Skip to main content
Top
Published in: BMC Primary Care 1/2009

Open Access 01-12-2009 | Research article

Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care

Authors: Walter Cullen, Sarah O'Brien, Austin O'Carroll, Fergus D O'Kelly, Gerard Bury

Published in: BMC Primary Care | Issue 1/2009

Login to get access

Abstract

Background

Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched 'controls' and to develop and pilot test a valid study instrument.

Methods

A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status.

Results

Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation.

Conclusion

Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words)
Literature
1.
go back to reference Cullen W, Bury G, Langton D: Experience of heroin overdose among drug users attending general practice. British Journal of General Practice. 2000, 50: 546-549.PubMedPubMedCentral Cullen W, Bury G, Langton D: Experience of heroin overdose among drug users attending general practice. British Journal of General Practice. 2000, 50: 546-549.PubMedPubMedCentral
2.
go back to reference Cullen W, Griffin S, Bury G, Plunkett P: Opiate overdose in Dublin. Irish Journal of Medical Science. 2003, 172: 46-10.1007/BF02914788.CrossRefPubMed Cullen W, Griffin S, Bury G, Plunkett P: Opiate overdose in Dublin. Irish Journal of Medical Science. 2003, 172: 46-10.1007/BF02914788.CrossRefPubMed
3.
go back to reference Darke S, Zador D: Fatal heroin 'overdose': a review. Addiction (Abingdon, England). 1996, 91: 1765-1772.CrossRef Darke S, Zador D: Fatal heroin 'overdose': a review. Addiction (Abingdon, England). 1996, 91: 1765-1772.CrossRef
4.
go back to reference Engstrom A, Adamsson C, Allebeck P, Rydberg U: Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973–1984. Int J Addict. 1991, 26 (1): 91-106.CrossRefPubMed Engstrom A, Adamsson C, Allebeck P, Rydberg U: Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973–1984. Int J Addict. 1991, 26 (1): 91-106.CrossRefPubMed
5.
go back to reference Wahren CA, Brandt L, Allebeck P: Has mortality in drug addicts increased? A comparison between two hospitalized cohorts in Stockholm. Int J Epidemiol. 1997, 26 (6): 1219-1226. 10.1093/ije/26.6.1219.CrossRefPubMed Wahren CA, Brandt L, Allebeck P: Has mortality in drug addicts increased? A comparison between two hospitalized cohorts in Stockholm. Int J Epidemiol. 1997, 26 (6): 1219-1226. 10.1093/ije/26.6.1219.CrossRefPubMed
6.
go back to reference Brugal MT, Domingo-Salvany A, Puig R, Barrio G, Garcia de Olalla P, de la Fuente L: Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain. Addiction (Abingdon, England). 2005, 100 (7): 981-989.CrossRef Brugal MT, Domingo-Salvany A, Puig R, Barrio G, Garcia de Olalla P, de la Fuente L: Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain. Addiction (Abingdon, England). 2005, 100 (7): 981-989.CrossRef
7.
go back to reference Ritter A, Cameron J: A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev. 2006, 25 (6): 611-624. 10.1080/09595230600944529.CrossRefPubMed Ritter A, Cameron J: A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev. 2006, 25 (6): 611-624. 10.1080/09595230600944529.CrossRefPubMed
8.
go back to reference Wodak A, Cooney A: Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006, 41 (6–7): 777-813. 10.1080/10826080600669579.CrossRefPubMed Wodak A, Cooney A: Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006, 41 (6–7): 777-813. 10.1080/10826080600669579.CrossRefPubMed
9.
go back to reference Kertesz SG, Pletcher MJ, Safford M, Halanych J, Kirk K, Schumacher J, Sidney S, Kiefe CI: Illicit drug use in young adults and subsequent decline in general health: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Drug Alcohol Depend. 2007, 88 (2–3): 224-233. 10.1016/j.drugalcdep.2006.10.017.CrossRefPubMed Kertesz SG, Pletcher MJ, Safford M, Halanych J, Kirk K, Schumacher J, Sidney S, Kiefe CI: Illicit drug use in young adults and subsequent decline in general health: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Drug Alcohol Depend. 2007, 88 (2–3): 224-233. 10.1016/j.drugalcdep.2006.10.017.CrossRefPubMed
10.
go back to reference Allwright S, Bradley F, Long J, Barry J, Thornton L, Parry J: Prevalence of antibodies to hepatitis B, hepatitis C and HIV among Irish prisoners: results of a national cross sectional survey. British Medical Journal. 2000, 321: 78-82. 10.1136/bmj.321.7253.78.CrossRefPubMedPubMedCentral Allwright S, Bradley F, Long J, Barry J, Thornton L, Parry J: Prevalence of antibodies to hepatitis B, hepatitis C and HIV among Irish prisoners: results of a national cross sectional survey. British Medical Journal. 2000, 321: 78-82. 10.1136/bmj.321.7253.78.CrossRefPubMedPubMedCentral
11.
go back to reference Clarke S, Keenan E, Bergin C, Lyons F, Hopkins S, Mulcahy F: The changing epidemiology of HIV infection in injecting drug users in Dublin, Ireland. HIV Medicine. 2001, 2: 236-240. 10.1046/j.1464-2662.2001.00085.x.CrossRefPubMed Clarke S, Keenan E, Bergin C, Lyons F, Hopkins S, Mulcahy F: The changing epidemiology of HIV infection in injecting drug users in Dublin, Ireland. HIV Medicine. 2001, 2: 236-240. 10.1046/j.1464-2662.2001.00085.x.CrossRefPubMed
12.
go back to reference Smyth B, O'Connor J, Barry J, Keenan E: Retrospective cohort study examining incidence of HIV and hepatitis C among injecting drug users in Dublin. Journal of Epidemiology and Community Health. 2003, 57: 310-311. 10.1136/jech.57.4.310.CrossRefPubMedPubMedCentral Smyth B, O'Connor J, Barry J, Keenan E: Retrospective cohort study examining incidence of HIV and hepatitis C among injecting drug users in Dublin. Journal of Epidemiology and Community Health. 2003, 57: 310-311. 10.1136/jech.57.4.310.CrossRefPubMedPubMedCentral
13.
go back to reference Miles DR, Kulstad JL, Haller DL: Severity of substance abuse and psychiatric problems among perinatal drug-dependent women. J Psychoactive Drugs. 2002, 34 (4): 339-346.CrossRefPubMed Miles DR, Kulstad JL, Haller DL: Severity of substance abuse and psychiatric problems among perinatal drug-dependent women. J Psychoactive Drugs. 2002, 34 (4): 339-346.CrossRefPubMed
14.
go back to reference McCusker M: Influence of hepatitis C status on alcohol consumption in opiate users in treatment. Addiction (Abingdon, England). 2001, 96: 1007-1014.CrossRef McCusker M: Influence of hepatitis C status on alcohol consumption in opiate users in treatment. Addiction (Abingdon, England). 2001, 96: 1007-1014.CrossRef
15.
go back to reference Transformation Programme 2007–2010. 2007, Naas: Health Services Executive Transformation Programme 2007–2010. 2007, Naas: Health Services Executive
16.
go back to reference Yach D, Hawkes C, Gould CL, Hofman KJ: The global burden of chronic diseases: overcoming impediments to prevention and control. Jama. 2004, 291 (21): 2616-2622. 10.1001/jama.291.21.2616.CrossRefPubMed Yach D, Hawkes C, Gould CL, Hofman KJ: The global burden of chronic diseases: overcoming impediments to prevention and control. Jama. 2004, 291 (21): 2616-2622. 10.1001/jama.291.21.2616.CrossRefPubMed
17.
go back to reference Kelly A, Carvalho M, Teljeur C: Prevalence of Opiate Use in Ireland: a 3-Source Capture Recapture Study. Report submitted to the National Advisory Committee on Drugs Sub-committee on Prevalence. 2003, Dublin: Small Areas Health Research Unit, Department of Public Health and Primary Care, Trinity College Dublin Kelly A, Carvalho M, Teljeur C: Prevalence of Opiate Use in Ireland: a 3-Source Capture Recapture Study. Report submitted to the National Advisory Committee on Drugs Sub-committee on Prevalence. 2003, Dublin: Small Areas Health Research Unit, Department of Public Health and Primary Care, Trinity College Dublin
18.
go back to reference Long J, Lynn E, Kelly F: Occasional Paper No. 17. Trends in Treated Problem Drug Use in Ireland, 1998 to 2002. 2005, Dublin: Health Research Board Long J, Lynn E, Kelly F: Occasional Paper No. 17. Trends in Treated Problem Drug Use in Ireland, 1998 to 2002. 2005, Dublin: Health Research Board
19.
go back to reference Matheson C, Pitcairn J, Bond CM, van Teijlingen E, Ryan M: General practice management of illicit drug users in Scotland: a national survey. Addiction (Abingdon, England). 2003, 98 (1): 119-126.CrossRef Matheson C, Pitcairn J, Bond CM, van Teijlingen E, Ryan M: General practice management of illicit drug users in Scotland: a national survey. Addiction (Abingdon, England). 2003, 98 (1): 119-126.CrossRef
21.
go back to reference Keen J, Oliver P, Rowse G, Mathers N: Does methadone maintenance treatment based on the new national guidelines work in a primary care setting?. Br J Gen Pract. 2003, 53 (491): 461-467.PubMedPubMedCentral Keen J, Oliver P, Rowse G, Mathers N: Does methadone maintenance treatment based on the new national guidelines work in a primary care setting?. Br J Gen Pract. 2003, 53 (491): 461-467.PubMedPubMedCentral
22.
go back to reference Gossop M, Marsden J, Stewart D, Lehmann P, Strang J: Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study. Br J Gen Pract. 1999, 49 (438): 31-34.PubMedPubMedCentral Gossop M, Marsden J, Stewart D, Lehmann P, Strang J: Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study. Br J Gen Pract. 1999, 49 (438): 31-34.PubMedPubMedCentral
23.
go back to reference Farrell M, Howes S, Vester A, Davoli M: Reviewing current practice in drug substitution treatment in Europe. 1999, EMCDDA, Osservatorio Epidemiologico Farrell M, Howes S, Vester A, Davoli M: Reviewing current practice in drug substitution treatment in Europe. 1999, EMCDDA, Osservatorio Epidemiologico
24.
go back to reference Misuse of drugs (supervision of prescription and supply of methadone) regulations (Statutory Instrument No 225). 1998, Dublin: Department of Health Misuse of drugs (supervision of prescription and supply of methadone) regulations (Statutory Instrument No 225). 1998, Dublin: Department of Health
25.
go back to reference Budd J, Robertson R: Hepatitis C and general practice: the crucial role of primary care in stemming the epidemic. British Journal of General Practice. 2005, 55: 259-260.PubMedPubMedCentral Budd J, Robertson R: Hepatitis C and general practice: the crucial role of primary care in stemming the epidemic. British Journal of General Practice. 2005, 55: 259-260.PubMedPubMedCentral
27.
go back to reference Cullen W, Stanley J, Langton D, Kelly Y, Bury G: Management of hepatitis C among drug users attending general practice in Ireland: baseline data from the Dublin area hepatitis C in general practice initiative. Eur J Gen Pract. 2007, 13 (1): 5-12. 10.1080/14017430601049365.CrossRefPubMed Cullen W, Stanley J, Langton D, Kelly Y, Bury G: Management of hepatitis C among drug users attending general practice in Ireland: baseline data from the Dublin area hepatitis C in general practice initiative. Eur J Gen Pract. 2007, 13 (1): 5-12. 10.1080/14017430601049365.CrossRefPubMed
28.
go back to reference Cullen W, Stanley J, Langton D, Kelly Y, Staines A, Bury G: Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation. Br J Gen Pract. 2006, 56 (532): 848-856.PubMedPubMedCentral Cullen W, Stanley J, Langton D, Kelly Y, Staines A, Bury G: Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation. Br J Gen Pract. 2006, 56 (532): 848-856.PubMedPubMedCentral
29.
go back to reference Smith SM, Ferede A, O'Dowd T: Multimorbidity in younger deprived patients: an exploratory study of research and service implications in general practice. BMC Fam Pract. 2008, 9: 6-10.1186/1471-2296-9-6.CrossRefPubMedPubMedCentral Smith SM, Ferede A, O'Dowd T: Multimorbidity in younger deprived patients: an exploratory study of research and service implications in general practice. BMC Fam Pract. 2008, 9: 6-10.1186/1471-2296-9-6.CrossRefPubMedPubMedCentral
30.
go back to reference Mertens JR, Lu YW, Parthasarathy S, Moore C, Weisner CM: Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls. Arch Intern Med. 2003, 163 (20): 2511-2517. 10.1001/archinte.163.20.2511.CrossRefPubMed Mertens JR, Lu YW, Parthasarathy S, Moore C, Weisner CM: Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls. Arch Intern Med. 2003, 163 (20): 2511-2517. 10.1001/archinte.163.20.2511.CrossRefPubMed
31.
go back to reference Mertens JR, Flisher AJ, Fleming MF, Weisner CM: Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls. J Adolesc Health. 2007, 40 (2): 173-179. 10.1016/j.jadohealth.2006.09.021.CrossRefPubMed Mertens JR, Flisher AJ, Fleming MF, Weisner CM: Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls. J Adolesc Health. 2007, 40 (2): 173-179. 10.1016/j.jadohealth.2006.09.021.CrossRefPubMed
32.
go back to reference Cherpitel CJ: Changes in substance use associated with emergency room and primary care services utilization in the United States general population: 1995–2000. Am J Drug Alcohol Abuse. 2003, 29 (4): 789-802. 10.1081/ADA-120026261.CrossRefPubMed Cherpitel CJ: Changes in substance use associated with emergency room and primary care services utilization in the United States general population: 1995–2000. Am J Drug Alcohol Abuse. 2003, 29 (4): 789-802. 10.1081/ADA-120026261.CrossRefPubMed
33.
go back to reference Mercer SW, Watt GC: The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007, 5 (6): 503-510. 10.1370/afm.778.CrossRefPubMedPubMedCentral Mercer SW, Watt GC: The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007, 5 (6): 503-510. 10.1370/afm.778.CrossRefPubMedPubMedCentral
34.
go back to reference Britt HC, Harrison CM, Miller GC, Knox SA: Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008, 189 (2): 72-77.PubMed Britt HC, Harrison CM, Miller GC, Knox SA: Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008, 189 (2): 72-77.PubMed
35.
go back to reference Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y: Integrating primary medical care with addiction treatment: a randomized controlled trial. Jama. 2001, 286 (14): 1715-1723. 10.1001/jama.286.14.1715.CrossRefPubMedPubMedCentral Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y: Integrating primary medical care with addiction treatment: a randomized controlled trial. Jama. 2001, 286 (14): 1715-1723. 10.1001/jama.286.14.1715.CrossRefPubMedPubMedCentral
Metadata
Title
Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care
Authors
Walter Cullen
Sarah O'Brien
Austin O'Carroll
Fergus D O'Kelly
Gerard Bury
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2009
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-10-25

Other articles of this Issue 1/2009

BMC Primary Care 1/2009 Go to the issue