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Home > GPs' attitudes to the Methadone Treatment Protocol.

Long, Jean (2008) GPs' attitudes to the Methadone Treatment Protocol. Drugnet Ireland , Issue 28, Winter 2008 , pp. 8-9.

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As demonstrated in the ROSIE study,1 methadone treatment reduces drug use, crime and death among opiate users in Ireland. Almost one-third (32%) of opiate users prescribed methadone substitution are cared for in private general practice. In light of this information, the Irish College of General Practitioners (ICGP) conducted a postal survey in 2006 to determine the attitudes of GPs to the Methadone Treatment Protocol (MTP).2

 A  questionnaire was sent to 600 GPs who were recorded on the ICGP's drug misuse database as having received training in the management of methadone clients. Just under 35% (207) responded.  It is notable that 247 GPs had patients on the Central Treatment List at the time of the study. [See PDF for figure]
 
 Almost half of the GPs who responded were aged between 46 and 60 years and 29% were female. Two of every three practices were situated in an urban area. Just over two-fifths of the GPs said that illicit drugs were a major problem in their practice area; the majority of these GPs practised in an urban location. Ninety-two per cent confirmed that they had attended special training in methadone treatment.
 
 Of the 207 GPs who completed the questionnaire, 72% were providing patients with methadone treatment at the time of the survey. Over half had 10 or fewer patients. Only 35 prescribing doctors or their staff did not want any more patients. Forty-six GPs were willing to take more patients, which suggests that there is capacity that could be used to transfer additional suitable clients to a normal health care environment.
 
 The vast majority of GPs thought that the MTP was beneficial to patients, though some said that methadone was addictive and difficult to get off (Figure 1). It was also noted that patients who attended daily might be prevented from working.
 
Only 3% of GPs reported that their training was not sufficient to stabilise patients receiving methadone substitution. One-third reported that their training was not sufficient to manage the complications of drug use. Over two-fifths reported that their training was not sufficient to manage patients who continued to use illicit drugs. Just under two-thirds reported that their training was not sufficient to manage patients with alcohol problems, while over half reported that their training was not sufficient to manage patients with benzodiazepine problems. These responses point to issues that could be dealt with in future training programmes.
 
The types of training that GPs considered most useful to them were small, locally based continuing education networks, individual mentoring, and distance learning. Consideration can be given to these preferences in the design of future training.
 
The additional services most desired by GPs were addiction counselling, in-patient detoxification and rehabilitation beds, and employment schemes
 
1. Cox G, Comiskey C and Kelly P (2007). ROSIE Findings 4: summary of 1-year outcomes: methadone modality. Dublin: National Advisory Committee on Drugs.
2. Delargy I (2008) Survey of general practitioners participating in the methadone treatment programme. Dublin: Irish College of General Practitioners.

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