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
1. Introduction
Opioid use and its consequences represent a serious global public health concern and, in
recent years, a number of new policy and public health concerns have emerged, including high
levels of drug-related deaths. Opioid substitution treatment (OST) represents the main approach
to the treatment of opioid dependence and is part of a wider range of treatment options
available to heroin users.
It is estimated that nearly half of the 1.3 million problem opioid users in the European Union are
receiving this treatment, a considerably higher rate than in most other world regions (EMCDDA,
2019a). The wide use of this treatment is supported by scientific evidence accumulated over
recent decades regarding the benefits of OST in treating opioid dependence and in ameliorating
its associated health and social consequences.
In spite of these clear benefits, recent years have seen increasing debate about the worrying
levels of diversion and misuse of OST medications in Europe (EMCDDA, 2019a), which appear
to be playing an increasing role in the European drug problem. In 2017, 19 European countries
reported that more than 10 % of all opioid clients entering specialised services presented for
problems primarily related to opioids other than heroin, most commonly problems associated
with the misuse of methadone or buprenorphine (EMCDDA, 2019a). A rise in overdose deaths
associated with methadone and buprenorphine, although not necessarily diverted, has also
been observed in recent years in Europe (EMCDDA, 2019a). These deaths currently represent
a substantial proportion of overdose deaths in some European countries.
In addition to increases in mortality rates, the consequences of the misuse of OST medications
may include poor adherence to treatment, negative-impact treatment outcomes, somatic
complications associated with injection of the medication and a risk of contracting blood-borne
viruses. Diversion of OST medicines has also been associated with increases in crime, has had
a negative impact on prescribers practice, has threatened the reputation of treatment services
and has compromised public acceptance of the long-term treatment of opioid-dependent
individuals (Alho et al., 2015; Wright et al., 2016; Reimer et al., 2016). The consequences of the
diversion and misuse of prescription OST medications in Europe are a continuing public health
concern and require heightened vigilance, particularly in light of the recent opioid epidemics in
the United States.
In this context, 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. Therefore, it is important that the
principle of balance (Box 1) is applied.

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT