The challenge of illicit drug addiction for general practice

Eighty-five drug misusers sought help and treatment from our central London practice in the 12 months between 1st November 1987 and 31st October 1988. They were all accepted for a short course of oral methadone reduction. At the end of the 12 months, according to the best information available from records, family, friends, neighbors, support agencies and patient reports, 19 (22%) were off all illicit drugs and 9 (16%) of those who had been unemployed at presentation had obtained regular employment. On average, our opiate misusers consumed 0.5 g of heroin daily at a daily street cost of approximately 40 pounds or 14,600 pounds annually. Sixty per cent of them admitted to financing their drug habit through criminal activities. Against the huge social cost of illicit drug misuse, the cost of providing primary health care to all these 85 addicts was 8% of each two doctors' consulting time at an annual cost of 2171 pounds per GP (25 pounds per hour of GP time). Thus for the methadone reduction programme for these 85 addicts to be judged effective based on cost alone, one would require a drug abstention ("success") rate of 0.003%.