Reimer Jens, Wright Nat, Somaini Lorenzo, Roncero Carlos, Maremmani Icro, McKeganey Neil, Littlewood Richard, Krajci Peter, Alho Hannu, D'Agnone Oscar
Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Eur Addict Res. 2016;22(2):99-106. doi: 10.1159/000438988. Epub 2015 Oct 2.
BACKGROUND/AIMS: Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion.
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.
Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended 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.
While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.
背景/目的：阿片类药物替代疗法（OST）可改善阿片类药物依赖的治疗效果。然而，治疗中使用的管制药物可能会被滥用或挪用，从而导致负面的治疗结果。本综述定义了一个框架，以评估滥用和挪用的影响。
完成了对已发表的关于OST药物滥用和挪用研究的系统综述；该证据与专家的实际经验相结合，以更好地理解滥用和挪用对个人和社会的影响。
对个人的直接影响包括康复进展受阻以及对健康的负面影响（过量用药、与注射行为相关的健康风险）。OST的挪用对社区产生的影响超出了预期的OST接受者范围。直接影响包括对他人的风险（无监督使用；儿童意外接触被挪用的药物）以及与毒品相关的犯罪行为。间接影响包括未治疗的阿片类药物依赖、犯罪和生产力损失的经济成本。
虽然阿片类药物依赖的治疗至关重要且必须得到支持，但在确保提供最佳护理的同时减少滥用和挪用至关重要。了解OST滥用和挪用的影响是确定解决这些问题策略的关键。
