The Methadone Treatment Programme (MTP) offers methadone maintenance treatment (MMT) to heroin addicts in Ireland and was introduced across the country in 1998. Given the central role of the GP in the delivery of care in the Irish health landscape, the MTP is regulated by the Irish College of General Practitioners (IGCP). The aim of this study1 was to assess and compare GP perceptions of the scale of local illicit drug use, attitudes towards and obstacles in the provision of methadone treatment, and the preferred adjunct modalities alongside MMT.

To achieve this aim, two surveys were carried out with GPs in 2006 and 2015. The survey contained a series of descriptive and open-ended questions and was emailed to all GPs registered on the MTP database, irrespective of their current level of engagement in the MTP. The authors stated that, where possible, comparisons were drawn between the opinions of GPs who had patients receiving MMT in both 2006 (n=147) and 2015 (n=170).

Results

In terms of response rate, 207 out of 600 (34.5%) GPs responded in 2006 and 217 out of 949 (22.87%) GPs responded in 2015. The authors acknowledged the response rate as a limiting factor in the study but outlined that this response rate is typical of the GP population. The profile of participating GPs as predominantly male and aged between 35 and 60 remained largely unchanged between 2006 and 2015. Notably, there was an increase of 57% in the number of female participants in 2015.

Perception of the illicit drug problem and provision of MTP

When asked their opinion on the extent of illicit drug use in their area, 66.5% of GPs felt it was a major problem. This perception was worse compared with 2006 (53.2%). By linking perception to demographic location, the authors found that the majority of GPs that reported illicit drugs as a major problem were practising in urban locations. Similarly, the majority of GPs from rural areas reported minimal problems with illicit drug use in their practices. Notably, no statistical significance was observed between these two variables.

GPs that had patients enrolled in the MTP were asked to provide details about any perceived obstacles to recruiting new patients into the programme. The majority of GPs (54% 2015; 71.8% 2006) cited either no obstacles or no referrals in response to this question. Second choices included ‘have enough already’ (16.3% 2015; 11.8% 2006) or that they had reached their ‘protocol maximum’ (27.2% 2015; 16.5% 2006). GPs that did not have patients currently enrolled in the MTP were invited to provide more information as to why this was the case. In 2015, 85% of these GPs reported that there was either no demand for the service in their area or they had never been asked to take on any patients. This was largely similar to 2006, where 83% of GPs cited the same reasons. Other reasons for not engaging with the MTP included a fear of violence, alienating private patients, a lack of knowledge, lack of community supports, and personal reasons such as a lack of empathy with addicts and discomfort with the topic of addiction.

Attitude towards the MTP and additional services

In general, the majority of GPs who had patients in the MTP in 2006 and 2015 had a positive attitude towards the programme. GPs agreed that the MTP eliminates chances of double scripting, allows for a good relationship with patients, improves the health of the patients and reduces criminality. Alongside the positive feedback for the MTP, GPs identified a lack of access to assessment and support services (including community liaison officers, literacy support, alcohol support services, and return to employment services) for patients receiving MMT. These were common issues between the 2006 and 2015 surveys. Furthermore, GPs highlighted a lack of accessible information about the types of services that are currently available and also the lack of a referral mechanism which can support the transfer of stabilised patients to primary care settings.

When asked to rank a list of services which they deemed necessary to further support the MTP, GPs in both years selected addiction counselling as their preferred choice (46.5% 2015; 51.7% 2006). GPs felt that inpatient rehabilitation detoxification beds, employment schemes and drop-in/social centres would also benefit patients in the MTP. The authors noted that the percentage of GPs who selected employment schemes and drop-in/social centres as their primary choice between 2006 and 2015 increased from 8.9% to 21.2% and 0.7% to 11.76%, respectively.

Discussion

Overall, the authors noted that this study highlighted a favourable opinion of Irish GPs towards participation in the MTP and obstacles and attitudes towards the provision of the programme. Notably, there was a perceived rise in the scale of local illicit drug use between 2006 and 2015. In addition, GPs provided a useful insight into the range of supplementary supports and services they believe are necessary for correct care of patients on the programme. By comparing survey results from 2006 and 2015, the authors found that the majority of GPs’ attitudes towards the MTP have remained largely positive. The authors concluded that there is a need for greater efficiency of referral mechanisms for stabilised patients and greater implementation of psychosocial, vocational and detoxification supports warranted in the Irish primary care setting.

1 Delargy I, O’Shea MT, Van Hout MC, Collins C (2016) General practitioner perspectives on and attitudes toward the methadone treatment programme in Ireland. Heroin Addiction and Related Clinical Problems, 18(4): 43‒50. https://www.drugsandalcohol.ie/25746/