External review of drug services for the Eastern Health Board.

The Eastern Health Board achieved a major expansion of drug services between 1995 and 2000. Over 4000 individuals had availed of methadone treatment by October 1999. Over 50 treatment sites were established in hospitals and satellite clinics. Satellite clinics informally reported rates of up to 40% plus returning to work, substantially higher than the international standard of 30%. A need was identified that coordinators develop to support level I GPs in order to increase capacity of the treatment service. Methods were examined to decrease the contact time for clients and allow a greater throughput of clients. The need for a needle exchange programme was identified. The need for a community based treatment programme was identified, emphasis to be placed on providing advice and treatment for a variety of drugs of abuse

The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales

BACKGROUND: GPs occupy a pivotal position in relation to providing services to opiate misusers in the UK, and this is now cited to support initiatives in other countries. AIMS: To investigate GP involvement in the management of opiate misusers; and to examine the nature of this prescribing of methadone and other opioids. DESIGN: GP data collected via self-completion postal questionnaire from a 10% random sample of the 30 000 GPs across England and Wales. Patient prescription data obtained on opiate misusers treated during the preceding 4 weeks. SETTING: Primary healthcare practice in England and Wales in mid-2001. METHOD: A questionnaire was mailed to a random 10% sample of GPs stratified by number of partners in the practice, with three follow-up mailshots. Data on drugs prescribed by these practitioners were also studied, including drug prescribed, form, dose and dispensing arrangements. RESULTS: The response rate was 66%. Opiate misusers had been seen by 51% of GPs in the preceding 4 weeks (mean of 4.1 such patients), of whom 50% had prescribed opiate-substitution drugs. This provided a study sample of 1482 opiate misusers to whom GPs were prescribing methadone (86.7%), dihydrocodeine (8.5%) or buprenorphine (4.4%). Of 1292 methadone prescriptions, mean daily dose was 36.9 mg — 47.9% being for 30 mg or less. Daily interval dispensing was stipulated by 44.6%, while 42.9% permitted weekly take-away supply. CONCLUSIONS: In 2001 nearly three times as many GPs were seeing opiate misusers than was the case in 1985. Half were prescribing substitute-opiate drugs such as methadone (to an estimated 30 000 patients). However, there are grounds for concern about the quality of this prescribing. Most doses were too low to constitute optimal methadone maintenance; widespread disregard of the availability of supervised or interval dispensing increases the risks of diversion to the blackmarket and deaths from methadone overdose. Increased quantity of care has been achieved. Increased quality is now required

Guidance for the use of methadone for the treatment of opioid dependence in primary care.

• Methadone is an effective evidence based medication used for the treatment of opioid dependence. • It is most effective when used as a maintenance agent at optimal dosing. • Its primary function is to reduce (and eventually replace) illicit opioid use and in so doing, reduce harm and improve the health and psychological well-being of the patient