HEROIN HIT

UNTREATED heroin addicts were less likely to die than those who dropped out
of Perth doctor George O'Neil's naltrexone program, a study has found.

The two-year study of 3617 WA heroin addicts by psychiatrist James
Fellows-Smith and general practitioner John Edwards found that addicts on
the streets had a one in 100 chance of dying.

Addicts prescribed naltrexone had a one in 61 chance of dying while those
prescribed methadone had a mortality rate of one in 458.

The study found that heroin overdose in combination with other central
nervous system depressants was the main cause of death in the naltrexone
and methadone test groups.

Naltrexone blocks the cravings for heroin. Dr Fellows-Smith said naltrexone
patients risked death when they stopped treatment suddenly. Most deaths in
the naltrexone test group occurred within a month of ceasing treatment.

"The majority relapse on to heroin and become highly vulnerable to
overdose," Dr Fellows-Smith said. "The most likely cause of this
significant and increased death rate for naltrexone patients is that the
drug (naltrexone) lowers their tolerance for opiates."

Even while on the naltrexone program, patients tended to use a cocktail of
other drugs, including amphetamines and tranquillisers.

Their use of a mixture of drugs with heroin could prove fatal when they
stopped using naltrexone, he said.

Patients remained on the naltrexone program for an average of three months
and 31 per cent were readmitted to the program. Methadone patients stayed
on the program for an average of six months and 45 per cent were readmitted.

Dr O'Neil said he was aware of the research and confirmed there had been 60
to 70 deaths among his patients since he began treating heroin addicts with
naltrexone 3 1/2,* years ago.

"Naltrexone is dangerous if you don't do it properly," he said. Naltrexone
worked 100 per cent of the time but the danger of dying from a drug
overdose when patients dropped off the program was real.

It was crucial that naltrexone patients had the backup of carers, either
family or friends, who would crush and administer the tablets and monitor
urine. In the past six months, 200 addicts who did not have the backup of
carers had been fitted with naltrexone implants.

Dr Fellows-Smith said that, given the high use of naltrexone treatment in
WA, doctors prescribing naltrexone would need to consider whether its use
could be justified."Certainly all patients on naltrexone and their families
need to be warned as to the life-threatening risks associated with its
use," he said.