General practitioner centred scheme for treatment of opiate dependent drug injectors in Glasgow

Abstract

Injecting opiate drugs is now common in the United Kingdom, particularly in deprived urban areas.1 The judicious use of oral methadone may enable many opiate dependent drug injectors to reduce or cease injecting, with consequent improvements in health and social stability.2 Key elements of effective methadone treatment include ensuring oral ingestion of an appropriate daily dose and addressing patients' other health and social problems.3 Successive reports to government have emphasised the key role of general practitioners in treating drug injectors.4 5 6 However, few have received training in managing such patients, and consequently many experience difficulty in treating them.7 8 Coping strategies range from refusing to register any drug injectors to prescribing various substitute drugs for unsupervised use, with the consequent dangers of overdose or diversion of the drugs to the black market.9 Although some practices provide effective care 10 11 little has been published on how this can be achieved across a larger population.12 In most countries methadone must be given under supervision at specialist addiction centres.2 Although this has the advantage of ensuring a consistent approach within each clinic population, specialist services may be inaccessible to many and may lack the capacity to meet need when the prevalence of drug injecting is high. Unusually, in the United Kingdom both hospital doctors and general practitioners are allowed to prescribe methadone for dispensing by community pharmacists, thus enabling the treatment of injectors to be decentralised. However, a recently published survey of community pharmacies in England and Wales found that methadone is frequently dispensed in large amounts for unsupervised use.13 The opportunities for abuse or diversion are clear. In a recent survey of drug related deaths in Manchester a large proportion seemed to be associated with methadone.14 Greenwood reported that many …