Opioid Agonist Diversion in Opioid-Dependence Treatment
Diversion is defined in this publication as unauthorized rerouting or use of a substance, and abuse is defined as any use of a prescription drug that deviates from medical practice. This refers to the manner in which medication is used such as snorting, injecting, taking excessive quantities, or combining it with other substances for intoxicative purposes.
Diversion and abuse of pharmacotherapy used in opioid-dependence treatment can have a serious negative impact on public health at the individual and societal level. Diversion can lower the credits of treatment services through increased morbidity and mortality and economic burden through lost productivity and unemployment. Diversion is a global problem, but most studies and concerns arise from the USA, Australia, and Northern Europe. While existing evidence confirms the occurrence of this issue, standardized indicators are missing and the phenomenon is not uniformly appreciated by prescribers and policy makers.
Most publications of diversion and abuse report the mortality rates associated with the diversion and abuse of methadone and prescription opioid analgesics. The reports of fewer buprenorphine-related deaths compared with deaths associated with methadone can be attributed to buprenorphine’s pharmacology and ceiling effect on respiratory depression. However, deaths due to asphyxia as well as following acute poisoning with severe respiratory depression have recently been attributed to buprenorphine in opioid abusers. The abuse prevalence and injection of buprenorphine tablets are reported in worldwide publications addressing the harms associated with it. Several studies indicate that inability to enter opioid maintenance or substitution treatment could be a significant contributor to diversion. In addition, studies are challenging the often-held view that regulation and restricted access are necessary to ensure the safety of individuals using opioid agonists’ medications.
To lower the diversion and develop strategies to avoid abuse, it is important therefore to examine and understand the reasons of it. One of the most important strategies to avoid diversion is good quality of the treatment and treatment outcomes. Some pharmacotherapies may have lover diversion potentiality, but the key factor is patient confidentiality and good quality of treatment.
KeywordsInfective Endocarditis Opioid Dependence Fatal Overdose Agonist Opioid Treatment Overdose Mortality
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