Existing guidelines for those working with opiate users are controversial and heavily criticised, and a report seen by MI recommends a radical overhaul of how services are delivered.
The struggle to both balance the books and keep the health services afloat is an all consuming one. Drug addiction services are perhaps one of the casualties of this focus. Although recent figures compiled by the Health Research Board (HRB) said the annual number of drug-related deaths and deaths among drug users in Ireland decreased from 652 in 2009 to 575 in 2010, problems remain.
Budget reductions, a continued scarcity of services outside the capital, and concern over the ICGP’s opiate treatment guidelines have combined to make a difficult area of medicine even more challenging.
The ICGP’s 2008 guidelines Working with Opiate Users in Community Based Primary Care have deeply concerned GPs working in addiction since their publication. A number of issues with the guidelines – its impact on patient care, the frequency and efficacy of urine tests, the reduction in methadone doses, and complaints about lack of consultation – became major sources of contention.
However, the controversy has taken another turn in recent days. The Medical Independent (MI) has seen a copy of the yet unpublished ICGP-commissioned Evaluation of the Audit of the Methadone Treatment Protocol in Ireland. The document makes recommendations, which if followed, will radically change methadone treatment practices and governance structures in Ireland.
Following interviews with GPs and other interested groups, the evaluation team, led by Dr Saket Priyadarshi, Senior Medical Officer, Greater Glasgow and Clyde Addiction Services, carried out the review last May.
The evaluation found that the audit’s criteria were seen as “not currently evidence based, not conforming to practice in most other countries...inflexible and in some cases may be restrictive to recovery and person centred care. They are based on the 2008 guidelines, but not consistent with current evidence base”.
Source: James Fogarty, medicalindependent.ie, 14/03/2011
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