Why do General Practitioners Work with Opiate Misusers?: a qualitative study of high and low activity general practitioners

Abstract

General practitioners (GPs) have been increasingly encouraged to become involved with the treatment of opiate misusers. Barriers to greater GP involvement have been recognized, but little is known about why some GPs are willing to have a higher degree of involvement with these patients. This study aimed to explore why some GPs are willing to work with opiate misusers and find out how GPs might be supported to become more involved with opiate misusers. Twenty-six 'high activity' GPs and 26 'low activity' GPs identified from a previous study in South London were interviewed about how they felt about their work with opiate misusers. Factors appearing to help GPs work with opiate misusers included a more holistic view of the opiate misuser as a person, a belief that treatment was benefiting the patient or the community and a perception of being supported to do the work. These doctors tended to have their practice geared up to facilitate working with opiate misusers. All GPs who prescribed for opiate misusers used 'shared care' arrangements, but these were not always satisfactory. Viewing abstinence as the main goal of treatment seemed to be associated with disillusionment and dissatisfaction with working with opiate misusers even among highly involved GPs.