Survey of general practitioners' opinions on treatment of opiate usersBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7088.1173 (Published 19 April 1997) Cite this as: BMJ 1997;314:1173
- Correspondence to: Ann Davies
- Accepted 21 June 1996
The government's Guidelines of Good Clinical Practice in the Treatment of Drug Misuse1 gave detailed guidance on the treatment of drug users and signalled a shift in official policy away from drug treatment clinics and towards treatment in primary care for opiate users.
Even though general practitioners are now seeing more drug users,2 there is little research on general practitioners' attitudes and practice in respect of opiate treatment in primary care. The last substantial report was by Glanz in 1985.3 We therefore conducted a survey of general practitioners' attitudes to opiate treatment.
Subjects, methods, and results
We sent a postal questionnaire to all 341 general practitioners in three districts in Greater Manchester. One district was inner city and the other two were metropolitan boroughs. The questionnaire focused on general practitioners' opinions on and knowledge of opiate use and their prescribing behaviour. In all, 270 general practitioners returned their questionnaires, giving a response rate of 79%. The response rate was 75% (58/77) from district A, 83% (95/115) from district B, and 79% (117/149) from district C. Of those general practitioners who responded, only 6% of general practitioners had not seen any opiate users in the past year; 16% had seen one user, 24% had seen two to three users, 31% had seen 4-10 users, 14% had seen 11-20 users, 5% had seen 22-50 users, 3% had seen 60-100 users, and 1% had seen 104-250 users.
Table 1) shows the responses to statements about treating opiate misuse. Younger general practitioners and general practitioners in contact with support services had more positive attitudes to opiate users (t=-3.34, P<0.05, df=239 and χ2=8.56, P<0.05, df=1 respectively) Overall general practitioners were twice as likely to hold positive attitudes (64%, 172) as negative attitudes (30%, 82).
It is encouraging that twice as many general practitioners hold positive attitudes as negative attitudes when dealing with opiate users. These general practitioners are making use of support services offered to them by specialist agencies and they are generally pleased with these services. However, many general practitioners felt they would become more involved in treatment if more specialist services existed. We cannot assess whether the relation between positive attitudes and greater contact with support services is causal from our data, but it is encouraging that the relation is positive. A positive attitude may be related to a better (short term) treatment outcome; the second part of the study will explore this possibility.
Only two thirds of general practitioners were familiar with the government's guidelines on drug misuse, and only two fifths had actually read them. This finding is similar to that of Bell et al five years ago.5 It is disappointing that although general practitioners are now seeing more opiate users than previously, few have read the guidelines. Most general practitioners said that they needed more training in dealing with opiate users and thought that they lacked the necessary knowledge and skills to deal effectively with users. The guidelines can be effective only if general practitioners are provided with sufficient training to be confident about their ability to treat opiate users.
We thank Len Bowers, Tom Carnwath, Mike Donmall, Mary Hopper, Mike Smith, Pat O'Dea and Hadi Mohamad, all the general practitioners who participated in this study, and the community drug teams for their help.
Funding: Regional Health Authority.
Conflict of interest: None.