Introduction

• Author: European Monitoring Centre for Drugs and Drug Addiction (EU body or agency)
• Pages: 6-9

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

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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.