Does methadone maintenance treatment based on the new national guidelines work in a primary care setting?
BACKGROUND
General practitioners (GPs) are being encouraged to treat more drug users but there are few studies to demonstrate the effectiveness of primary care treatment.


OBJECTIVE
To determine whether patients retained on methadone maintenance treatment for one year in a modern British primary care setting, with prescribing protocols based on the new national guidelines, can achieve similar harm reduction outcomes to those demonstrated in other settings, using objective outcome measures where available.


METHODS
Longitudinal cohort study.


METHODS
The Primary Care Clinic for Drug Dependence, Sheffield.


METHODS
The intervention consisted of a methadone maintenance treatment provided by GPs with prescribing protocols based on the 1999 national guidelines. The first 96 eligible consenting patients entering treatment were recruited; 65 completed the study. Outcome measures were current drug use, HIV risk-taking behaviour, social functioning, criminal activity, and mental and physical health, supplemented by urinalysis and criminal record data.


RESULTS
Frequency of heroin use was reduced from a mean of 3.02 episodes per day (standard deviation [SD] = 1.73) to a mean of 0.22 episodes per day (SD = 0.54), (chi 2 = 79.48, degrees of freedom [df] = 2, P < 0.001), confirmed by urinalysis. Mean numbers of convictions and cautions were reduced by 62% (z = 3.378, P < 0.001) for all crime. HIV risk-taking behaviour, social functioning, and physical and psychological wellbeing all showed significant improvements.


CONCLUSIONS
Patients retained on methadone maintenance treatment for one year in a primary care setting can achieve improvements on a range of harm reduction outcomes similar to those shown by studies in other, often more highly structured programmes.
Keen
Jenny
J
Institute of General Practice and Primary Care, University of Sheffield. J.Keen@sheffield.ac.uk
Oliver
Phillip
P
Rowse
Georgina
G
Mathers
Nigel
N
D000328:Adult; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data; D004739:England; D005194:Family Practice; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation* / Q000652:urine; D010352:Patient Dropouts / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012309:Risk-Taking; D016320:Substance Abuse Treatment Centers; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone