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Trends of people using drugs and opioid substitute treatment recorded in England and wales general practice (1994-2012).

Davies HR, Nazareth I, Petersen I - PLoS ONE (2015)

Bottom Line: Reduction of overall illegal drug use in England and Wales has decreased from 11% to 8.2% (2012/13) over the past 10 years.Overall, males (IRR 2.02, 95% CI:1.97-2.07), people in the age-group; 16-24 (IRR 6.7, 95% CI:6.4-6.9) compared to those over 25 years and the most deprived (IRR 4.2, 95% CI:3.9-4.4) were more likely to have a recording of drug use.Most drug users do not receive treatment in primary care.

View Article: PubMed Central - PubMed

Affiliation: University College London Department of Primary Care and Population Health, Rowland Hill Street, London, NW3 2PF, United Kingdom.

ABSTRACT

Background: Illicit drug use is a multifaceted public-health problem with potentially serious impacts. The United Kingdom has one of the highest prevalence of illegal drug use in Europe. Reduction of overall illegal drug use in England and Wales has decreased from 11% to 8.2% (2012/13) over the past 10 years. People who use drugs often seek help from their family doctors.

Aims: To investigate General Practitioners (family doctors) first recording of drug use and opioid substitute treatment in primary care settings.

Design: A descriptive study design. Males and females (16-64 years old) were extracted from The Health Improvement Network (THIN) database.

Setting: England and Wales primary care.

Method: The first recording of drug use and opioid substitution treatment in primary care was estimated for the period (1994-2012). Poisson regressions were conducted to estimate incidence risk ratios (IRR).

Results: We identified 33,508 first recordings of drug use and 10,869 individuals with prescriptions for opioid substitute treatment. Overall, males (IRR 2.02, 95% CI:1.97-2.07), people in the age-group; 16-24 (IRR 6.7, 95% CI:6.4-6.9) compared to those over 25 years and the most deprived (IRR 4.2, 95% CI:3.9-4.4) were more likely to have a recording of drug use. Males (IRR 1.2 95% CI:1.2-1.3), in the age-group; 25-34 (IRR 1.8 95% CI:1.7-1.9) and the most deprived (IRR 3.9 95% CI:3.6-4.3) were the groups more likely to have a opioid substitute treatment prescription.

Conclusion: It is evident from this study that there is little recording of drug use and opioid substitute treatment in primary care. Most drug users do not receive treatment in primary care.

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Related in: MedlinePlus

Adaptation of Access to Health care pyramid.
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pone.0122626.g004: Adaptation of Access to Health care pyramid.

Mentions: The main strength of this study is that THIN provides a large amount of data from real life primary care. This study, however, merely examines data that has been captured in primary care and is not attempting to estimate a community incidence of the problem. There are some limitations to our study. Firstly this study only covers individuals who have been in contact with their GP in regards to their drug use. Many people use drugs for recreational use and only a small percentage become problem drug users [5]. Drug use is stigmatised and discriminated against in society [27]. This stigma may continue when drug users seek help for either stopping their addiction or for obtaining replacement therapy [27]. Patients, therefore, may decide not to disclose this information to a health professional. Disclosure may however occur when the drug users’ behaviour causes harm and functional impairment [27]. GPs are also aware that the patient-doctor relationship could be compromised if the patient is coded as a drug user [28]. The majority of opioid substitute treatment for drug use occurs in the community drug clinics, only a small proportion reach primary care and even a smaller proportion are recorded electronically [5,29] (See Fig 4). Self-referral (40%) to community drug clinics is more common than GP referral (6%) [5]. Due to patient confidentiality, the patients’ details from self-referrals are not always shared with the GP. The GPs are therefore not always aware when an individual receives treatment and the treatment would not be recorded in their patient records [5].


Trends of people using drugs and opioid substitute treatment recorded in England and wales general practice (1994-2012).

Davies HR, Nazareth I, Petersen I - PLoS ONE (2015)

Adaptation of Access to Health care pyramid.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414600&req=5

pone.0122626.g004: Adaptation of Access to Health care pyramid.
Mentions: The main strength of this study is that THIN provides a large amount of data from real life primary care. This study, however, merely examines data that has been captured in primary care and is not attempting to estimate a community incidence of the problem. There are some limitations to our study. Firstly this study only covers individuals who have been in contact with their GP in regards to their drug use. Many people use drugs for recreational use and only a small percentage become problem drug users [5]. Drug use is stigmatised and discriminated against in society [27]. This stigma may continue when drug users seek help for either stopping their addiction or for obtaining replacement therapy [27]. Patients, therefore, may decide not to disclose this information to a health professional. Disclosure may however occur when the drug users’ behaviour causes harm and functional impairment [27]. GPs are also aware that the patient-doctor relationship could be compromised if the patient is coded as a drug user [28]. The majority of opioid substitute treatment for drug use occurs in the community drug clinics, only a small proportion reach primary care and even a smaller proportion are recorded electronically [5,29] (See Fig 4). Self-referral (40%) to community drug clinics is more common than GP referral (6%) [5]. Due to patient confidentiality, the patients’ details from self-referrals are not always shared with the GP. The GPs are therefore not always aware when an individual receives treatment and the treatment would not be recorded in their patient records [5].

Bottom Line: Reduction of overall illegal drug use in England and Wales has decreased from 11% to 8.2% (2012/13) over the past 10 years.Overall, males (IRR 2.02, 95% CI:1.97-2.07), people in the age-group; 16-24 (IRR 6.7, 95% CI:6.4-6.9) compared to those over 25 years and the most deprived (IRR 4.2, 95% CI:3.9-4.4) were more likely to have a recording of drug use.Most drug users do not receive treatment in primary care.

View Article: PubMed Central - PubMed

Affiliation: University College London Department of Primary Care and Population Health, Rowland Hill Street, London, NW3 2PF, United Kingdom.

ABSTRACT

Background: Illicit drug use is a multifaceted public-health problem with potentially serious impacts. The United Kingdom has one of the highest prevalence of illegal drug use in Europe. Reduction of overall illegal drug use in England and Wales has decreased from 11% to 8.2% (2012/13) over the past 10 years. People who use drugs often seek help from their family doctors.

Aims: To investigate General Practitioners (family doctors) first recording of drug use and opioid substitute treatment in primary care settings.

Design: A descriptive study design. Males and females (16-64 years old) were extracted from The Health Improvement Network (THIN) database.

Setting: England and Wales primary care.

Method: The first recording of drug use and opioid substitution treatment in primary care was estimated for the period (1994-2012). Poisson regressions were conducted to estimate incidence risk ratios (IRR).

Results: We identified 33,508 first recordings of drug use and 10,869 individuals with prescriptions for opioid substitute treatment. Overall, males (IRR 2.02, 95% CI:1.97-2.07), people in the age-group; 16-24 (IRR 6.7, 95% CI:6.4-6.9) compared to those over 25 years and the most deprived (IRR 4.2, 95% CI:3.9-4.4) were more likely to have a recording of drug use. Males (IRR 1.2 95% CI:1.2-1.3), in the age-group; 25-34 (IRR 1.8 95% CI:1.7-1.9) and the most deprived (IRR 3.9 95% CI:3.6-4.3) were the groups more likely to have a opioid substitute treatment prescription.

Conclusion: It is evident from this study that there is little recording of drug use and opioid substitute treatment in primary care. Most drug users do not receive treatment in primary care.

Show MeSH
Related in: MedlinePlus