One‐year follow‐up of opiate injectors treated with oral methadone in a GP‐centred programme

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Abstract
Aims. To examine changes in drug‐related behaviour in opiate‐dependent injectors treated with oral methadone, in a shared care scheme where consumption of the daily dose is usually supervised by a community pharmacist. Design. One‐year cohort study. Setting. Recruitment from the main routes into methadone prescribing in Glasgow during 1996: General Practitioner Drug Misuse Clinic Scheme and the Drug Problem Service. Participants. Current opiate injectors entering methadone treatment. Findings. Among the 204 injectors recruited, 148 (73%) were re‐interviewed at 6 months and 118 (58%) at both 6 and 12 months. Twenty‐nine per cent of the cohort remained continuously on methadone for 12 months. In that group, over the 12‐month period, self‐reported daily opiate injecting reduced from 78% to 2%; overdose in the previous 6 months from 24% to 2%; mean daily drug spend from £50 to £4; and mean monthly number of acquisitive crimes reduced from 13 to three. Assuming participants lost to follow‐up were unchanged, significant improvements in the total cohort were seen in daily opiate injecting (from 80% at recruitment to 43% at 12 months), overdose (from 27% to 15%), mean daily drug spend (from £63 to £38) and mean monthly number of acquisitive crimes (from 18 to 11). Discontinuation of treatment was mainly due to imprisonment (39%) or sanctions by the prescriber (33%). Conclusion. Treatment of opiate‐dependent drug injectors with methadone in a community‐wide general practitioner‐centred scheme, with supervised daily consumption, was associated with major beneficial change for a substantial proportion of patients.

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