NEWS: AAP - 04/02/2007 'Drug addicts 'risk overdose in treatment'

Drug addicts 'risk overdose in treatment'
By Tamara McLean
February 04, 2007 12:35pm

HEROING addicts trying to kick their deadly habit using drug-blocking implants remain at risk of a fatal overdose, new Australian research suggests.

Scientists have identified five deaths involving implantable naltrexone, including two cases where users had high levels of the opioid-suppressant in their system.

This is the first proof that addicts can overdose and die while implanted with the drug designed to help them overcome their dependence.

Lead researcher Amy Gibson, from the National Drug and Alcohol Research Centre at the University of NSW, said it seemed those addicts had overdosed on heroin while trying to push through naltrexone's “blocking” powers.

“There is the impression out there that the implant is a bit of a magic cure, that it will block everything and make it impossible to die,” Ms Gibson said.

“We've shown that that's not the case.”

Naltrexone implants were introduced in Australia a decade ago to get around the problem of users forgetting to take their daily dose of the drug, branded as ReVia.

The implant, worn by about 1000 Australians, is usually a capsule or month-long supply of pills inserted under the skin of the stomach to block the effects of heroin in the brain.

It is not officially registered for use but can be accessed at clinics as a result of a loophole.

Writing in the latest Medical Journal of Australia, the researchers identified five incidents between 2000 and 2004 where users had died of drug overdoses while wearing the implant or soon after it was removed.

An autopsy on one young man showed elevated levels of heroin and much higher levels of naltrexone than needed to block the opiate.

And a woman who died of a naltrexone-combined overdose had been suffering pains near her implant in the days before death.

“There's potential for a lot more deaths to be happening; it's just not being picked up,” Ms Gibson said.

The results suggest addicts may take an excessive dose of heroin to overcome the block from the implant, but the naltrexone itself may also have contributed to death.

The researchers said it was important doctors alert their patients to the risk of overdose on the treatment.

“We think it's important people are given a realistic expectation of the risks,” Ms Gibson said.

A spokesman for naltrexone supplier Bristol-Myers Squibb said the company sold the drug in tablet form only and could not comment on implant use.

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Heroin treatment may raise risk of overdose
Jill Stark
February 5, 2007

A CONTROVERSIAL treatment to help drug addicts kick heroin could put them at risk of fatal overdoses, research has revealed.

When implanted in the body, naltrexone — a drug that sends addicts into immediate withdrawal — was thought to prevent heroin overdoses by blocking the effects of opiates.

But doctors from the Drug and Alcohol Research Centre at the University of NSW found five drug-related deaths among people using the implants in coronial records.

Four men and a women, with an average age of 26, died between 2002 and 2004. Two of them were from Victoria.

Researchers believe some addicts may have taken large doses of heroin to overcome the "block" effect of the implant.

"The big thing that has been claimed is if you are actively in treatment with naltrexone implants you can't overdose, and the fact of the matter is these people did," one of the study's authors, Dr Louisa Degenhardt, said.

Naltrexone, which has been used since the late 1990s in Australia as an alternative heroin withdrawal method to methadone, has divided the drug treatment community.

Normally used for alcoholism treatment, its effectiveness in heroin addiction is untested. And although the oral tablet has been licensed by the Therapeutic Goods Administration, the implant method has not been clinically tested.

Two deaths occurred when users were undergoing implant treatment, one happened soon after an implant was removed and two about six months after insertion.

Addiction specialist Nick Lintzeris, from drug treatment agency Turning Point, said it was possible some of the deaths had occurred after naltrexone had worn off. "The problem is when you stop using it (naltrexone) you become sensitive to the effects of heroin, so that even much smaller doses of heroin than you used to use could be potentially lethal," he said.

The research will be published today in The Medical Journal of Australia.

LINKS

www.mja.com.au

www.turningpoint.org.au

http://geobay.com/deabf0

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A press release was issued yesterday (Sunday 4 February) by the Medical Journal of Australia (MJA) re: a paper by Amy Gibson, Louisa Degenhardt and Wayne Hall on opioid overdose deaths that have occurred in patients with naltrexone implants.

From Australian coronial records, the authors identified five deaths involving implantable naltrexone between 2000 and 2004. One man died from acute narcotism with a naltrexone implant in place and a blood naltrexone level of 0.3 mg/L. A woman died of combined drug effect (including naltrexone) accompanied by severe pain from a naltrexone implant site. These cases indicate that patients can die from opioid overdose with a naltrexone implant and blood naltrexone levels higher than reported blockade levels.

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