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More ‘hands-on’ training needed on methadone prescribing

Dr Patrick Troy, a GP working in addiction services in west Dublin, told the Medical Independent (MI) that some GPs grant “‘take-aways’ or privileges” to patients “who then sell their surplus of methadone on the streets”.

He said he was not inferring incompetence on GPs and that even some experienced GPs in addiction clinics were also at fault for inappropriate, unsupervised dosing.

Many addicts view doctors as a potential source of supply and all methadone-prescribing GPs should be directly exposed to patients during training, he said.

Dr Troy suggested that the ICGP entry-level course for prescribing methadone in general practice should include an “on-the-ground” element  among the steps to help mitigate diversion. The Foundation Course in Substance Misuse can be completed online in around three hours and qualifies GPs to treat stabilised, opiate-dependent patients in their own practice.

Dr Ide Delargy, Director of the ICGP Substance Misuse Programme, told MI that the foundation course provides GPs and GP registrars with a “broad introduction” to substance misuse.

It is desirable for all GPs/registrars to complete this course and it is compulsory for those wishing to treat stabilised, opiate-dependent patients in their own practice, she said.

“We are not asking [level one] GPs to take on complex patients; we are asking them to take on patients that are known to their practice, are on their practice lists, and are stable,” Dr Delargy noted.

Level two training (Substance Misuse and Associated Health Problems Certificate Course) runs for six months and includes workshops, e-learning modules and a practice improvement project. Level two GPs can initiate treatment. GPs in HSE addiction clinics are not required to undertake either course, although it is recommended.

Dr Delargy acknowledged that a certain amount of methadone becomes available on the street.

“But I think all prescribers, including HSE prescribers in clinics, need to be mindful when they are prescribing as to the safety of methadone and to ensure that the person they are prescribing to is capable and willing to mind that methadone if they are giving patients doses to take home,” she added.

A recent study identified “overwhelmingly positive” GP attitudes towards the methadone treatment programme, stated Dr Delargy.

See feature on p12-14

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