[General practitioner views on drug-assisted rehabilitation and the Norwegian substance abuse reform].
BACKGROUND
Due to increased use of injected heroin in Norway the official policy has shifted from an ideal drug-free position to a more realistic harm reduction, where one element is substitution therapy. This implies controlled distribution of opiates, methadone and buprenorfine to selected individuals, combined with close follow-up and social rehabilitation. After the "substance abuse reform" was implemented in 2004, a number of treatment facilities have been included in the ordinary specialist health care system, and the clients who can document their right to <<necessary health support>> have obtained ordinary patient rights according to the Patients Rights Act. General practitioners are supposed to follow up these patients, by prescribing opiates to those eligible for substitution therapy, and by participating in local <<responsibility groups>>. We wanted to investigate how general practitioners' perceive their involvement in substitution therapy, and to see whether this view had changed from 2000 to 2006.


METHODS
Postal questionnaires were sent to 1606 doctors in 2000 and to 1400 of the same doctors in 2006. Of the 1318 (82 %) who responded in 2000, 227 were general practitioners and 78 were municipal medical officers; of the 966 (69 %) who responded in 2006, 227 were regular general practitioners. 208 of these had also responded in 2000. In 2006 we also asked the doctors about the recent substance abuse reform.


RESULTS
53 % of the general practitioners were in favour of substitution therapy with methadone or buprenorfine; 50 % said they might prescribe the drugs themselves and 77 % were positive towards participating in "responsibility groups". Two thirds felt that transferral of responsibility for patients with substance abuse problems to the specialist health care service, was a necessary and useful reform. The fraction of doctors with a positive attitude towards substitution therapy increased slightly from 2000 to 2006, but individual viewpoints varied largely.


CONCLUSIONS
Political and cultural rather than medical arguments seem to dominate doctors' views on these issues.
Aasland
Olaf Gjerløw
OG
olaf.aasland@legeforeningen.no Legeforeningens forskningsinstitutt Postboks 1152 Sentrum 0107 Oslo og Institutt for helseledelse og helseøkonomi Universitetet i Oslo.
Spilhaug
Guri
G
Johannesen
Arne
A
D000328:Adult; D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000008:administration & dosage; D005194:Family Practice; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D009294:Narcotics / Q000008:administration & dosage*; D009664:Norway; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012944:Social Support; D011795:Surveys and Questionnaires
D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone