• Please log in or register to access this feature.

Definitions related to the use of pharmaceutical opioids: Extramedical use, diversion, non-adherence and aberrant medication-related behaviours

  1. BRIONY LARANCE1,*,
  2. LOUISA DEGENHARDT2,3,
  3. NICK LINTZERIS4,5,
  4. ADAM WINSTOCK6,
  5. RICHARD MATTICK1

Article first published online: 4 MAY 2011

DOI: 10.1111/j.1465-3362.2010.00283.x

Issue

Drug and Alcohol Review

Drug and Alcohol Review

Special Issue: Pharmaceuticals. Guest Editors: Suzanne Nielsen and Raimondo Bruno

Volume 30, Issue 3, pages 236–245, May 2011

Additional Information

How to Cite

LARANCE, B., DEGENHARDT, L., LINTZERIS, N., WINSTOCK, A. and MATTICK, R. (2011), Definitions related to the use of pharmaceutical opioids: Extramedical use, diversion, non-adherence and aberrant medication-related behaviours. Drug and Alcohol Review, 30: 236–245. doi: 10.1111/j.1465-3362.2010.00283.x

Author Information

  1. 1

    National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

  2. 2

    Burnet Institute, Melbourne, Australia

  3. 3

    Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia

  4. 4

    The Langton Centre, South East Sydney and Illawarra Area Health Service, Sydney, Australia

  5. 5

    Faculty of Medicine, University of Sydney, Sydney, Australia

  6. 6

    Addictions, Kings College London, London, UK

*Briony Larance BSc (Psych) (Hons), Senior Research Officer, Louisa Degenhardt PhD, MPsych (Clinical), Professor, Nick Lintzeris MBBS, PhD, FAChAM, Director, Adam Winstock MSc, MRCPsych, FAChAM, Clinical Senior Lecturer, Richard Mattick PhD, MPsych (Clinical), Professor. Ms Briony Larance, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. Tel: +61 (0)2 9385 0241; Fax: +61 (0)2 9385 0222; E-mail: b.larance@unsw.edu.au

  1. Conflict of interest statement: Louisa Degenhardt, Briony Larance and Richard P. Mattick received an untied educational grant from Reckitt Benckiser for a post-marketing study examining the diversion and injection of buprenorphine-naloxone in Australia, 2006–2008. The design, conduct, interpretation and reporting of the wider study's findings were determined by the study investigators; the funder had no role. The company also had no knowledge of, or role in, the development or writing of this paper.

Publication History

  1. Issue published online: 4 MAY 2011
  2. Article first published online: 4 MAY 2011
  3. Received 31 March 2010; accepted for publication 12 November 2010.

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (147K)

Keywords:

  • diversion;
  • adherence;
  • misuse;
  • prescription opioid;
  • terminology

Abstract

Aims.This paper (i) reviews the language used to describe and manage those patient practices that fall outside standard medical models of opioid treatment (for pain and opioid dependence), and (ii) proposes a consistent terminology that can be applied across multiple healthcare settings.

Method.Peer-reviewed and grey literature documenting empirical studies of (non-)adherence with opioid treatment, proposed definitions or other potentially important aspects of terminology were included in this review.

Results.There are international inconsistencies in the terminology used to describe the unintended consequences of opioid treatment, and the terms used often lack specificity. The terms ‘hazardous use’, ‘extramedical use’, ‘opioid dependence’, ‘diversion’, ‘non-adherence’ and ‘aberrant behaviours’ are defined. We advocate for consistent application of these terms in the context of opioid treatment, and propose that care is taken to describe individual practices and intentions.

Conclusions.The increasing global attention on the use and diversion of pharmaceutical opioids warrants a discussion of current terms and definitions. Exaggerated concerns regarding ‘addiction potential’ may result in restrictions in the supply of opioids and the under-treatment of legitimate medical conditions. Researchers, clinicians, policy-makers and patients need to ensure greater care is given to terminology, including detailed descriptions of patient practices, the context in which they occur and severity of associated harm.[Larance B, Degenhardt L, Lintzeris N, Winstock A, Mattick R. Definitions related to the use of pharmaceutical opioids: Extramedical use, diversion, non-adherence and aberrant medication-related behaviours. Drug Alcohol Rev 2011;30:236–245]

View Full Article (HTML) Get PDF (147K)