Substance-misusing patients in primary care: incidence, services provided and problems. A survey of general practitioners in Wiltshire

This research aimed to discover the monthly incidence of patients misusing illicit drugs or alcohol seen by general practitioners; services provided; difficulties encountered; and general practitioner willingness. The total population of general practitioners (n = 210) in the Health Commission for Wiltshire was sent a postal questionnaire: 49% responded (n = 103), and 10% of respondents were interviewed. The number of alcohol-misusing patients seen per month was much higher than illicit drug-misusing patients: 46% of respondents saw fewer than one patient for prescribed opiates, and 71% saw fewer than one solvent misuser, per month; in contrast, only 7% of respondents saw fewer than one alcohol-misusing patient per month. Ninety-two per cent of general practitioners provided general medical services for alcohol misusers, and 86% for illicit drug misusers. Fifty-four per cent of respondents provided substitute medication for illicit drugs, while 42% provided detoxification medication for illicit drugs. Sixty-five per cent provided medication for alcohol detoxification. Difficulties encountered included missed appointments, time-wasting, aggressive behaviour, communication difficulties and upset to other patients. Twelve per cent of general practitioners were willing to provide more services for illicit drug users, compared with 27% for alcohol users. The greater unwillingness to work with illicit drug users appeared disproportionate to the number previously encountered Interventions to improve the situation for general practitioners and substance-misusing patients are discussed.