{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:55:08Z","timestamp":1777402508988,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2010,7,12]],"date-time":"2010-07-12T00:00:00Z","timestamp":1278892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2010,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:bold>Aim\u2003<\/jats:bold> To provide a clinician's perspective on the problem of diversion of prescribed pharmaceuticals.<\/jats:p><jats:p><jats:bold>Methods\u2003<\/jats:bold> The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986\u20132006, Australia 1996\u20132008 and the United States and France from the mid\u20101990s.<\/jats:p><jats:p><jats:bold>Results\u2003<\/jats:bold> Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long\u2010term opioid prescribing. All long\u2010term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements\u2014including dilution of methadone take\u2010aways, supervision of administration for high\u2010risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines.<\/jats:p><jats:p><jats:bold>Conclusion\u2003<\/jats:bold> Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels.<\/jats:p>","DOI":"10.1111\/j.1360-0443.2010.03014.x","type":"journal-article","created":{"date-parts":[[2010,7,12]],"date-time":"2010-07-12T14:35:52Z","timestamp":1278945352000},"page":"1531-1537","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["The Global Diversion of Pharmaceutical Drugs"],"prefix":"10.1111","volume":"105","author":[{"given":"James","family":"Bell","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,8,5]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(03)00055-3"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.234.7.734"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1081\/JA-120004176"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1999.94811757.x"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2000.95339310.x"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595239996275"},{"key":"e_1_2_6_8_2","first-page":"37","volume-title":"Proceedings of an International Opioid Overdose Symposium, Sydney, Australia, August 14\u201315, 1997","author":"Farrell M.","year":"1998"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.51.4.435"},{"key":"e_1_2_6_10_2","volume-title":"The Taskforce to Review Services for Drug Misusers","author":"Department of Health","year":"1996"},{"key":"e_1_2_6_11_2","volume-title":"Drug Misuse and Dependence\u2014Guidelines on Clinical Management","author":"Department of Health","year":"1999"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyl207"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyl248"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7517-1-6"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.03.020"},{"key":"e_1_2_6_16_2","volume-title":"The Injection of Methadone Syrup in Sydney, Australia","author":"Darke S.","year":"1995"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595230220119318"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595230500263939"},{"key":"e_1_2_6_19_2","volume-title":"Queensland Drug Trends 2003 Findings from the Illicit Drug Reporting System (IDRS)","author":"Kinner S.","year":"2003"},{"key":"e_1_2_6_20_2","volume-title":"Methadone Associated Mortality; 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