In 2000, a nationwide survey of GPs in Scotland explored factors influencing treatment decisions, attitudes to, and involvement with drug misusers.1
Since then there have been changes in both general practice and drug misuse management, including: greater integration between health and social services in Scotland; new national guidelines for drug misuse;2
a new GP contract with the NHS, which includes enhanced services for drug misusers; increased availability of drug misuse training; introduction of alternative treatments (for example, buprenorphine); higher prevalence of blood-borne viruses particularly hepatitis C among injecting users;3
and changes in the nature of illicit drug use (for example, psychostimulant use).
In Scotland, the number of methadone users is increasing,4
with a current estimate of 22 000 people prescribed methadone.5
There are over 400 drug-related deaths annually.6
The main drug used is heroin, but polydrug use is common. Cocaine and crack cocaine are used increasingly in the opiate-using population.7
There has been a long debate among drug treatment service providers about the relative roles of primary care and specialist services. Since 2000, a specialised GP role has emerged across the UK, recognised in the GP contract, and managing both simple and more complex cases. Specialist service contracts specify the provision of ‘enhanced’ services (which can be ‘national’, ‘local’, or ‘directed’) beyond the provision of general medical care for management of the patient’s drug problem.
While evidence-based guidelines for the treatment of drug misuse provide clear guidance on preferred treatment strategies, the authors’ previous survey showed that only a minority of GPs use guidelines, and practice often did not match recommendations.1
National guidelines have been updated but there is no evidence about whether GPs follow these.
These changes may have influenced GP management of drug misusers. This paper reports the findings from a survey of Scottish GPs to ascertain current practice in drug misuse, and how this has altered since 2000.
How this fits in
Previous research found GP involvement in the management of drug misusers was considerable. Primary care provision of services is considered a complementary part of drug treatment services and, given the scale of the problem, an essential part in maximising capacity and increasing access to care. This survey presents current involvement and how it has changed in 8 years.