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New hope for heroin users: Naltrexone implants.
By admin | June 21, 2008
A study at the University of Western Australia has found that heroin addicts with naltrexone implants are far less likely to return to heroin use than those taking oral tablets.
But critics are sceptical about the study and say that naltrexone is still a risky option for drug users trying to kick the habit.
Naltrexone is a drug which blocks the effects of heroin on the brain. It is usually taken as a tablet, but if heroin users stop taking the pill they often fall back into drug use.
That is why scientists have been working on an implant which automatically releases naltrexone into the body.
Gary Hulse from the University Of Western Australia is confident about the naltrexone’s success.
“It means that you’ve got a a one-stop shop. People can come in, they receive their treatment or implant and for five months or six months, they carry that treatment with them,” he said.
The six-month trial involved 69 heroin users. Fifty-four completed the trial. Of the 28 participants who received a naltrexone tablet, 15 returned to regular heroin use. Of the 26 people who received a naltrexone implant, just two returned to heroin use.
Researchers like Mr Hulse say it is a good result for naltrexone implants.
“This is a relatively safe and a treatment which has good clinical outcomes,” he said.
The study is yet to be published in a peer-reviewed medical journal, but the team at the University of Western Australia are confident the research will be well received.
“I’m not only confident that it’ll be published in a peer review but I would be surprised if this wasn’t accepted by one of the extremely high rating journals,” said Mr Hulse.
But critics like Dr Alex Wodak, from the Alcohol And Drug Services at Vincents Hospital in Sydney, have little time for the new study.
“The paper hasn’t been published yet in a scientific journal and so therefore, it’s the equivalent of hearsay in a court of law. That is, it’s not really evidence,” he said.
Naltrexone is a controversial drug. The implants are yet to be approved by Australia’s Therapeutic Goods Administration (TGA) and there have been mixed results for heroin users.
Some patients have stopped using heroin after receiving an implant. But others have cut them out of their body or suffered serious side effects.
“The implants, I know for a fact, were at one stage required by the therapeutic goods administration to be stamped, not for use in human subjects, and the authors have conceded that to me in writing,” said Dr Wodak.
But researchers such as Moira Sim from the Naltrexone Trial Independent Monitoring Committee say the implants used in the Perth trial were approved by the TGA.
“The committee reviewed all the processes that the trial went through and we are confident that they followed the correct processes that the data was collected properly, and therefore I’m very confident in the results of the trial,” she said.
The researchers say the next step will be to conduct a trial comparing naltrexone implants with methadone and other drugs used to control heroin addiction.
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source: ABC News, http://www.abc.net.au
Topics: Addiction Science, Addiction Treatment, Research | 1 Comment »
December 29th, 2008 at 7:37 am
Naltreone is a drug that always works efficiently providing the medication has been taken or delivered effectively. The problem for heroin addicts and for those with other addictions that may respond to naltrexone treatment is one of making sure that the drug is delivered. In Perth we have treated 2,300 patients for opiate dependance, 230 for alcohol dependance and 230 for amphetamine dependance with naltrexone implants. The randomised study by the university of Western Australia talked about above is the first RCT with an implant delevering naltrexone at theraputic levels for 4-6 months. The comment that naltrexone is a contraversial drug is out of context with a thorough research program on naltrexone since 1964. Providing the drug is delivered properly at appropriate concentrations it always blocks the opiate receptors. The development work in Perth to allow more efficient delivery of naltrexone opens up a method which shortens the number of years of opiate dependance and protects against overdose for prolonged periods of time. We have had no overdose deaths in the first 9 months following treatment in approximately 4000 patient years of treatment. We will continue to work to improve this area of medicine and we are confident that the randomised controlled trials of long acting naltrexone described above will help. In the past we have been limited to using opiate agonists (eg methadone) as the safest method of managing opiate dependance. Long acting naltrexone implants specifically control the opiate dependance for long periods of time (4-10months) without maintaining and therefore prolonging the opiate dependance that the patient wanted treatment for. In Australia and Scotland we have large groups of patients who are now dependant on their opiate replacement medication who wish to become independant of their opiate dependance. There should be no contraversy in the fact that treatments like naltrexone implants offer an excelent replacement to methadone and other opiate medications for these patients now wanting to cease their prescribed and non prescribed opiates. As doctors get more experience with these new medications comments on contraversy will disappear. There is no doubt in my mind having managed more than 4000 naltrexone implant treatments that naltrexone implants will become as important as methadone in treating heroin addicts who wish to escape from opiate dependance. In the mean time we all need to do our medicine as well as we possibly can and avoid regarding naltrexone or methadone as contraversial. Both have been delivered in good programs to patients requesting medical assistance and have been incredibly useful to those patients.It is essential for all in the field to use the medications available as well as we can.
Dr George O’Neil
email@drgeorgeoneil.com
conflict of interest statement;
I have been prescribing oral naltrexone for 11 years and implant naltrexone for 8 years,made by staff employed in a research team (in a company relating to my family. I have been providing a not for profit service through the team at freshstart.org.au