Addressing misuse and diversion of opioid substitution medication: guidance based on systematic evidence review and real-world experience

J Public Health (Oxf). 2016 Sep;38(3):e368-e374. doi: 10.1093/pubmed/fdv150. Epub 2015 Oct 27.


Background: Opioid dependence treatment, comprising opioid substitution treatment (OST) and psychosocial intervention, is accepted to improve outcomes in opioid addiction for both the individual and public health. OST medication such as methadone or buprenorphine may be misused or diverted. This results in failure to recover from addiction, increased crime and the spread of blood-borne viruses. Worldwide, attempts to address misuse and diversion have been proposed and implemented with varying impact.

Methods: A structured, expert-led process recommended the most impact. As an initial step, a broad range of strategies were defined, and a systematic review of published literature identified 37 highly relevant sources of evidence. Experts reviewed this evidence and ranked the list of strategies for effectiveness and ease of implementation, based on their clinical experience.

Results/conclusions: Three groups of strategies to address misuse or diversion are defined, depending on impact (effectiveness and ease of implementation). Preferred strategies include the promotion of access to treatment and the use of product formulations less likely to be misused. However, additional data and innovative approaches to address this complex problem are needed.

Keywords: diversion; misuse; opioid addiction; opioid substitution treatment (OST); strategy; treatment outcomes.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Humans
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / prevention & control
  • Prescription Drug Diversion / prevention & control*
  • Prescription Drug Misuse / prevention & control*
  • Program Evaluation


  • Analgesics, Opioid