General practice or drug clinic for methadone maintenance? A controlled comparison of treatment outcomes

The model for management of opiate dependence in the United Kingdom includes long term methadone maintenance. A consequence is either long waiting lists for treatment or that treatment capacity is expanded. General practitioners are encouraged to prescribe methadone for opiate dependent patients, but little is known about the differences between patients or outcomes in primary or secondary care settings. This paper compares patients' characteristics and treatment outcomes in a specialist drug clinic and a general practice operating a shared care policy (with the specialist clinic). We undertook a retrospective review of patient records. All patients prescribed methadone maintenance during a 2 year period in one general practice were compared with one in three patients treated at a drug clinic during the same period. Outcome was determined at the end of a treatment episode or on 30 June 1997 (whichever was sooner). Eighty-nine drug clinic and 36 general practice patients were followed up for a minimum of nine months each. Patient characteristics were similar at the start of treatment. A 'good' outcome (remaining in treatment or becoming drug free) was equally likely in either setting. Patients treated in the general practice setting were significantly more likely to be immunised (or have known natural immunity) against hepatitis B (adjusted odds ratio 6.0). Our findings suggest that with similar patient groups this model of care in general practice can produce results at least as good as those of a drug clinic.