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In Glasgow, over 2,000 patients are being treated with methadone in what is believed to be the largest primary care based scheme in the United Kingdom. Dispensing is decentralized, and direct supervision of methadone consumption is provided in 139 of the total 212 community pharmacies in the Greater Glasgow Health Board district.
Support of GPs who prescribe opiate agonists for drug dependent patients is long-standing in Scotland. Thus, in 1988 the Community Drug Problem Service (CDPS) was established in Edinburgh to offer "assessment, prescribing, advice, counseling and support to drug users by GPs and other agencies." CDPS works alongside the Lothian GP Facilitator Team, which supports local practices through regular courses and meetings, and dsistributes a bi-monthly informational series to all GPs in Scotland.
Several published articles document the Scottish experience with office-based prescribing and community pharmacy dispensing of opiate agonists. Matheson et al reported on a survey of all community pharmacies in the country (n=1142). Almost 80% responded, and of these 61% "currently dispensed drugs for the management of drug misuse," with methadone being the most common. At the request of the physician-prescriber, 65% of methadone prescriptions were dispensed daily, and a third of all patients consumed their daily dose under a pharmacist's supervision (one out of five pharmacy respondents offered such direct supervision of consumption, and an additional 14% were prepared to but had no current demand for the service.
Reference: Matheson C, Bond CM, Findlay H: Prescribing and dispensing for drug misusers in primary care: current practice in Scotland. Family Practice 1999; 16:375-379
The history, practice and experience of methadone prescribing in primary care settings in Glasgow and Edinburgh were described recently by Weinrich and Stuart. In Edinburgh, in 1998, almost 60% of all primary care practices were prescribing methadone to a total of 1,600 patients.
Glasgow applies more restrictions on GP prescribing than Edinburgh - e.g., there is an upper limit (20) on the number of patients permitted in each practice, and at least for the first year of treatment methadone must be consumed six days per week under direct supervision of pharmacists. By 1998 2,900 out of an estimated 4,00-7,000 injection drug users were receiving methadone maintenance, and 1999 figures show that 138 GPs (30% of the total in Glasgow) prescribed the medication.
The outcomes of GP-prescribing of methadone in both cities were deemed positive in terms of criminality and spread of HIV. The authors concluded that "prescription of methadone by primary care physicians can safely increase the availability" of this treatment; that physician education and financial incentives "improve prescribing practices;" that likelihood of methadone-related deaths is diminished by supervised consumption of medication; and that physician support is of critical importance.
Reference: Weinrich M and Stuart M: Provision of Methadone Treatment in Primary Case Medical Practices - Review of the Scottish Experience and Implications for US Policy. JAMA. 2000; 283; 1343-1348
For complete information visit the Scotland Government Web Site .