Training for doctors ‘essential’ to expanding Naloxone Programme into General Practice in Scotland
12 February 2013
GP awareness of Scotland’s Naloxone programme is “minimal”, with training for GPs being essential prior to expanding the national programme into General Practice, according to a new report published today.
Many GPs feel insufficiently skilled or knowledgeable to be involved in the national training and provision initiative launched more than two years ago to help reduce drug-related deaths, says the new report General Practitioner Engagement with the Scottish National Naloxone Programme: A Needs Assessment Project.
The study says that the possibility of opportunistic intervention for reducing Drug Related Deaths –including through Naloxone provision – among GPs seemed to be “off their radar” – despite GPs being in an “ideal position” to direct patients to Naloxone training and supply schemes or provide the service themselves.
A key barrier is the typecasting of Naloxone prescribing as a specialist service that only specialists should provide, according to General Practitioner Engagement with the Scottish National Naloxone Programme: A Needs Assessment Project.
The survey of over 200 GPs by researchers from the University of Aberdeen research team found “negative attitudes to drug users were generally evident”.
Their report calls for the “potential stigmatisation” of drug users as a patient group to be reviewed. This call comes less than a month after the British Medical Association highlighted doctors’ possible reluctance to work with stigmatised drug and alcohol users in a section on Doctors' duty to deal with drug users in a major report Drugs Of Dependence: The role of medical professionals.
However, there were “tentative and encouraging signs” that GPS would be willing to be more involved in Naloxone distribution if certain enablers were addressed, said the report.
Most important of these was evidence-based training, which was “recognised by GP respondents as essential.”
“From interviews it became apparent that GPS were not really aware of what primary care Naloxone provision may involve,” said the report, commissioned to identify at national level the best ways to enable GPs to engage effectively with the national Naloxone programme which was launched in November 2010.
“GPs tend to classify Naloxone distribution as a specialist services and therefore assume it’s not part of their remit.
“Even those with higher involvement or specialist training in substance misuse considered this a service that is not necessarily relevant to them.
“Almost as a default response, many GP respondents considered that current practice of specialist services delivering Naloxone as part of current shared care arrangements seemed to be the preferred choice.
“Further comments made in interviews and written comments as to why some people are not prepared to prescribe Naloxone suggested attitudinal barriers towards drug users more generally.”
The report states:
Material for GPs on Naloxone distribution should emphasise it is a lifesaving medication and there is a good evidence base to support the national programme
There should be a range of training and information resources to meet the mixed needs of GPs – both online and local evening training sessions are essential
Targeted training to practices not part of a shared care scheme in areas of known drug use may be required
Training for GPs should cover practically aspects of Naloxone administration, risk factors for DRDs and address GPS expressed concerns
There should be an in-depth exploration of stigmatisation of drug users by other GPs and other generalist health professionals to enable the delivery of a reduction in DRDs and Scotland’s recovery-based drug strategy
Further research is required to test novel approaches to changing ‘entrenched’ negative attitudes towards drug users generally
Enhanced care for substance use problems should include running Naloxone training sessions for known drug users in a practice
All GPs should be made aware that Naloxone packs can be prescribed/supplied, on an opportunistic basis, to any drug users considered at risk – it must be emphasised this is not a specialist service.