Addressing misuse and diversion of opioid substitution medication: Guidance based on systematic evidence review and real-world experience

Nat Wright, Oscar D'Agnone, Peter Krajci, Richard Littlewood, Hannu Alho, Jens Reimer, Carlos Roncero, Lorenzo Somaini, Icro Maremmani

Research output: Contribution to journalArticleResearchpeer-review

14 Citations (Scopus)

Abstract

© 2015 The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Background Opioid dependence treatment, comprising opioid substitution treatment (OST) and psychosocial intervention, is accepted to improve outcomes in opioid addiction for both the individual and public health. OST medication such as methadone or buprenorphine may be misused or diverted. This results in failure to recover from addiction, increased crime and the spread of blood-borne viruses. Worldwide, attempts to address misuse and diversion have been proposed and implemented with varying impact. Methods A structured, expert-led process recommended the most impact. As an initial step, a broad range of strategies were defined, and a systematic review of published literature identified 37 highly relevant sources of evidence. Experts reviewed this evidence and ranked the list of strategies for effectiveness and ease of implementation, based on their clinical experience. Results/Conclusions Three groups of strategies to address misuse or diversion are defined, depending on impact (effectiveness and ease of implementation). Preferred strategies include the promotion of access to treatment and the use of product formulations less likely to be misused. However, additional data and innovative approaches to address this complex problem are needed.
Original languageEnglish
Pages (from-to)e368-e374
JournalJournal of Public Health (United Kingdom)
Volume38
Issue number3
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • diversion
  • misuse
  • opioid addiction
  • opioid substitution treatment (OST)
  • strategy
  • treatment outcomes

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