Opiate addiction and overdose: GP training in Ireland
Ireland shares a high rate of opiate addiction with countries throughout Europe; GPs play a key role in providing opiate substitution therapy following specialist stabilisation. Ireland also has a high rate of opiate overdose death among opiate dependent patients - more deaths happen than in all road accidents each year. Naloxone is an effective overdose treatment but is limited to use by doctors, nurses and paramedics. A policy initiative to allow lay access to naloxone is being developed but the role of general practice is unclear. As part of a wider project on the role of general practice in opiate addiction, we surveyed doctors in specialist training for general practice to inform the implementation of any GP- based distribution system.
Methods: Questionnaire survey to all attending the 2015 national GP trainees conference, covering training/experience in addiction and overdose, attitudes to naloxone availability and a standardised addiction training needs assessment.
Results: Response rate 61.8% (136/220), representing around 20% of all GP trainees and 25% of 3rd / 4th year trainee in Ireland. Trainees have little exposure to opiate dependency in their training practices - 12.7% of training practices provide Opiate Substitution Therapy, over 60% have no or <10 opiate dependent patients and only 10% of trainees have completed the ICGP Substance Misuse Course (required to prescribe OST). However, 60.9% (80/132) had previously administered naloxone in opiate overdose, almost all in hospital posts.Most trainees (63.6%) were in favour of wider naloxone distribution. Half would consider taking part in a naloxone distribution project. However, many trainees reported training needs and believed their competence in addiction care was only moderate.
Discussion: Trainees have little structured training in opiate addiction care in general practice and very limited exposure to OST / addiction care in training practices. Trainees are supportive of overdose prevention interventions and have significant exposure to overdose in hospital medicine. The deficiencies in training and preparation for general practice in relation to a key public health issue must be urgently addressed.