The paper by Dr Jenny Keen and colleagues,1 covered in your news section recently, is excellent (‘Methadone maintenance guide-lines improve outcomes in primary care’, Guidelines in Practice, June 2003). It shows what can be achieved in primary care based research and what can be accomplished by a well run methadone substitution scheme in general practice.
Central to the success of the Sheffield clinic appears to be the committed involvement of GPs with a special interest, who successfully implemented national guidelines with support from specialist nursing staff and local pharmacists who supervised methadone dispensing.
Highly significant reductions in patients’ heroin use, risk behaviours such as injecting, and criminal involvement were seen during the study period. Patients also showed marked improvement in their psychological and physical health. Overall drop-out rates were relatively low for a treatment scheme for heroin users, at 35% over one year.
I often struggle with the concept of evidence-based medicine in general practice, both in my GMS work and in managing problem drug use. There seems to be no study-based evidence either for or against most things I do in practice. What evidence there is comes in the main from highly structured secondary care settings, very different from the environment in which I work.
Dr Keen’s paper addresses both issues very well. It describes a treatment service for drug users in primary care which is instantly recognisable to me, and shows excellent outcome statistics. I feel supported by the evidence presented, and encouraged by Dr Keen and her collaborators.
Dr Jez Thompson, GP, Leeds
- Keen J, Oliver P, Rowse G, Mathers N. Does methadone maintenance treatment based on the new national guidelines work in a primary care setting? Br J Gen Pract 2003; 53: 461-7.