would, in the case of an individual patient, be as effective as OAT. Such proof needs to be based on an independent medical opinion. This paper discusses the scope and limitations of the European Court of Human Rights’ judgment.