Pubdate: Mon, 05 Jul 1999
Source: Sydney Morning Herald (Australia)
Contact:  http://www.smh.com.au/
Author: Judith Whelan

'MIRACLE CURE' FOR HEROIN HAS ITS DANGERS

Naltrexone, hailed by many as a "miracle cure" for heroin addiction, can be
an ineffective and often dangerous way of getting addicts off heroin, the
latest Australian study of the drug has found.

The study, published in today's issue of the Medical Journal of Australia,
found that three months after detoxification with naltrexone, fewer than one
in four addicts were heroin-or methadone-free.

It also raised concerns about the safety of the drug, which blocks the
effects of heroin, but also lowers patients' resistance to heroin once they
stop taking naltrexone. Three months after the 30 patients in the study were
given naltrexone under light sedation in hospital, one had died from an
overdose and two others at least had overdosed but survived.

According to Dr James Bell, the director of the Langton Centre and the study
team leader, this latest research showed naltrexone-assisted detoxification
was helpful for some people, but for the majority it was ineffective: many
found it unpleasant to take, and stopped. Three quarters of those studied
had returned to heroin or methadone three months after their detox.

"It is not all negative news," he said, "but nor is it a magical cure."

In the same issue of the Journal, two of Australia's foremost doctors in the
treatment of drug addiction criticise recent media excitement about
naltrexone therapy, saying it ignores "the reported modest success of
naltrexone maintenance in the treatment of heroin dependence over almost 20
years".

The lack of stringent clinical studies on its efficacy, safety and
cost-effectiveness meant that "no good evidence has yet been presented to
challenge the assumption that naltrexone ... is at best modestly effective,
and at worst unsafe, in management of unselected cases of opioid
dependence", write Professor Wayne Hall, of the National Drug and Alcohol
Research Centre at the University of NSW, and Dr Alex Wodak, the director of
the Alcohol and Drug Service at St Vincent's Hospital.

Most scientific studies of naltrexone's effects had been "anything but
rigorous", Dr Wodak said yesterday.

The Langton Centre study was "an attempt at rigour", he said, although he
conceded it was very small. But its findings were significant, he said: "It
showed modest results in terms of what we'd like to see [for
naltrexone-assisted detoxification]. Claims that have been made for this
treatment are that there's an 80 to 90 per cent success rate. That is not
borne out by this study."

Naltrexone-assisted withdrawal is available in Westmead Hospital and the
Langton Centre, but is mainly carried out in NSW in private clinics. Such
treatment, not covered by Medicare or private insurance, can cost patients
thousands of dollars. "It is generally poor people mortgaging their house to
pay for this," Dr Wodak said.

They then have to maintain a daily dose of naltrexone for six to 12 months
after detox, which costs $190 a month.

Studies being conducted and to be reported in 2001, may give a clearer
picture of the long-term efficacy and safety of the drug, Professor Hall and
Dr Wodak wrote in the Journal. "In the meantime, thanks to an uncritical
media, aggressive marketing and political intervention, Australia is in the
midst of a large, uncontrolled experiment using naltrexone- accelerated
withdrawal and maintenance to treat unselected opioid-dependent people in
the absence of systematic national monitoring of efficacy, safety, or
adverse events."

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