Specialist clinicians' practice and views regarding methadone/buprenorphine supervision and contingency management: a national survey

Abstract

Aims and methods: The aim of the study was to determine the current models of supervised consumption of methadone/buprenorphine practised, and to establish the extent to which contingency management is used, and in what forms. A postal questionnaire was sent to all lead specialist clinicians in the field of substance misuse in England in 2010 (n = 194).

Results: The response rate was 66% (n = 129). Clinicians generally supervised patients for a period of 3 months, although considerable flexibility was used depending on individual circumstances. The majority of patients consumed their methadone/buprenorphine on pharmacy premises 6 d per week. Supervised consumption arrangements were believed by respondents to cause a minority of patients to drop out of treatment and prevent a minority from starting treatment. Contingency management is widely used throughout England, with the most common forms relating to changes in supervision or dispensing arrangements.

Conclusion: There is marked heterogeneity in clinicians’ practice of supervised consumption, suggesting uncertainty regarding the optimal approach. Further research, such as an RCT, is required.

• Contingency management
• opiate dependence
• supervised consumption

Acknowledgements

The authors would like to thank the clinicians who took the time to complete a questionnaire and Drug Action Team coordinators and others who took the time to provide contact details of clinicians.

Declaration of interest

This study was conducted as part of a final year honours thesis and formed part of a wider programme of work into the practice of supervision and contingency management in opiate maintenance treatment. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.