DRUG 'CURES SOME ADDICTS'

Doctors have welcomed the Government's decision to make the anti-addiction
drug naltrexone available, but primarily as a treatment for alcoholism
rather than opiate-addiction.

The professor of drug and alcohol studies at the University of Queensland,
Dr John Saunders, said he was delighted the drug had been authorised. He
said naltrexone, which blocks the opiate receptors in the brain, thereby
lowering tolerance to heroin, could potentially be suitable for 30 to 40
per cent of alcoholics, as opposed to 5 to 15 per cent of heroin users.

He said it represented a "sea change" in the treatment of addiction in
Australia, where behavioural and substitution therapies such as methadone
had dominated while there had been less interest in drug treatments.

Professor Saunders cited a United States naltrexone trial in which 52 per
cent of alcoholics were still not drinking six months after the treatment
compared with only 5 per cent of people taking a placebo.

Redfern GP Dr Andrew Byrne, who specialises in the treatment of addiction,
said the results of naltrexone studies in opiate users had been "singularly
disappointing". The best results were when people were highly supervised -
on parole for example. But for "average addicts" a high proportion failed
to comply with the daily drug regimen or later relapsed, and there was also
evidence of a high risk of deaths from overdose if people reverted to
heroin after taking naltrexone, because their tolerance was greatly
diminished.

A naltrexone trial involving 43 heroin addicts in Newcastle between 1994
and 1996, reported last year in the international journal Drug and Alcohol
Review, recorded eight patients completely or virtually heroin-free for the
whole six-month period. But only two of the patients stuck to the drug
regime for the full period, and more than half had dropped out within 10
weeks.

Dr Byrne said: "This isn't a drug that saves lives or improves the
wellbeing of drug addicts. My estimate is there are about one to 2 per cent
of people in whom naltrexone should be seen as an option."

The treatment was most useful for users in the 35 to 40 age group who had
made a serious commitment to change their lives by giving up drugs or
alcohol, said the acting president of the Victorian Alcohol and Drug
Association, Mr John Evans.

"One of the factors is that they still miss the euphoric feelings
associated with drug use", Mr Evans said. He cautioned that counselling and
support was a vital part of the treatment and said rigorous prescribing
guidelines would need to be available to GPs.

Another risk was "diversion" - people giving away or selling naltrexone
prescribed for themselves.

The NSW Minister for Health, Dr Refshauge, said a randomised clinical trial
of naltrexone would start later this year at Westmead Hospital. The trial
of 560 drug addicts would be one of the most comprehensive in the world but
results are unlikely to be known until after 2000.

Two pilot studies last year at Sydney and Westmead hospitals required
participants to sign forms saying they understood they risked death if they
took heroin after naltrexone treatment.

Dr Refshauge and the Opposition spokeswoman on Health, Mrs Jillian Skinner,
both caution that naltrexone should not be seen as a miracle cure.

Mrs Skinner said yesterday that the rapid detoxification drug had exciting
potential, but it was not suitable for every addict. "It is not to be ever
regarded as a magic pill," she said. "The risks of overdose are very high."