The Women’s Weekly piece garnered huge political and public interest and support within a very short period of time in Australia. Within political circles it is particularly controversial. Federal Liberal MP Bronwyn Bishop and then Minister for Health and current Federal Opposition Leader Tony Abbott were the most vocal supporters of naltrexone within federal parliament. Naltrexone was the miracle cure of the year!
Skeptical clinicians and researchers (who had been caught out before) were ridiculed by the parliamentary enquiry (and social commentators) chaired by MP Bronwyn Bishop who maintained praise for naltrexone and naltrexone implants. The Pharmaceutical Benefits Advisory Committee twice considered naltrexone and approved it for alcohol dependence but not for heroin dependence. They felt that the taxpayer should not be asked to subsidize naltrexone for heroin treatment. The then Prime Minister John Howard lobbied the Committee to change their mind – to no avail.
The Small Print of Naltrexone and Naltrexone Implants
Advocates of naltrexone implants rightly commented that the treatment itself was very effective; however, the dilemma lay in the fact that patients stopped taking naltrexone orally. An implant was developed (inserted under the skin in a small surgical procedure) which slowly released naltrexone into the bloodstream as effectively as if a patient were taking naltrexone tablets orally.
The Therapeutic Goods Administration (TGA), which is the regulatory body that monitors treatments such as this, still has not authorized the use of naltrexone implants; however, those who wanted implants inserted were able to, under a special government scheme designed for patients who had terminal diseases like cancer or AIDS (those who had only months to live) who required access to unauthorized treatments because they were pressed for time.
The TGA insists that some naltrexone implants are stamped “not for use in humans.” Very few doctors or researchers who specialize in drug and alcohol issues still support naltrexone or naltrexone implants. The consensus amongst Australian and overseas experts (due to thalidomide deformations in the 60s of thousands of people) is that new drugs are ineffective and unsafe until proven otherwise.
Reports started circulating about how risky naltrexone and the implants were. Was there an increased risk of death if people took heroin whilst on naltrexone or after having stopped naltrexone? Clinics were opening up all over costing between $5000 – $10 000 of which partners and families were scraping this amount together to help loved ones suffering heroin addiction.
As a result of these worrying reports, several states funded research projects which found that people who continued with naltrexone treatment did wonderfully well; however, in one Australian study, it found that only two percent of patients were taking the treatment after six months. Australian research like their overseas counterparts discovered that the death rate was eight times higher in those stopping naltrexone than those who stopped methadone. Within the drug using community, the rumours concerning naltrexone seemed confirmed and furthermore it cost (to them) a small fortune.
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It seems as if the jury is still out with regard to naltrexone and naltrexone implants.
The Questions to Ask Regarding Naltrexone and Naltrexone Implants
If a medical professional advises Naltrexone, it is advisable to seek answers to the following questions:
- If 100 patients were inserted tomorrow with a naltrexone implant or started taking naltrexone orally how many of those patients would not have taken heroin six months from that insertion?
- If 100 patients were inserted tomorrow with a naltrexone implant or started taking naltrexone orally how many of those patients will develop serious side effects within six months from that insertion? How many mild side effects within six months? How many within 12 months?
- How safe is this treatment?
- What is the total cost of naltrexone treatment (and followup) after six and 12 months?
- Are naltrexone implants approved by the TGA and if not, why not?
- Are naltrexone implants stamped “not for use in humans”?