Balancing access to opioid substitution treatment with preventing the diversion of opioid substitution medications in Europe

European Union Publications Office
Publication date:


Opioid use and its consequences represent a serious global public health concern, with high levels of opioid-related deaths. Compelling scientific evidence has been accumulated over recent decades regarding the benefits of opioid substitution treatment (OST) in treating opioid dependence and in ameliorating its associated health and social consequences. It is estimated that in 2018 nearly half of the 1.3 million high-risk opioid users in the European Union were receiving this treatment. However, recent years have seen increasing debate about the worrying levels of diversion and misuse of OST medications, which appear to be playing an increasing role in the European drug problem. For example, nearly 15 % of clients entering specialised drug treatment for an opioid problem in recent years in the European Union, Norway and Turkey sought treatment for problems associated with the misuse of an OST medication. Available European data indicate that diverted prescription OST medications originate principally from domestic supplies. In Europe, the primary sources for high-risk opioid users to acquire OST medications for non-medical use are friends and family (who generally obtain them through legitimate medical supply), drug dealers and their own legitimate medical prescriptions. Cross-border trafficking and the internet appear to play a lesser role in supply. The large majority of individuals misusing prescription OST medications in the European Union are long-term high-risk opioid users with a history of opioid dependence and past treatment experiences. Two out of three treatment entrants for primary methadone misuse reported having been in OST before. According to European studies, not being in OST remains, however, one of the most important factors in the misuse of prescription OST medications and, in this case, OST medications may be used primarily for self-medication purposes. Clearly, it is a challenge for, but also a responsibility of, the stakeholders involved in the provision of OST to ensure the availability and accessibility of this effective treatment while developing and implementing effective anti-diversion policies. To improve our understanding of the underlying factors associated with the increasing levels of misuse of OST medications in Europe, the current report analyses various dimensions of the history, availability, diversion and misuse of OST medications in European countries. The objective is to explore, at a systemic level, the relationship between these dimensions and to identify potential implications for policy and practice at national and European levels.

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