1 March 1996

Problem drug users

[Letter in Br J Gen Pract. 1996 Mar;46(404):200.]
I read with interest the editorial on problem drug users by Wilson et al (September Journal, p. 454).

I agree with the general theme of the authors, but would take exception to two related assertions.

While adding psycho-social supports certainly improves treatment outcomes, the provision of methadone alone with virtually no additional support has also been shown to yield significant benefits to patients. Even doctors with little experience in the area, given some guidelines based on simple pharmacology and therapeutics, would be doing much good and little harm in prescribing to addicts who are otherwise denied appropriate treatment.

Though respecting Scottish GPs' claims for increased funding for the treatment of addictions, it is my belief that most drug and alcohol treatment lies directly within the scope of general medical services.

Over the past 10 years in New South Wales, the number of GP methadone prescribers has risen from a handful to over 200. Most treat their patients using their nursing, pathology and pharmacy staff, as they would for patients with other conditions. Most GPs have found it a very rewarding experience and there have been no 'horror stories' reported. One of the accompaniments has been a drug-user HIV incidence below 1%, compared with up to 50% in some foreign studies.

I was shocked to read that some British GPs are so busy that others must write their prescriptions. In addition, may I suggest that there is evidence for the benefit of other prescribed drugs in chemical dependence. Naltrexone, buprenorphine, disulfiram and even heroin itself have all shown some promise.

Andrew Byrne