The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus

[Diffusé le 29-11-2015]

Source : European Addiction Research 2015; 22 (2): 99-106

Reimer J.a Wright N.b Somaini L.c Roncero C.d Maremmani I.e McKeganey N.f Littlewood R.g Krajci P.h Alho H.i D'Agnone O.j

aCentre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany;
bClinical Research Director, Spectrum CIC, Wakefield, UK;
cAddiction Treatment Centre, Biella, Italy;
dAddiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron Hospital - Public Health Agency, Barcelona (ASPB), Universidad Autónoma de Barcelona, CIBERSAM, Barcelona, Spain;
eSanta Chiara University Hospital, University of Pisa, Pisa, Italy;
fCentre for Dug Misuse Research, Glasgow, UK;
gapplied strategic, London, UK;
hDivision of Mental Health and Addiction, Department of Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway;
iUniversity of Helsinki, Helsinki, Finland;
jHonorary Professor of the Faculty of Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK

Professor Hannu Alho
Addiction Medicine Unit, University of Helsinki
Stockholm Street 8B, PO Box 20, Biomedicum Helsinki
FI-00014 Helsinki (Finland)
E-Mail hannu.alho@thl.fi

Abstract

Background/Aims Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion.
Methods A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society.
Results Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended exposure of children to diverted medication) and drug-related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity.
Conclusion While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.

2015 S. Karger AG, Basel


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