Pubdate: Fri, 15 Jun 2001
Source: Sydney Morning Herald (Australia)
Copyright: 2001 The Sydney Morning Herald
Contact:  http://www.smh.com.au/
Details: http://www.mapinc.org/media/441
Author: Julie Robotham
Note: *Name and some personal details have been changed.

FINDING A NEW HIGH WITH FAMILY AND AN EXTRA $2,000 A WEEK

Naltrexone implants are the latest weapon against heroin addiction. Julie 
Robotham reports.

Mark says the polymer block under his skin is his salvation.

So far, it is saving him $2,000 a week, several hours every day and his 
marriage and family. Possibly, it is saving his life.

The implant will leak a steady stream of the anti-addiction drug naltrexone 
into Mark's bloodstream around the clock for up to six months. It will stop 
the 33-year-old self-employed carpenter craving the heroin he began using 
three years ago to ease pain from an injury. If he takes heroin, the 
naltrexone will stop him getting high.

Meanwhile Mark's tolerance to opiates will plummet, making him more 
vulnerable to overdose if he does use again. He hopes the $1,000 implant 
will keep him physically away from the object of his addiction while 
counselling deals with any psychological urge to backslide.

"With tablets you can spit it out, or hide it under your tongue," Mark* 
told the Heraldthis week. His wife supervised an earlier attempt to kick 
heroin with oral naltrexone. "It was hard for her. She didn't need another 
kid to look after."

Trust is returning to the relationship as Mark spends more time at his 
South Coast home. "I used to get up at 3am and drive to Cabramatta to buy 
heroin and then go to work in Sydney and then go back to Cabramatta before 
going home. It was five or six hours of driving a day."

Mark is one of the first three heroin users in NSW to receive the implant, 
inserted under the skin during local anaesthetic. The controversial 
treatment has been used in hundreds of patients in Western Australia, 
Victoria and Queensland, but has caused deep divisions among doctors and 
addiction specialists. Proponents say they prevent overdose deaths and help 
patients stick with medication. Detractors say they are untested and oversold.

The director of research at the National Drug and Alcohol Research Centre, 
Associate Professor Richard Mattick, said evidence from Australian medical 
trials showed naltrexone tablets were much less effective than claimed 
three years ago, when they were first publicised as a heroin "cure".

"The suggestion that the implants are the better, improved miracle cure is 
tiresome," Professor Mattick said. "It's important not to over-promise to 
families."

The implants, which are not formally approved by the Federal Health 
Department, are prescribed under special provisions which allow doctors to 
sidestep the usual rules for individual patients at risk of death. 
Prescribers argue this applies to heroin users because of the possibility 
of overdose.

Professor Mattick said while doctors were entitled to use the exemption, 
"the broad prescription of these devices goes against the spirit and the 
intention of the [Therapeutic Goods] Act".

But Dr George O'Neil, who has treated more than 450 patients in Western 
Australia with naltrexone implants, said they were a genuine advance over 
tablets, which are available to addicts only on private script.

He says the drug works best when there are fewer opportunities to avoid it. 
"Even with their mother caring for them, the success rate [with tablets] 
was only 20 to 30 per cent. When the mothers crushed the tablets [to stop 
spitting out] that increased to 60 to 70 per cent and when we started 
teaching mothers to measure their urine it was 80 per cent. With implants 
they're full of naltrexone whether they like it or not."

The Sydney psychologist overseeing the NSW patients' treatment at Edgecliff 
Medical Centre, Mr Ross Colquhoun, said methadone suited some people but 
others found queuing for a daily dose humiliating. "These people live in 
pain and humiliation. They don't need any more. [Addiction is] not a 
wilful, indulgent thing. It's a neurological disorder," he said.
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MAP posted-by: Beth