Opiate addiction, overdose and lay access to naloxone: the views of GPs in Ireland

Problem

Ireland shares a high rate of opiate addiction with countries throughout Europe; GPs play a key role in providing Opiate Substitution Therapy (OST) 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 GPs in Ireland to inform the implementation of any GP- based distribution system. Ireland has approximately 2,600 GPs in practice.

Approach

In late 2015, all 714 GPs affiliated with Academic General Practice, UCD were invited to complete an anonymous postal survey.

Findings

448/714(62.7%) responded; over 95% are principals in GP. Roughly equal thirds practice in urban, rural and mixed areas throughout Ireland. 31% report completing the ICGP Substance Misuse course (required for OST), 25% prescribe OST and 75.3% of their practices have opiate addicted patients. 53% support wider naloxone availability and 31% would take part in such a scheme. Clear distinctions emerge between those who provide OST (who are significantly more likely to be supportive of lay naloxone availability) and those who do not.Respondents identified intranasal naloxone as a much more acceptable lay route of delivery than traditional injected preparations.

Consequences

Our survey indicates wide experience with opiate dependent patients but limited addiction training and methadone prescribing among GP principals. While wider naloxone availability is supported, interest is largely confined to those GPs already engaged in OST; addicted patients and their families attending other GPs should not be excluded from any initiative to reduce deaths from opiate overdose in the community. Policy initiatives to widen naloxone availability should address these issues.