NALTREXONE NEEDS PATIENT SELECTION

THE high death rate associated with the use of naltrexone in WA for heroin
addicts is nothing new. Naltrexone was developed in the 1970s but had
limited use overseas because trials were disappointing and associated with
a high death rate.

Overseas research also showed that careful patient selection is critical to
success with naltrexone. Dr O'Neil promoted a single treatment for opiate
dependence as suitable for all patients without adequately considering
these known risks. It is very unusual in medicine for a doctor to promote a
single drug as the only treatment for a medical condition. Responsible
medical practice would be to consider the use of a range of drugs,
selecting out the optimal treatment for each patient.

The Health Department carries some responsibility because use of other
sedative drugs contributed to the high death rate. About two years ago the
department restricted the prescribing of Rohypnol, a powerful sedative also
known as a "date-rape" drug, to psychiatrists only. Dr O'Neil and doctors
at his clinic were given special permission to prescribe it, even though
they are not psychiatrists, and there was no scientific evidence to support
this use.

Your report (1/3) said that the use of methadone was associated with a
significant saving of life. However, this drug costs patients $4 a day. In
contrast, the department specifically made naltrexone, the more dangerous
treatment, available for nothing. I hope the department will also make
methadone available without cost.

Dr. PETER NELSON, Fremantle.