AuthorEuropean Monitoring Centre for Drugs and Drug Addiction (EU body or agency)
TECHNICAL REPORT | Balancing access to opioid substitution treatment with preventing diversion of medications
necessary and proportionate to ensure the effectiveness of the treatment and its security to third
parties, and that authorities should ensure that treatment is paid for and that healthcare
professionals are duly remunerated.
The implementation of effective anti-diversion strategies while maintaining adequate access to
effective treatment requires accurate evaluation of the individual and systemic determinants of
the phenomenon in each country. Importantly, some European countries still need to improve
access to OST to those in need in order to achieve adequate coverage levels. The development
of responses should include all stakeholders involved in the provision of OST and in the
prevention of diversion and misuse, as well as patients, with the ultimate goal of reducing the
harmful use of opioids, improving overall access to and the quality of OST, and reducing drug-
related deaths.
Accessibility: the degree to which a medicine is obtainable for those who need it at the
moment of need with the least possible regulatory, social or psychological barriers.
Affordability: the degree to which a medicine is obtainable for those who need it at the moment
of need at a cost that does not expose them to a risk of serious negative consequences, such
as not being able to satisfy other basic human needs.
Availability: the degree to which a medicine is present at distribution points in a defined area
for the population living in that area at the moment of need.
Benzodiazepine: a class of drugs that have a hypnotic and sedative action; they are prescribed
mainly as tranquillisers to control symptoms of anxiety, but are also used for recreational
Controlled medicines: medicines containing controlled substances, namely the substances
listed in the international drug control conventions.
Diacetylmorphine (the principal psychoactive constituent of heroin): a short-acting opiate
agonist. Illicit (street) heroin may be smoked or solubilised with a weak acid and injected.
Diversion: the act of redirecting a prescription medication (e.g. an OST medication) from
legitimate sources to illegitimate or illegal sources.
Doctor shopping: the practice of visiting multiple physicians to obtain multiple prescriptions.
Essential medicines: those medicines that are listed in the World Health Organization model
list of essential medicines. This list presents a list of minimum medicine needs for a basic
healthcare system, listing the most efficacious, safe and cost-effective medicines for priority
Misuse of medications (including OST medications): the use medications outside legitimate
therapeutic guidance.
Morphine: a naturally occurring alkaloid extracted from opium; it is a powerful narcotic
substance with a strong analgesic (painkilling) action and it has other significant effects on the
central nervous system.

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