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1. 1997 Davies A and Huxley P: Survey of general practitioners' opinions on treatment of opiate users (BMJ, vol. 314, 1173-1174). Surveyed all 341 GPs in Grater Manchester, UK. Response rate was 79% and two-thirds of respondents had positive attitude towards treating opiate users. "Most... felt they needed more training in dealing with opiate users... "
2. 1998 Martin E, Canavan A and Butler R: A decade of caring for drug users entirely within general practice (Brit. J. Gen. Pract., vol. 48, 1679-1682). Firstly, it is of note that authors state, "The government encourages general practitioners to become involved in caring for drug users."
This is a report of experience of one practice in Bedford "without secondary care support to drug users during period 1986-1995. The primary diagnosis "addiction drug" was found for 192 patients, of whom 155 were seen more than three times. Of these, 37% were prescribed methadone – and one-third of these became abstinent (long-term follow-up not assessed). Overall, 41% of methadone recipients took the medication intravenously, and these patients were more likely to be "stable" — defined as stable address and social groups and employment. During the decade of observation, "only 6.8% of [patients demonstrated any sort of aggression and only 1.6% were physically aggressive. Only 3.8% of patients were found to be getting prescriptions from more than one doctor, and only 7.3% of patients needed to be removed from the list for any reason."
The bottom line: "Drug users can be effectively cared for entirely within a general practice... Among those prescribed methadone ampoules [i.e., for parenteral use], a higher than average proportion had stable lifestyles and had a stable job."
3. 1997 Deehan A, Taylor C and Strang J: The GP, the drug misuser, and the alcohol misuser: major differences in GP activity, therapeutic commitment and 'shared care' proposals (Brit. J. Gen. Pract., vol. 47, 705-709). Survey of "all GPs in outer London area" – response rate of 52%. Bottom line: concluded that "there are some cautious grounds for optimism that GPs are willing to work with alcohol misusers; however, with regard to drug misusers, we find a GP workforce that is only minimally involved with this group and would not be greatly encouraged by the provision of additional training, support, or incentives."
4. 1999 Gossop M, Marsden J et al: Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice (Brit. J. Gen. Pract., vol. 49, 31-34). This was a multisite follow-up study of outcomes of 452 opiate addicts who received methadone treatment in primary health care and specialist clinic settings; parameters were substance use, health and crime.
Bottom line: "Results demonstrate the feasibility of treating opiate addicts using methadone in primary care settings, and show that treatment outcomes for such patients can be as satisfactory as for patients in specialist drug clinics.
5. 2001 Lewis D and Bellis M: General practice or drug clinic for methadone maintenance? A controlled comparison of treatment outcomes (Int. J. Drug Policy, vol. 12, 81-89) "GPs [in UK] are encouraged to prescribe methadone for opiate dependent patients..." This study in Liverpool compared all patient prescribed methadone maintenance during a 2-year period in one general practice with patients at a "drug clinic." Remaining in treatment or becoming drug-free "was equally likely in either setting." Bottom line: "Our findings suggest that with similar patient groups this model of care in general practice can produce results at least as good as those of a drug clinic."
6. 1992 Leaver EJ, Elford J, Morris JK and Cohen J: Use of general practice by intravenous heroin users on a methadone programme (Brit. J. Gen. Pract., vol. 42, 465-468. Study of a general practice in central London in 1990 of patients (29 subjects only) who were concomitantly enrolled in a methadone "programme." It was found that the methadone patients were more likely to miss appointments, request emergency appointments and receive more prescription medications than controls. "The implication that this may have in discouraging budget holding practices" from treating such patients is discussed.
7. 1996 Hindler C, King M et al: Characteristics of drug misusers and their perceptions of general practitioner care (Brit. J. Gen. Pract., vol. 46, 149-152) Assesses the perception of 145 addict-patients on GPs providing their general medical care in 4 practices in London. While 88% of the addicts stated their GP was aware of their drug problem, half the GPs "were not prescribing replacement drugs." Patients attributed this to "lack of knowledge or trust on the part of the doctor."
The authors conclude "There is a need to clarify the role of GPs in this field and provide them with better educational opportunities."
8. 1995 Wilson P, Watson R and Ralston GE (editorial): Supporting problem drug users: improving methadone maintenance in general practice. (Brit. J. Gen. Pract., vol.45, 454-455). "Many problems can be avoided by understanding that drug dependence is usually a chronic condition and that relapse is to be expected." Authors note the "widespread support for maintenance prescribing for opiate dependence with the synthetic opiate, methadone," and comment on the benefits of arranging for "administration to be supervised by a pharmacist... " They feel that many retail pharmacists will offer this service.
9. 2000 Keen J, Rowse G et al: Can methadone maintenance for heroin-dependent patients retained in general practice reduce criminal conviction rates and time spent in prison? (Brit. J. Gen. Pract., vol. 50, 48-49). Studied 57 patients treated at two general practices in Sheffield. Bottom line: patients maintained on methadone in the general practices studied "had significantly fewer convictions... and spent significantly less time in prison than they had before the start of treatment."
10. 1994 Scott RA and Burnett SJ (Letter): Supervised administration of methadone by pharmacists (BMJ, vol. 308, 1438). Describes an "arrangement" of several GPs in Glasgow SCOTLAND with several community pharmacists to provide direct supervision of methadone ingestion. Questionnaires were distributed to all community pharmacies in Greater Glasgow; response rate was 63%, n=135. A total of 97 pharmacies (72% of respondents) dispensed methadone, and half of these - 43 - supervised its administration. Overall, considering respondents who currently did and did not dispense methadone, 45% said they were, or would be willing to, supervise ingestion of methadone.
11. 2001 Ash T (new article): Injection of help (UK Newsquest Regional Press – This is Lancashire, August 13, 2001, Dateline Leyland) In what is termed a "ground-breaking scheme," chemists (i.e., pharmacists) would not only supply prescribed methadone but also administer it in-house. An official is quoted as saying this approach "has proved very positive in other areas," and the local police commander said, "I would be strongly supportive of such a scheme... we are very keen [the addicts] get proper supervised support to get them off illegal drugs and improve their health." And finally, the spokesperson for the local pharmaceutical association said, "We are behind the scheme as anything that helps to ensure people are getting treatment we are all for."