General practitioners and opioids agonists treatment

Abstract:
Primary health care clinics and general practitioners (GPs) together with specialised substitution treatment centres represent the major providers of opioid substitution (maintenance) treatment in substantial number of European countries. No research has focused on the substitution treatment in Czech general practitioners´ offices until now, even though general practitioners are allowed to prescribe buprenorphine (Subutex) since 2001. Aim of the study: To gain data about experience of GPs with substitution treatment as well as with patients in substitution treatment, and about attitudes and needs of the Czech GPs in relation to the substitution treatment. Method: Structured questionnaire has been distributed to GPs via Bulletin of the Society of General Practitioners and via district representatives of this Society. 398 questionnaires have been returned by mail (respondence rate was low – 10 %), thus a reporting bias might decrease the validity of study results. Results: 28 (7 %) general practitioners have own experience with the buprenorphine prescription. The percentage is higher in Prague and region of Ústí nad Labem (27 %, 12 % resp.) – the regions with the highest prevalence of problem heroin use in the Czech Republic. The percentage in other regions is lower (0-6 %), including the regions with relatively high prevalence of heroin problem use of western and southern Bohemia. Own experience of GPs with substitution prescription practice are largely positive or very positive (78 %). The main perceived pros are the availability and effectiveness of the treatment. One third of the general practitioners without own experience in substitution treatment (prescription) is positive when asked if they would like to perform it in future. More information about drug abuse issues, methodological support, and good availability of specialists for consultations are seen as the most important factors for future implementation of prescription in their own practice. The obligatory reporting of the patients in opioid substitution treatment to the central register is not considered as a substantial obstacle for introduction of opioid substitution treatment by general practitioners. Decision makers should use the potential of GPs to increase availability of the opioid substitution treatment in the Czech Republic.