GP attitudes to managing drug- and alcohol-dependent patients: a reluctantrole

The aim of this study was to determine the experience, confidence and views of GPs in South west Sydney towards managing drug and alcohol dependence a nd their interest in participating in shared care methadone prescribing. Fi ve hundred and forty-eight GPs were mailed a self complete questionnaire, N on-responders were followed-up by telephone. Seventy-six per cent of GPs re sponded; 52% considered methadone maintenance to be effective. GPs were mor e confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fai rfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patien ts referred to them. GPs who had more patients on methadone in their practi ce (especially those in Fairfield and Liverpool) considered methadone effec tive and were more likely to be interested in having patients referred to t hem. The most frequent reasons for not being interested were concerns about patients being demanding or aggressive or the impact on their practice, Th e most frequently requested support for shared care prescribing was for 24- hour back-up from specialist services, especially requested by those with l ess experience with patients on methadone. A shared-care approach to facili tating greater GP involvement in prescribing appears feasible, especially a mong GPs with some precious experience with patients on methadone.