General practice management of illicit drug users in Scotland: a national survey

AIMS

To describe the level of involvement of general practitioners (GPs) in the management of illicit drug dependency; nature of current practice in the management of illicit drug dependency; influence of guidelines on practice; GP training experience and needs; and to consider the policy implications of the findings.

DESIGN

A cross-sectional postal questionnaire survey.

SETTING

General practice in Scotland.

PARTICIPANTS

A 1 : 4 randomized sample (n = 926) of general practice principals, stratified according to age, gender and number of practice partners.

MEASUREMENTS

A structured postal questionnaire.

FINDINGS

A 63% response rate was achieved after two reminders (n = 583). Sixty per cent of respondents treated drug users, 51.5% provided methadone maintenance but only 58% used doses in the recommended range. Maintenance prescribing of dihydrocodeine and benzodiazepines was provided by 24% and 44.8% of respondents, respectively. While 79.3% had received the national clinical guidelines only 22.5% believed this had influenced their practice. Only a third of respondents had received drug dependency training. Beliefs about whether prescribing for drug misusers is part of a GPs professional remit was split.

CONCLUSIONS

There was relatively high involvement with drug users, with methadone maintenance being the most common treatment provided. Maintenance prescribing of dihydrocodeine and benzodiazepines were common despite a lack of clinical evidence supporting the effectiveness of these treatments. This may reflect the nature of the presenting drug problems and highlights the difficulties some GPs may face in managing multiple drug dependencies within current guidelines. Further local training to implement guidelines along with trials of alternative treatments currently outwith guidelines should be considered.

Community pharmacy services for drug misusers in Scotland: what difference does 5 years make?

AIMS

To assess current levels of participation of community pharmacists in needle exchange provision, assess participation in dispensing any drugs for drug misuse, explore methadone dispensing practice, assess involvement in health promotion for drug misusers, assess levels of training in drug misuse and compare all of the above with data from 5 years previously.

DESIGN

A cross-sectional postal questionnaire.

SETTING

All community pharmacies in Scotland (n = 1162).

PARTICIPANTS

A total of 969 pharmacists managing community pharmacies on a day-to-day basis (response rate 83.4%).

MEASUREMENTS

Descriptive data were collected on demography, drug misuse services provided and training. Data were combined with a dataset from an identical survey conducted 5 years previously for statistical comparison.

RESULTS

Levels of needle exchange provision has not changed significantly (9.7% in 2000 compared to 8.6% in 1995). Of all respondents, 71.5% now dispense drug for the management of drug misuse, 68.9% dispense methadone and 56.7% provide a supervised methadone consumption service. The number of methadone clients receiving methadone through pharmacies has increased from 3387 in 1995 to 8792 in 2000 and the mean number of clients dispensed methadone per pharmacy has increased from 7.3 in 1995 to 13.2 in 2000; 65.1% of all methadone clients now consume their methadone under pharmacist supervision. The proportion of pharmacists dispensing methadone who provide a supervised consumption service has increased significantly from 37% to 82.8%. Considerable changes in pharmacy practice are evident with significant increases in the number of pharmacists who always lay down ground rules, ask for identification on first visits, make up prescriptions in advance and provide verbal advice and leaflets on the management of drug misuse. Training in drug misuse doubled from 31.8% to 66.8%.

CONCLUSIONS

Community pharmacy involvement with drug misusers has increased dramatically in the last 5 years. However, this increase is largely in methadone dispensing and supervision. Pharmacists appear to be more proactive in providing advice and information, perhaps as a result of greater training.