title: Methadone prescribing under supervised consumption on premises: a Scottish clinician's perspective on prescribing practice.
abstract: OBJECTIVE
  Specialist services have increased their capacity considerably in recent years to initiate and/or provide ongoing treatment for drug misuse. Consequently, methadone prescribing has substantially increased and over 17,000 patients are currently receiving methadone. Clinical guidance promotes consumption on the premises (COP) initially to ensure patients take medication as prescribed and also to prevent diversion. Diversion poses two risks: the patient may remain under-treated and continue illicit heroin use; diverted drugs put others at risk. However, COP can be restrictive. Current UK guidance is vague and not evidence-based recommending 'around three months subject to assessment of compliance and individual circumstances'. The overall aim of this study was to describe clinical practice regarding prescribing methadone under COP in Scotland, and reasons for this. Design and Methods. A structured, postal questionnaire was sent to all lead clinicians in specialist drug treatment centres in Scotland in 2009 (n=42). The questionnaire explored current practice, influence of supervision on retention, views of best practice and contingency management.
  
  
  RESULTS
  The response rate was 76% (n=32). Clinicians usually supervise for a minimum of three months with patient-centred criteria used to determine when to reduce or stop COP. Employment, clinical stability, family support and concerns for the safety of children in the home influenced decision making. Contingency management approaches to supervision were widely used (62%).
  
  
  CONCLUSIONS
  In Scotland, clinicians' practice is variable and individualised to patients, but generally cautious regarding relaxing supervision conditions. This may reflect the lack of evidence-based guidance.
authors: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK. g.b.anthony@abdn.ac.uk
authors: Geraldine B
authors: GB
authors: Anthony
authors: Catriona I
authors: CI
authors: Matheson
authors: Richard
authors: R
authors: Holland
authors: Christine
authors: C
authors: Bond
authors: Kennedy
authors: K
authors: Roberts
authors: Anne Mac
authors: AM
authors: Rae
authors: Eddie
authors: E
authors: Whitelaw
authors: Saket
authors: S
authors: Priyadarshi
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D012606:Scotland
chemical_list: D009292:Narcotic Antagonists; D055553:Prescription Drugs; D008691:Methadone