Prescribing and dispensing for drug misusers in primary care: current practice in Scotland

Background. Substitute prescribing has increased in Scotland, as in the res t of the UK. Both GPs and pharmacists are becoming increasingly involved in service provision for drug misusers, but anecdotal evidence has suggested considerable variation in prescribing and dispensing practice. Objective. We aimed to gain baseline data on (i) current prescribing practi ce by medical practitioners and drug agencies, (ii) dispensing practice by community pharmacists across Scotland for the management of drug misuse and (iii) variations in practice between health boards. Methods. A structured questionnaire was posted to all community pharmacies in Scotland (n = 1142), in order to gather information on prescribing from prescriptions held at the time of the survey and information on current dis pensing practice in managing drug misusers. Results. The response rate was 79%. Sixty-one per cent of pharmacists were currently dispensing drugs for the management of drug misuse. The most freq uently prescribed drug was methadone, dispensed by 46% of pharmacists, foll owed by diazepam (37%), dihydrocodeine (26%) and temazepam (25%). Sixty-fiv e per cent of methadone prescriptions were dispensed daily on request from the prescriber. Of the 3387 people receiving a methadone prescription, 32.9 % had to consume their daily dose on the pharmacy premises under a pharmaci st's supervision. Nineteen per cent of pharmacies currently provided a serv ice to supervise the consumption of methadone by clients and a further 14% were prepared to but had no current demand. The proportion of prescriptions requiring supervision of methadone consumption varied considerably between health board areas. Conclusions. Methadone is the most widely prescribed drug for drug misuse a cross Scotland, but there is considerable variation between health board ar eas in how prescribing is managed. Prescribing practice should be revised l ocally, in a process involving GPs and pharmacists. Pharmacists have an imp ortant role in preventing drug misuse in primary care, but need further sup port to optimize good practice.