Specialist clinicians' practice and views regarding methadone/buprenorphine supervision and contingency management: a national survey

Aims and methods: The aim of the study was to determine the current models of supervised consumption of methadone/buprenorphine practised, and to establish the extent to which contingency management is used, and in what forms. A postal questionnaire was sent to all lead specialist clinicians in the field of substance misuse in England in 2010 (n = 194).

Results: The response rate was 66% (n = 129). Clinicians generally supervised patients for a period of 3 months, although considerable flexibility was used depending on individual circumstances. The majority of patients consumed their methadone/buprenorphine on pharmacy premises 6 d per week. Supervised consumption arrangements were believed by respondents to cause a minority of patients to drop out of treatment and prevent a minority from starting treatment. Contingency management is widely used throughout England, with the most common forms relating to changes in supervision or dispensing arrangements.

Conclusion: There is marked heterogeneity in clinicians’ practice of supervised consumption, suggesting uncertainty regarding the optimal approach. Further research, such as an RCT, is required.