April 2011


Opioid substitution therapy

A study of GP participation in prescribing

Volume 40, No.4, April 2011 Pages 241-245

Jane Scarborough

Jaklin Eliott

Annette Braunack-Mayer


Opioid substitution therapy (OST) is the most commonly provided treatment for heroin dependence in Australia and has been shown to be effective. Access to OST outside of specialised public clinics and prisons relies on the participation of general practitioners. In Australia there is a shortage of GPs available to prescribe OST, which results in an unmet need for OST services. Studies have reported barriers to GP involvement in drug and alcohol work and there is little research looking at the perceptions and experiences of GPs involved in prescribing OST.


Semistructured qualitative interviews were conducted with eight experienced prescribers of OST in general practice settings in South Australia.


All participants described similar positive and negative aspects associated with prescribing OST. Some participants commenced prescribing in such a manner as to limit the scope of their involvement. Ceasing OST prescribing was not necessarily linked to negative experiences. Exprescribers indicated that they were unlikely to recommence prescribing.


This study has limited generalisability due to the small sample size but it does highlight some insights that can be gained from talking to experienced OST prescribers.

Opioid substitution therapy (OST) with either methadone or buprenorphine is the most commonly provided treatment for heroin dependence in Australia1 and has been shown to be effective.2–4 In Australia, OST is delivered in specialised public clinics, prisons and general practice settings (including community and private general practices).1 Importantly, there is an unmet need for OST services in Australia, including in South Australia (SA), where this study was conducted.1 To address this demand, variations on a community based model for service delivery, via general practice settings, have been adopted throughout the country5 and several states have invested significant effort to increase the workforce base of general practitioners prescribing OST.1 In SA, GPs must actively ‘opt in’ to become involved in OST and participation rates remain low. There were approximately 2000 GPs practising in SA in 2008.6 Using the national method of data collection, the Drugs of Dependence Unit (DDU) of Drug and Alcohol Services SA (DASSA) has estimated that only 55 SA GPs prescribed OST to 1599 patients in 2008.7

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Correspondence afp@racgp.org.au

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