E-Mail karger@karger.com Review Eur Addict Res 2016;22:99–106 DOI: 10.1159/000438988 The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus Jens Reimer a Nat Wright b Lorenzo Somaini c Carlos Roncero d Icro Maremmani e Neil McKeganey f Richard Littlewood g Peter Krajci h Hannu Alho i Oscar D’Agnone j a Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; b Clinical Research Director, Spectrum CIC, Wakefield, UK; c Addiction Treatment Centre, Biella, Italy; d Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d’Hebron Hospital – Public Health Agency, Barcelona (ASPB), Universidad Autónoma de Barcelona, CIBERSAM, Barcelona, Spain; e Santa Chiara University Hospital, University of Pisa, Pisa, Italy; f Centre for Drug Misuse Research, Glasgow, UK; g Applied strategic, London, UK; h Division of Mental Health and Addiction, Department of Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway; i University of Helsinki, Helsinki, Finland; j Honorary Professor of the Faculty of Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK impact includes risk to others (unsupervised use; unintend- ed exposure of children to diverted medication) and drug- related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity. Conclusion: While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possi- ble care. Understanding the impact of OST misuse and diver- sion is key to defining strategies to address these issues. © 2015 S. Karger AG, Basel Introduction Opioid dependence is a problem that exacts a signifi- cant toll on public health and generates criminal, health and economic costs quantifiable in the billions. The Unit- ed Nations Office on Drugs and Crime estimates that there are between 16 and 39 million problem drug users worldwide [1]. Key Words Misuse · Diversion · Buprenorphine · Methadone · Opioid substitution treatment Abstract Background/Aims: Opioid substitution treatment (OST) im- proves outcomes in opioid dependence. However, con- trolled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review de- fines a framework to assess the impact of misuse and diver- sion. Methods: A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society. Results: Direct impact to the indi- vidual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with in- jecting behaviour). Diversion of OST has impacts on a com- munity that is beyond the intended OST recipient. The direct Published online: October 2, 2015 E u r o pea n Addi cti o n c R e e s ar h Professor Hannu Alho Addiction Medicine Unit, University of Helsinki Stockholm Street 8B, PO Box 20, Biomedicum Helsinki FI–00014 Helsinki (Finland) E-Mail hannu.alho  @  thl.fi © 2015 S. Karger AG, Basel 1022–6877/15/0222–0099$39.50/0 www.karger.com/ear