Characteristics of drug-using patients and treatment provided in primary and secondary settings

Background: The expansion of drug treatment services has outstripped the capacity of specialist prescribers in the UK, and GPs have increasingly been recruited as prescribers of substitution therapies. Local circumstances have usually dictated the exact model of service provision used. Objectives: To explore the differences in patient groups served and treatment offered by primary and secondary care services in the city of Birmingham. Method: Treatment staff in all statutory and non-statutory agencies were interviewed about the demographic details of all active patients, the treatment that each patient was receiving and their level of drug-related problems. Results: 1597 patients were being treated by drug treatment services, with 577 (36.1%) of these under the care of the primary care-based agency. Patients treated in primary care were significantly younger (mean age 30.3 vs. 34.1 years), more likely to be male (77.1 vs. 70.5%), and had fewer drug related problems (mean CISS=6.9 vs. 8.5). A higher percentage of primary care patients were receiving a prescription for opioid maintenance therapy (73.7 vs. 64.9%), with a greater proportion of these (21.4 vs. 10.0%) receiving buprenorphine, rather than methadone. There was no significant difference in the mean doses of methadone or buprenorphine received in primary or secondary care. Conclusions: The differences between the primary and secondary care settings were smaller than expected, although were predominantly in the expected direction. Less than half of the patients with CISS scores of 6 or less were being treated in primary care. The results provide a baseline against which the role of primary care provision in substance misuse treatment can be evaluated.