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HEROIN ADDICTION AND
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Editor: Icro Maremmani, MD - Pisa, Italy, EU |
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Associate Editors: |
Thomas Clausen, MD - Oslo, Norway
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Statistical Editor: |
Mario Miccoli, PhD - Pisa, Italy, EU |
HARCP Archives
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Heroin Addiction and Related Clinical Problems: 2015, 17, 5 (pages: 43 - 50)
Misuse and Diversion of Opioid Agonist Opioid Treatment Medicines: Assessment of the Scale of the Problem and Review of the Changing Environment for Care in the Nordic Countries
Alho H., Jansen J., Krajci P., Littlewood R., Rúnarsdóttir V., and Nyberg F.
Summary: Background: Opioid addiction is effectively treated via a multidisciplinary approach including agonist opioid treatment (AOT) and psychosocial intervention. Misuse and diversion of AOT medicines such as methadone and mono-buprenorphine comprise a significant problem occurring in the Nordic countries with some of the highest frequencies in Europe. Misuse and diversion are associated with poor treatment compliance and increases in risk of blood-borne infections, crime, and mortality. Regulations and guidelines for provision of AOT medication vary among the Nordic countries. Aim: The extent and impact of misuse and diversion in the Nordic countries has not been documented in the literature. This review of local sources summarizes the extent and impact of misuse and diversion of AOT medication to provide a basis for improving outcomes in opioid addiction care. Methods: PubMed was searched using the terms “methadone” or “buprenorphine” and “misuse” or “diversion”. Titles and abstracts of search results were inspected for location and relevance. Government sources and mainstream media were also searched for relevant reports. Results: Misuse and diversion of AOT medicines is a significant issue in the Nordic countries; these opioids are available outside of treatment and are misused, including by young addicts. To address this problem, changes in medicines used in treatment in Finland and Iceland have already been implemented and considerations are under way in Norway and Sweden. Conclusions: All persons involved in AOT should take action to better understand AOT medication misuse and diversion as this can lead to a step change improvement in outcomes.
