Methadone prescribing under supervised consumption on premises: A Scottish clinician's perspective on prescribing practice

Introduction and Aims. 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 gui...

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Published in:	Drug and alcohol review Vol. 31; no. 3; pp. 342 - 347
Main Authors:	ANTHONY, GERALDINE B., MATHESON, CATRIONA I., HOLLAND, RICHARD, BOND, CHRISTINE, ROBERTS, KENNEDY, RAE, ANNE MAC, WHITELAW, EDDIE, PRIYADARSHI, SAKET
Format:	Journal Article
Language:	English
Published:	Melbourne, Australia Blackwell Publishing Asia 01-05-2012
Subjects:	Attitude of Health Personnel Consumption Contingency learning Cross-Sectional Studies drug misuse Female Guidance Health Care Surveys Heroin Dependence - rehabilitation Humans Male Methadone Methadone - therapeutic use Narcotic Antagonists - therapeutic use pharmacy Practice Patterns, Physicians' - statistics & numerical data Prescribing Prescription Drugs Scotland supervision Scotland
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Summary:	Introduction and Aims. 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%). Discussion and Conclusion. 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.[Anthony GB, Matheson CI, Holland R, Bond C, Roberts K, Mac Rae A, Whitelaw E, Priyadarshi S. Methadone prescribing under supervised consumption on premises: A Scottish clinician's perspective on prescribing practice. Drug Alcohol Rev 2012;31:342–347]
Bibliography:	ArticleID:DAR316 ark:/67375/WNG-6288KLHP-L istex:A9B9B8F4CB577E3ED8D6DA4FDB0F9250A5BBB81D ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0959-5236 1465-3362
DOI:	10.1111/j.1465-3362.2011.00316.x