Study in Lothian confirms findings

See editorial by Farrell and pp 581, 613

Editor—Ann Davies and Peter Huxley comment that little research is being done on general practitioners' attitudes and practice in the treatment of opiate misusers even though general practitioners are now seeing more drug misusers.1 According to the authors the last substantial report was by Glanz in 1985.2 We would like to draw attention to similar studies conducted in Lothian in 1988 and 1993.3 The 1993 study was a postal survey of the experience of, attitudes toward, and confidence in dealing with drug misusers among general practitioners in Lothian. Questionnaires were sent to all 517 general practitioners (response rate 75%). The study also compared changes in general practitioners' involvement with and confidence in dealing with drug misusers from 1988 to 1993; there was a significant increase in both areas. Davies and Huxley found that 80% of the general practitioners in Greater Manchester prescribed substitute drugs for opiate misusers; we found that 73% of the general practitioners in Lothian prescribed substitute drugs, while only 12% stated that they would not do so. Moreover, 67% of the general practitioners in Lothian had given advice on safer drug use and only 2% stated that they would not give such advice.

General practitioners in Lothian, like their colleagues in Greater Manchester, expressed the need for more training in dealing with drug misusers. For example, in Lothian they showed a lack of confidence in the management of drug related aggression and violence in the practice, a problem shared with general practitioners in other areas.4 Training can help build confidence. A positive similarity between the two studies is that general practitioners in both Greater Manchester and Lothian generally have an understanding approach toward drug misuse.

Local guidelines and support increase confidence

Editor—We were encouraged to read about the generally positive attitudes …