GPs take growing role in drug misuse fight

Almost 40% of all practices are involved in the treatment of drug users, figures from the National Treatment Agency reveal – a rise of 25% in just five years.

Yet the increasing involvement of GPs has also fuelled a rapid rise in the number of prescription for the heroin substitute, methadone, leading to claims that some are ‘excessively liberal’ in their prescribing of the drug.

The NTA figures show around 30% of practices were involved in drug treatment in 2002/03, but this had increased to 37% in 2007/8. Alongside this shift, the latest NHS figures on methadone prescriptions for substance dependence in primary care show a rise of nearly 60% from 2003 to 2007 in England, at a cost of over £27m per year.

Dr Chris Ford, a GP in Kilburn, west London, and GP advisor to the clinical network Substance Misuse Management in General Practice, said improved training and the enhanced service offered as part of the GP contract were drawing more practices into treatment of drug misuse.

‘There aren’t many things you can do where you can see a change in general practice, so it is rewarding,’ she said.

Professor Neil McKeganey, director of drug misuse at the University of Glasgow, also welcomed the rise in GP involvement in drug treatment, but warned the rise in methadone prescribing by GPs left many patients at risk of overdose.

‘There is a real worry that prescribing of methadone has become excessively liberal. It is much easier to overdose on methadone than with heroin, as users are unable to calibrate their consumption and methadone can accumulate in the body for longer periods,’ he warned.

Professor McKeganey said methadone-related deaths were rising and he recommended GPs followed up patients on methadone more carefully, making sure only those making progress remained on the drug for long periods.

But Dr Ford defended the use of methadone, saying it was a ‘very good drug’ that improved the quality of life and health of patients with substance misuse problems.

‘The best way to keep these patients from death is to put them on methadone.’

Earlier this month, the National Patient Safety Agency warned of the dangers of incorrect use of powerful opiods, with methadone causing around 8% of patient safety incidents with opiods from 2003 to 2008.