Abstract

• Author: European Monitoring Centre for Drugs and Drug Addiction (EU body or agency)
• Pages: 5-5

TECHNICAL REPORT | Balancing access to opioid substitution treatment with preventing diversion of medications

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Abstract

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.