Sunday, March 7, 2010

Comparison of oral and implant Naltrexone - Colquhoun – 2005

Dr Colquhoun recently published a nice paper on the effectiveness of Naltrexone implants. The study was performed in Australia and it was in a very real world setting similar to the clinics and physician’s offices in this country.

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The study involved 83 patients who had all been recently detoxified off Heroin and other opiates. The patients wanted to use Naltrexone to help them stay off Heroin and other opiates. Half of them took oral Naltrexone daily with the help of a support person who agreed to witness the medication everyday. This group of patients agreed to take the oral Naltrexone for 6 months. The other half had Naltrexone implants made by George O’Neil’s group. The O’Neil Implants are a bit larger than the ones we use here in the US. Some patients got a single implant which has been shown to last 3 months and some got a double implant that delivers adequate Naltrexone levels for 5 months.

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The patients were followed and outcomes were determined by self report with corroboration from their support persons. Relapse was defined as when patients used more than 1 or 2 times (they determined that some patients used one or two times to test out the implant). Patients who couldn’t be contacted were assumed to have relapsed.

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The results were very impressive:

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Contacted and had not relapsed

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At 6 months -

Naltrexone Implant 81%

Supervised Oral Naltrexone 45%

At 12 months -

Naltrexone Implant 61%

Supervised Oral Naltrexone 40%

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These are very impressive results – actually in both groups. Compared with traditional treatment without any Naltrexone the results are very good. The strong results held up even after the Naltrexone was stopped after 6 months. A large number of patients were still able to maintain their abstinence.

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Some of the other data from the study is quite interesting. The patients who relapsed in the group taking oral Naltrexone usually stopped their oral Naltrexone within 2 weeks. It could be that they were unable to deal with their Post acute withdrawal symptoms or perhaps they weren’t very motivated in the first place.

The patients who relapsed in the implant group were more likely to have had a history of selling Heroin, and were more likely to have a history of previous physical or sexual abuse. They often tried to use with the implant in place and reported that they would try to get over the blockage or if they couldn’t feel anything they liked to try anyway.

Dr Coleman

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