Reduced treatment ++ ++ ++ “ “ effectiveness (e.g. running out of medication relapse to other substance use, destabilized other conditions) Use by non-prescribed Intoxication, overdose +++ ++ + routes (injected, (higher peak plasma intranasal) concentration) Vein damage, infections, ++ +++ ++ “ “ BBV Intentional or Intoxication and +++ ++ ++ accidental use of overdose risk. Particular opioid medication by concern with children person for whom not and others with low prescribed. opioid tolerance Opioid related harms, ++ ++ ++ “ “ including adverse drug effects, route of administration, economic, legal and psychosocial consequences Regular use of opioid Development of ++ ++ ++ medication by person dependence to for whom not medication prescribed. Illegal activities Regulatory and legal and ++ ++ ++ associated with consequences selling, diverting or possession of medications not prescribed to patient. Poor reputation of Stigma against patients ++ ++ ++ opioid treatment from and treatment services misuse of unsupervised medication Reduces attractiveness of ++ ++ ++ “ “ treatment to target population, health providers and community
“ “ Reduced treatment effectiveness (e.g. running out of medication relapse to other substance use, destabilized other conditions) ++ ++ ++ Use by non-prescribed routes (injected, intranasal) Intoxication, overdose (higher peak plasma concentration) +++ ++ + “ “ Vein damage, infections, BBV ++ +++ ++ Intentional or accidental use of opioid medication by person for whom not prescribed. Intoxication and overdose risk. Particular concern with children and others with low opioid tolerance +++ ++ ++ “ “ Opioid related harms, including adverse drug effects, route of administration, economic, legal and psychosocial consequences ++ ++ ++ Regular use of opioid medication by person for whom not prescribed. Development of dependence to medication ++ ++ ++ Illegal activities associated with selling, diverting or possession of medications not prescribed to patient. Regulatory and legal and consequences ++ ++ ++ Poor reputation of opioid treatment from misuse of unsupervised medication Stigma against patients and treatment services ++ ++ ++ “ “ Reduces attractiveness of treatment to target population, health providers and community ++ ++ ++