Opioid management practices for the prevention of drug diversion and misuse: a review of the clinical evidence and guidelines.

Opioids are indicated as part of a comprehensive plan for the management of chronic pain in carefully selected and monitored patients. A marked increase in the misuse, abuse, and diversion of prescription opioids, however, has become a societal and public health concern and has led to increased healthcare costs and alterations in treatment plans. Non-medical use of prescription opioids is a public health concern because it has been linked to serious personal health consequences, including addiction, fatal opioid overdose, injection drug use and poly drug use. Opioid diversion signifies any instance where drugs are re-routed from their lawful purpose at any point in the pharmaceutical manufacturing and distribution process.3 For example, opioids can be diverted in the preclinical stages through theft at plants, in transit or at pharmacies. Opioids can also be diverted during the post-clinical phase by sharing, selling and misusing of prescribed medications or by stealing medications. Opioid misuse can be defined as the use of opioids for a medical purpose, other than as directed or indicated, whether or not intentional and regardless of harm. Substance abuse can be defined as the use of any substance when such use is unlawful, or when such use is detrimental to the user or others. The distinctions between these terms are often blurred and within the literature there has been no consensus around the definitions of opioid diversion, opioid misuse and substance abuse. The purpose of this report is to review the clinical evidence regarding opioid management practices to reduce drug diversion and misuse; examine the evidence-based guidelines for opioid management practices to reduce opioid diversion and misuse; and examine the clinical evidence regarding opioid use or prescription patterns for the prediction of substance abuse