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. - --- MAP posted-by: Beth