SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
General practice is the place to work with young people (Oct 2008)

I was really touched yesterday when Leo came to see us, his GP and counsellor, bringing us both a packet of "Love Hearts" as a thank-you. I loved them as a child but didn't know that they still existed! Leo is 17 years old and had been referred a few weeks ago by the local Addaction. He had been sent there from the Youth Offending Service as he had been arrested in possession of Class A drugs. Leo had been assessed by Addaction's young persons' worker and sent to us for treatment. He engaged well with us and settled on substitute prescribing. His goals were to avoid a prison sentence and to eventually become drug free. He had not been able to tell his family because he feared he would be thrown out, as had happened to his brother.

Leo was the last in a trickle of young people we have been sent recently. All have been referred by Addaction, with whom we are jointly working. None of the others has yet been in trouble but all were on the cusp. They were sent to general practice because, as in so many other areas, there is no specific service for young people and our local CAMS, by their own admission, have no experience or competence in working with young people who use drugs.

The other four young people we have been sent are all 15 or 16 years old and come from one community. They got into heroin when there was no cannabis to be found, enjoyed it and became dependent. They come and see us once a week after school in their uniforms. They have no mental health issues and we are able to be flexible with times and appointments. We have experience of dealing with young people of all types so why should drug use be any different? And what better place for these young people to be seen than in general practice? They appear in the waiting room like any other patient.

Traditionally this work is supposed to be carried out by CAMS and drug users under 18 years old are not supposed to be seen in general practice, but this seems outdated. The NTA Young Persons Team seem to agree and have recently been reviewing the treatment needs of the under 18s with substance misuse problems. They are also reviewing the need to develop training for primary care practitioners who work with this group. They now feel that the majority of the needs of this group could potentially be met by GPs with specialist training who would be able to address their wider general medical needs as well.

This group of young people in our area has prompted all the teams who work with young people to come together for a meeting. All agreed that this joint working with general practice was the best approach and the idea now is to set up a special service level agreement to cover this.

We were presented with the "Love Hearts" because Leo felt our court report had helped to get him a community sentence rather than a custodial one. Let's hope our early intervention and care in general practice with the other young people supports them to become drug free and helps keep them out of the criminal justice system.

- Dr Chris Ford