Opioid users' attitudes towards and use of NHS clinics, general practitioners and private doctors

The pathway to care of patients with SUD who presented at addiction treatment centers (AMATEM) in Turkey

Aim: Recent studies have shown that alcohol and drug use in Turkey is rising year on year. In order to prevent and treat substance use disorder (SUD), many Alcohol and Drug Research, Treatment and Training Centres (AMATEM) have been established in Turkey. The purpose of this study was to investigate the pathway to care of patients who presented at AMATEM.Method: A total 235 patients with SUD between16-69 age groups who presented at AMATEMs in 2017 were included in this study. A sociodemographic form and a structured self-report questionnaire consisting of 36 items assessing the pathways of care were given to all the patients. Data were analysed with descriptive statistics using SPSS software.Results: The majority of the patients included in the study were single (55%) and male (96%). Patients mostly had a secondary school level of education (51%) and social security (65%). The majority of the patients stated that they used more than one substance (44%), opiates (20%) or alcohol (18%).Conclusion: This is the first study evaluating the pathway of care in patients with SUD in Turkey. It was observed that a significant majority of patients with SUD presented to AMATEMs and patients who applied to different health institutions stated that they were mostly informed about SUD and AMATEM. There were also patients with negative attitudes towards AMATEMs and non-medical treatment seeking behavior other than AMATEM. Families, relatives and friends of patients with SUD have an important place in reaching the treatment.

The perceptions and aspirations illicit drug users hold toward health care staff and the care they receive

Over the 30 years of conflict, Northern Ireland escaped the worst excess of illegal drug trafficking and usage. However, the recent 'peace dividend' has brought with it an unprecedented rise in the availability and use of illicit drugs. With this, new problems and pressures have been brought to bear on the health service. The literature would suggest that drug users are loathed and feared by health care staff. Staff will also admit to be lacking in the knowledge and skills necessary for the delivery of appropriate support and treatment for this client group. Further, the literature has little to offer on the experiences and aspirations of drug users in relation to their treatment and the staff who care for them. In order to understand the drug users' experiences of health care and health staff, focus group methodology was employed to obtain qualitative data. A total of 20 illicit drug users from across Northern Ireland took part. Supporting the literature, all had experienced 'care' that they felt was filled with judgement, hostility and loathing. They recognized clearly the challenge they pose to health care staff. These findings indicate that there is obvious dissonance between those tasked to care for drug users and drug users themselves, with little respect being shown on either side. Results suggest that action needs to be taken to address the deficits in the knowledge, skills and values of health care professionals in relation to illicit drug users. The findings will be of interest to service providers within and outside the United Kingdom.

Methadone maintenance in general practice: patients, workload, and outcomes

OBJECTIVE

To assess recruitment to and work-load associated with methadone maintenance clinics in general practice; to investigate the characteristics of patients and outcomes associated with treatment.

DESIGN

Study of case notes.

SETTING

Methadone maintenance clinics run jointly by general practitioners and drug counsellors in two practices in Glasgow.

PARTICIPANTS

46 injecting drug users receiving methadone maintenance during an 18 month period, 31 of whom were recruited to clinic based methadone maintenance treatment and 15 of whom were already receiving methadone maintenance treatment from the general practitioners. Mean (SD) age of patients entering treatment was 29.6 (5.5) years; 29 were male. They had been injecting opiates for a mean 9.9 (5.1) years, and most had a concurrent history of benzodiazepine misuse. Average reported daily intake of heroin was approximately 0.75 g. Participants in treatment had high levels of preexisting morbidity, and most stated that they committed crime daily.

RESULTS

2232 patient weeks of treatment were studied. Mean duration of treatment during the study period was 50.7 (21.1) weeks and retention in treatment at 26 weeks was 83%. No evidence of illicit opiate use was obtained at an average of 78% of patients' consultations where methadone had been prescribed in the previous week; for opiate injection the corresponding figure was 86%.

CONCLUSIONS

Providing methadone maintenance in general practice is feasible. Although costs are considerable, the reduction in drug use, especially of intravenous opiates, is encouraging. Attending clinics also allows this population, in which morbidity is considerable, to receive other health care.

Research and the help-seeking process

Recognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help-seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help-seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help-seeking by problem drug takers, and identifies areas for further research. These include the need to 'unpack' the concept of 'drug problems' and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out-of-treatment groups; to assess the role of 'significant others'; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help-seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider context of their lifestyles.

The challenge of illicit drug addiction for general practice

Eighty-five drug misusers sought help and treatment from our central London practice in the 12 months between 1st November 1987 and 31st October 1988. They were all accepted for a short course of oral methadone reduction. At the end of the 12 months, according to the best information available from records, family, friends, neighbors, support agencies and patient reports, 19 (22%) were off all illicit drugs and 9 (16%) of those who had been unemployed at presentation had obtained regular employment. On average, our opiate misusers consumed 0.5 g of heroin daily at a daily street cost of approximately 40 pounds or 14,600 pounds annually. Sixty per cent of them admitted to financing their drug habit through criminal activities. Against the huge social cost of illicit drug misuse, the cost of providing primary health care to all these 85 addicts was 8% of each two doctors' consulting time at an annual cost of 2171 pounds per GP (25 pounds per hour of GP time). Thus for the methadone reduction programme for these 85 addicts to be judged effective based on cost alone, one would require a drug abstention ("success") rate of 0.003%.

Heroin misusers: what they think of their general practitioners

One hundred and sixteen heroin misusers were assessed at hospital clinics regarding their contact with General Practitioners (GPs), their routes of referral and their estimation of GP reaction to a consultation regarding heroin misuse. Thirty-nine (25%) had not previously contacted their GPs for drug misuse; 103 (89%) approached the specialized clinics through means other than a GP; the reported, or anticipated, responses concerning GP attitudes were generally unfavourable. Lack of training and support for GPs are remediable explanations for the findings.