DO GENERAL-PRACTITIONERS AND GENERAL PSYCHIATRISTS WANT TO LOOK AFTERDRUG MISUSERS - EVALUATION OF A NONSPECIALIST TREATMENT POLICY

A new means of monitoring drug misuse which was developed in the north west of England, but is now widely used throughout the United Kingdom , is described and evaluated. Report forms which had been specially de signed and ensured the anonymity of drug misusers were widely distribu ted among doctors and non-medical health workers who may have had cont act with drug misusers. The forms were returned post-free to a centre where they were entered on a customized drug misuse database. There we re 2127 reports from the north west of England (population 3.99 millio n) relating to 1792 individuals over a 15-month period. However, despi te intensive promotion of the project among doctors, the number of rep orts from doctors remained virtually unchanged over the 15 months desp ite a 33% increase in the overall number of reports. When the reports from three health districts, selected so as to be representative of th e region demographically (total population 658500, population aged 15- 44 years 292200), were considered there was a substantial fall (70%) i n reports from general practitioners which was considerably greater th an the 2% fall in all reports. In a linked study all the psychiatrists , 30% of probation officers and a one in six sample of general practit ioners from the three selected health districts were approached for in terview at the beginning of the 15-month period and again a year later . This structured enquiry about caseloads, treatment, and attitudes al so revealed a fall in the number of drug misusers attended by general practitioners and general psychiatrists and a reduction in the service s provided for them by general practitioners. These findings raise dou bts about the viability of national policies which expect unsupported general practitioners or general psychiatrists to be the first line of treatment for drug misusers.