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



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.



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.
University of Leeds, UK.
Nat
N
Wright
Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
Oscar
O
D'Agnone
Division of Mental Health and Addiction, Department of Substance Use Disorder Treatment, Oslo University Hospital, Nydalen, Norway.
Peter
P
Krajci
applied strategic, Colechurch House, 1 London Bridge Walk, London SE1 2SX, UK.
Richard
R
Littlewood
University of Helsinki, 0014 Helsinki, Finland.
Hannu
H
Alho
Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martini Strasse, Germany.
Jens
J
Reimer
Head, Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron Hospital - Public Health Agency, Barcelona (ASPB), Universidad Autónoma de Barcelona. CIBERSAM. Barcelona, Spain.
Carlos
C
Roncero
Addiction Treatment Centre, Cossato 13836, Biella, Italy.
Lorenzo
L
Somaini
University of Pisa, Via Bonnano, 56122 Pisa, Italy.
Icro
I
Maremmani
D000701:Analgesics, Opioid / Q000627:therapeutic use; D006801:Humans; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000517:prevention & control; D064226:Prescription Drug Diversion / Q000517:prevention & control*; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D015397:Program Evaluation
D000701:Analgesics, Opioid
diversion; misuse; opioid addiction; opioid substitution treatment (OST); strategy; treatment outcomes