NALTREXONE DOES NOT KILL PEOPLE

In the article "Constant craving", I believe your correspondent has
portrayed my (few reported) remarks as implying that I am critical of
Naltrexone as a contributor in the management of opioid addiction.

On the contrary, as the anaesthetist involved in the trial at Westmead
Hospital, I am very encouraged by the early results in accelerating the
development of a state of abstinence using Naltrexone combined with
sedating and/or anaesthetic techniques.

I did comment that I felt most of the problems with inappropriate
prescription could be solved by better education of general practitioners.

No-one involved in meaningful, substantial trials of this drug suggests
that Naltrexone by itself is a "magic bullet". Addiction is a chronic
relapsing brain disease and its management must be seen in this context.

Of course, treatment is likely to fail if accelerated abstinence is not
combined with psycho-social support of varying degree, depending on the
individual circumstances.

A good outcome in the management of addiction is thus significant reduction
of drug use, long periods of abstinence and only occasional relapses which
can be readily treated. The early results in this country would suggest
that this is happening.

Finally, the obsession to link overdose to recent use of Naltrexone
overlooks the well-known fact that any period of abstinence, by any means,
will render brain receptors more sensitive to oploids and thus make
overdose a risk whenever opioids are used, legally or illegally. It is not
Naltrexone that kills people.

Sadly this message seems to be lost in the rhetoric of the moment.

Peter Cox
Consultant Anaethesist,
Balmain
May 16