Survey of Scottish GPs and drug treatment
This was a follow up to a nationwide survey of GPs in Scotland completed in 2000. They used a similar questionnaire to the original study and sent it to a random sample of one in four Scottish GPs (n=1065). After a poor initial response they sent an abbreviated questionnaire on the key areas from the main questionnaire.
The main questionnaire was completed by 447 GPs and the short questionnaire by a further 173 GPs giving an overall response rate of just over 60%. This represents almost 40% of all Scottish practices.
The proportion of responders currently treating drug misusers was 43.7% and this is a statistically significant decrease compared to 2000 (62.3% p<0.001). The most common reason from not treating drug users was given as ‘practice policy’ (59.3%). However, almost 45% of GPs said an enhanced service was provided by the practice. The questionnaire also enquired into methadone prescribing. The maximum dose that GPs would prescribe in 2000 was less than 60mg in 33.6% of respondents but this has dropped to 6.8% in 2008.
It’s encouraging that GPs seem to be more comfortable prescribing at the recommended effective levels. The apparent reduction in the number of GPs treating substance users may reflect an increase in GPs with a special interest with better organisation within practices rather than an actual reduction in care delivered.
Methadone prescribing had dropped but overall the levels of opiate substitution were much the same when buprenorphine and dihydrocodeine preparations were considered. One finding the authors did not comment on was the number of practices that prescribe benzodiazepines. While this has dropped from 45% to 32% it does seem worthy of remark that nearly one-third of users have long term benzo scripts. Are these really long-term prescriptions or could they be benzo reductions? The study doesn’t tell us but called them ‘maintenance scripts’.
It is also notable that short-term community detoxification and referral to residential detoxification had dropped from levels of around 39% in 2000 to 24-25% in 2008. While this may represent service user preference it would be concerning if there were issues around access that have driven this percentage down rather than any other factors. Again, there’s not enough here to draw any firm conclusions.
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Matheson C, Porteous T, van Teijlingen E, & Bond C (2010). Management of drug misuse: an 8-year follow-up survey of Scottish GPs. The British journal of general practice : the journal of the Royal College of General Practitioners, 60 (576), 517-20 PMID: 20594442
