Naltrexone implants have not been subject to the usual rigorous scrutiny required for new devices in Australia, but are widely used through the Special Access Scheme
In this issue of the Journal, Lintzeris and colleagues report eight patients with naltrexone implants who developed serious medical complications considered to be related to the implant (→ Unplanned admissions to two Sydney public hospitals after naltrexone implants).1 Intuitively, naltrexone is an attractive treatment for opioid dependence, as it is inexpensive, long-acting and generally well tolerated, and blocks the actions of heroin when taken orally. However, empirical support for naltrexone has been unimpressive,2-4 with research showing that poor adherence to treatment limits its effectiveness. An Australian study found that, while patients who adhered to treatment did well, only 2% were still taking the drug 3 months after conventional inpatient detoxification.5
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- 1. Lintzeris N, Lee S, Scopelliti L, et al. Unplanned admissions to two Sydney public hospitals after naltrexone implants. Med J Aust 2008; 188: 441-444.
- 2. Roozen HG, de Waart R, van der Windt DA, et al. A systematic review of the effectiveness of naltrexone in the maintenance treatment of opioid and alcohol dependence. Eur Neuropsychopharmacol 2006; 16: 311-323.
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- 6. Tattersall M, for the Australian Drug Evaluation Committee (ADEC). ADEC 200th meeting recommendations. Canberra: Therapeutic Goods Administration, 1999. http://www.tga.gov.au/docs/html/adec/adec0200.htm (accessed Jan 2008).
- 7. Digiusto E, Shakeshaft A, Ritter A, et al. Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Addiction 2004; 99: 450-460.
- 8. Barnao T. I woke up ... cured of heroin. Australian Women's Weekly 1997; July: 31-34.
- 9. Shanahan MD, Doran CM, Digiusto E, et al. A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Addict Behav 2006; 31: 371-387.
- 10. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Naltrexone for extended-release injectable suspension for treatment of alcohol dependence. Substance Abuse Treatment Advisory 2007; 6 (1). http://kap.samhsa.gov/products/manuals/advisory/text/0701_naltrexone.htm (accessed Jan 2008).
- 11. Department of Health and Ageing. Therapeutic Goods Administration. Special Access Scheme at a glance. http://www.tga.gov.au/hp/sasglance.htm (accessed Mar 2008).
- 12. Degenhardt L, Hall W, Warner-Smith M. Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS. Sex Transm Infect 2006; 82 Suppl 3: iii56-iii63. doi:10.1136/sti.2005.019273.
- 13. Comer SD, Sullivan MA, Yu E, et al. Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2006; 63: 210-218.
Robert Ali received an untied educational grant from Reckitt Benckiser to convene an annual scientific meeting in Asia. All funds were used for travel, accommodation and living expenses for himself and delegates.