Based on the theories of reasoned action (TRA) and planned behavior (TPB), predictors of condom use intentions were investigated in 949 young people (16-24 years of age) from a national survey conducted in England. Contrary to expectations, the TPB did not perform significantly better than the TRA, even among women. Measures of past behavior were the best predictors of intentions and attenuated the effects of attitude and subjective norm. There was only weak evidence for the multiplicative assumption underlying the TRA and TPB. Although the TRA components were not the strongest predictors, the beliefs on which they are based are potentially amenable to change through information-based intervention programs. A number of practical suggestions for developing intervention strategies are offered.
Key messages * Nearly all opiate prescriptions for the treatment of addiction are for methadone * Tablets and ampoules make up one fifth of methadone prescriptions * Arrangements already exist for daily dispensing of methadone to patients, but many prescribers (particularly general practitioners and private doctors) prescribe large amounts with long intervals between pick ups * As well as ampoules, methadone tablets (when crushed) may be injected; clearer guidance is needed on the clinical criteria for prescribing injectable methadone * Daily dispensing arrangements are insufficiently used, and guidelines for prescribers on dispensing arrangements need to be reviewed frequently with bulk provision in weekly, fortnightly, or even monthly pick ups. Doctors issuing private prescriptions should exercise the same precautions against misuse and diversion as their NHS colleagues, and the current stark differences between NHS and private prescriptions should be examined critically.Overall, these findings indicate a system that is operating inefficiently-perhaps even a system in trouble. The lack of evidence of differentiation of primary and secondary healthcare prescribing is disturbing, as are the profound differences between NHS and private practice. The widespread disregard of the opportunities for interval dispensing (especially for tablets and ampoules, which have a greater potential for misuse) indicates a failure to appreciate the abuse potential and the substantial value on the black market of injectable forms of methadone. With the prescribing of methadone increasing so rapidly'5 and with the above evidence of the instability of this feature of Britain's drug policy, policymakers and planners must find improved methods of harnessing the benefits of methadone prescribing. [16][17][18]
An important component of government policy on services for drug misusers is to encourage general practitioners to take a more active role. There are, however, some indications that general practitioners regard drug misusers as undesirable patients, although no evidence is available. As part of a wider investigation of the role of general practitioners in the treatment of opiate misuse, a questionnaire, which was sent in mid-1985 to a 5% random sample of general practitioners in England and Wales, included a section designed to elicit their views on policy and treatment connected with opiate misuse. The results showed that although most general practitioners consider opiate misuse to be a priority concern for the Health Service, they also generally regard opiate misusers as especially difficult to manage, beyond their competence to treat, and less acceptable as patients than others in need of care. General practitioners who have qualified recently were somewhat less unfavourable in their views. These findings suggest that the effective implementation of government policy will require trying to modify general practitioners' attitudes and providing support for them.
With the recent unprecedented growth in the spread of drug misuse in the United Kingdom the role of the general practitioner has become more and more prominent, both in response to demands for treatment and as the focus of national policy on drug misuse. Although general practitioners may be the first contact, few data are available on the extent of their contact with drug misusers. A postal survey was carried out in mid-1985 of a 5% national sample of general practitioners in England and Wales concerning their role in and views on the treatment of opiate misusers, including the extent of their contact with such patients during a four week period. Of the 1166 general practitioners surveyed, 845 replied, a response rate of 72%. The results show that roughly one in five general practitioners in England and Wales attended an opiate misuser during this four week period, seeing an estimated 6000 to 9000 patients, one third of whom were "new" to the general practitioner. A cautious estimate of between 30,000 and 44,000 new cases of opiate misuse presenting to general practitioners in a year is suggested, with some adjustment necessary because of double counting. A wide variation in the prevalence of consultations among regional health authorities was found, and several of the regions with a high prevalence are outside the London area. The scale of contact thus confirms the importance of the general practitioner in the national response to drug misuse.
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