GP attitudes to managing drug- and alcohol-dependent patients: a reluctant role

The aim of this study was to determine the experience, confidence and views of GPs in South west Sydney towards managing drug and alcohol dependence and their interest in participating in shared care methadone prescribing. Five hundred and forty-eight GPs were mailed a self complete questionnaire, Non-responders were followed-up by telephone. Seventy-six per cent of GPs responded; 52% considered methadone maintenance to be effective. GPs were more confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fairfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patients referred to them. GPs who had more patients on methadone in their practice (especially those in Fairfield and Liverpool) considered methadone effective and were more likely to be interested in having patients referred to them. The most frequent reasons for not being interested were concerns about patients being demanding or aggressive or the impact on their practice, The most frequently requested support for shared care prescribing was for 24-hour back-up from specialist services, especially requested by those with less experience with patients on methadone. A shared-care approach to facilitating greater GP involvement in prescribing appears feasible, especially among GPs with some precious experience with patients on methadone.