Muirhouse Medical Group is a NHS general practice in a deprived area of Edinburgh that has, since the early 1980s, had a large caseload of young patients with addiction problems. Initial efforts to develop a practical response was characterised by, what would now be considered, inadequate prescribing. A range of medications were prescribed but results were poor and relapse into injecting heroin was the norm. When a serious engagement with longer term prescribing of adequate doses of opiates such as methadone and dihydrocodeine was employed, the situation improved. Lessons from visits to Amsterdam and New York City, and the emergence of Hepatitis B and HIV in the practice population, concentrated prescribing on opiate substitution by 1986. Since then a series if improvements have allowed the establishment of a policy of support for a local population of dependent patients.
Historical data is available for over 1000 patients with injecting drug use histories, of whom over 300 are now dead. Currently this practice has over 400 drug dependent patients at any time. The discussion will include a breakdown of cases by age, gender, year of first injection and medication prescribed by dose, length of use and outcome. Details of co-morbid problems such as blood borne virus infection and causes of death over the long time period will also be analysed. Description will be included of a community based system which has specialist support and CPN case workers in addition to general practitioners which allows time for training and teaching.
Primary care and general practice is an effective and comprehensive place to support a long term multidimensional problems such as addiction. This practice has, in many ways, proved to be a resource for teaching, research and policy making in Scotland and more widely.
Dr Roy Robertson