The Psychiatrist (2009) 33: 336-340. doi: 10.1192/pb.bp.108.021154
© 2009 The Royal College of Psychiatrists
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Adherence to substitute opioid prescribing: survey of inner-London drug services

John Dunn, Lead Consultant in Substance Misuse

*Camden & Islington Foundation Trust, 457 Finchley Road, London NW3 6HN, email: john.dunn{at}royalfree.nhs.uk

Michael Haskew, Staff Grade Psychiatrist in Substance Misuse

Camden & Islington Foundation Trust, London

Anshuman Pant, Consultant Psychiatrist in Substance Misuse Psychiatry

Leicestershire Partnership NHS Trust, Community Drug Team, Loughborough

Declaration of interest

None.

AIMS AND METHOD

To investigate non-adherence to substitute opioid treatment, using a cross-sectional study design, with 630 patients from three London community drug services. Adherence was measured as the number of doses collected from the pharmacy as a proportion of the total number of doses stipulated on the prescription during a 28-day period and was further investigated through laboratory urine drug screens.

RESULTS

Overall, 30.5% (n =191) of individuals failed to pick up at least one dose of medication from the pharmacy over 1 month, but only 1.6% (n =10) missed 50% or more of their doses. Non-adherence was associated with supervised consumption, more frequent pick-up, shorter duration of treatment, younger age, a lower dose of methadone and a recent urinalysis result positive for opiates.

CLINICAL IMPLICATIONS

Treatment services need to monitor levels of adherence to treatment and develop strategies to improve it so that treatment can be optimised effectively.