MORE DRUG THERAPY FEARS

A CONFIDENTIAL report for top-level Federal and State government
officials has raised serious concerns about the controversial heroin
treatment drug naltrexone.

The National Drug and Alcohol Research Centre's evaluation of four
heroin treatments uncovered high incidences of overdoses and suicide
among heroin addicts who had been prescribed naltrexone.

The West Australian has a copy of the centre's preliminary report.

It says the rate of fatal and non-fatal heroin overdoses among the
naltrexone group of patients was 46 per 1000. This compared with 13
per 1000 heroin overdoses among buprenorphine patients, two per 1000
for methadone patients and zero for addicts treated with
levo-alpha-acetylmethadol or LAAM.

The two-year evaluation also found the highest rate of attempted and
completed suicides among those patients prescribed naltrexone.

There were 6.6 suicide-related incidents per 1000 involving
naltrexone patients, compared with 4.3 per 1000 for those prescribed
methadone, 2.1 per 1000 for buprenorphine and zero for LAAM. LAAM is
a radical new treatment not available in WA.

However, patients who stuck to the four therapies revealed similar gains.

Naltrexone kept addicts alive, but "serious adverse events" including
death, were recorded when patients suddenly stopped taking it and
reverted to using heroin.

"These results point to the need for clinicians to alert both
patients and families to the potential risk of heroin overdose if
naltrexone treatment is ceased, or if naltrexone is not taken
regularly (generally daily), as tolerance for opioids will be low,"
it said.

The West Australian understands that Subiaco drug treatment doctor
George O'Neil was among a small number of private doctors encouraged
to take part in the evaluation but he declined. The national
evaluation involved oral naltrexone, not the controversial naltrexone
implants.

The preliminary report by the University of NSW-based drug and
alcohol research centre is in line with two recent studies by
Leederville psychiatrist James Fellows-Smith and general practitioner
John Edwards, and Nedlands clinical haematologist John Raven.

The study by Dr Fellows-Smith and Dr Edwards found that untreated
heroin addicts were less likely to die than those who were prescribed
naltrexone but dropped out of Dr O'Neil's program.

Dr O'Neil branded both the Fellows-Smith/Edwards and Raven studies as
seriously flawed.