A survey of community drug team prescribing policies and client views

Abstract

Aims and methods: A postal and telephone survey of 140 community drug teams in England and Wales was performed to survey existing prescribing policies for substitute prescriptions, including prevalence of supervised methadone consumption, use of methadone higher doses, injectables and prescribed benzodiazepines. Questionnaires were directed to the prescribing doctor. A second survey involved questionnaires distributed to clients at three community drugs teams in Essex. Participants were asked to comment on various aspects of prescribing policies.

Results: Results were obtained from 120 community drug teams (86%) and 104 clients who had received substitute prescribing. Around 22% of teams reported that methadone was supervised in a minority of new patients. Low doses (under 60 mg methadone per day) were rarely used (fewer than 10 patients) in 45% of services. Buprenorphine was prescribed in 97% of services. Fewer than half of community drug teams prescribed benzodiazepines (other than alcohol detoxification) or injectable drugs. A total of 104 responses were received from service users in Essex. The majority were opposed to supervised consumptions, although they were in broad agreement with other policies.

Conclusion: Regulations concerning supervised consumption of methadone are ignored in at least one-fifth of community drug teams. The opposition of service users to supervised consumption may lead to the continued popularity of methadone to take away in England and Wales. Service users in Essex were generally in agreement with other aspects of prescribing policy including the reluctance to use higher doses of methadone.

Keywords:

• Methadone
• opiate dependence
• prescribing policies
• user views
• community drug teams