Thursday, October 29, 2009

Heroin Dependence Implant

The October issue of the Archives of General Psychiatry contained a report about the potential usefulness of an implant containing sustained release naltrexone for the treatment of heroin dependence. Heroin dependence is very difficult to treat with relatively few users who are able to maintain abstinence. The standard treatments now include both methadone and buprenorphine which are heroin substitution therapies that greatly reduce the risk of complications such as HIV, hepatitis C, unemployment, criminality and prostitution. There are limitations to both of these treatments however and many patients continue to use heroin despite taking these medications so anything new that shows promise is very encouraging.

Since 1984 an oral form of naltrexone has been available to treat heroin dependence but has essentially been useless. Naltrexone is an opioid antagonist. It sits on the opioid receptors and blocks the ability of heroin and other opioids to bind to these receptors. As a result, using heroin has no effect. The problem is though that all one has to do is stop taking the naltrexone and the ability to get high returns quickly. So oral naltrexone has been of very limited usefulness. What has been developed is a sustained release version of naltrexone which can be implanted under the skin and which can have an effect for up to 6 months providing a long period in which the user can move away from the heroin lifestyle.

The study included 70 adult patients who were randomly assigned to receive oral naltrexone plus a placebo implant or daily placebo tablets with a naltrexone implant. During the 6 month period 63% of patients receiving the implant reported complete abstinence with 17% returning to daily heroin use and the rest reporting heroin use a few times per month. In contrast the patients taking only oral naltrexone had 62% returning to regular heroin use, 26% reporting abstinence and the others heroin use several times per week. Although not looked at in this study about 20% of heroin addicts remain abstinent in this time period with psychosocial treatments only.

63% 6 month abstinence is amazing in heroin addiction and I hope that these findings can be replicated by others in follow-up studies.

Thought for the day

Most heroin users hate their lifestyle. They just feel trapped.

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