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
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
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
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