Survey of doctors prescribing diamorphine (heroin) to opiate-dependent drug users in the United Kingdom

FRANÇAIS :
Cette enquête postale auprès des 164 médecins ayant une licence pour prescrire de la diamorphine et des 108 médecins qui seraient habilités à avoir une licence (travaillant en clinique privée) montre que la majorité des médecins ayant une licence sont des psychiatres (5 médecins généralistes seulement) et 46 d'entre eux traitent 448 patients. Il y a de grandes variations dans leur pratique (les doses journalières vont de 5 à 1500 mg). Parmi les médecins prescripteurs, beaucoup citent le manque de ressource comme raison pour ne pas prescrire à plus de patients et les médecins non prescripteurs invoquent également le manque de ressource et aussi les faibles preuves de l'efficacité de ce traitement. Il en résulte que la prescription de diamorphine est rare au Royaume Uni et qu'il n'y a pas de consensus sur qui doit être traité et de quelle façon.
ENGLISH :
Aim. To determine the scale and practice of diamorphine (heroin) prescribing for opiate dependence in the United Kingdom in 2000. Design. Postal Survey. Setting. England. Scotland and Wales. Participants. One hundred and eleven of the 164 doctors in the United Kingdom on the Horne Office record as holding a licence to prescribe diamorphine (response rate 68%), and 59 of the 108 doctors in the United Kingdom eligible to hold a licence (working in drug clinics), but not doing so (response rate 54%). Measurements. The characteristics of doctors (a) holding a licence and (b) currently prescribing; the number of opiate users receiving a prescription; current treatment delivery, clinical criteria for patient eligibility; and reasons for prescribing or not prescribing diamorphine. Findings. Seventy of the 111 doctors actually held a licence. While the majority were consultant psychiatrists, five were general practitioners. Forty-six were currently prescribing to 448 patients.The majority of prescribers reported that they had not initiated a prescription for diamorphine but had inherited patients already receiving such a prescription. Most of those who prescribed considered that in selected cases it could produce clinical and social improvement. There were great variations in clinical criteria for patient eligibility, prescribing practice, daily dose prescribed (range 5-1500 mg) and the daily dose-equivalent of 100 mg methadone (range 50-900 mg). Many respondents cited lack of appropriate resources as a reason for not prescribing to more patients. Reasons for non-prescribing varied from lack of resources to little evidence of its effectiveness. Conclusions. The prescribing of diamorphine, to opiate dependent drug users remains rare in the United Kingdom. Not all eligible doctors seek a licence to prescribe, and not all those with licences actually prescribe it. There is no clear consensus on who should be treated with diamorphine and in what way. (Author' s abstract)