HEROIN "CURE" GETS BLAME AS 13 ADDICTS DIE

At least 13 Australians have died after stopping the controversial
treatment for heroin addiction, naltrexone, prompting concerns about an
"explosion" in the drug's use.

It is not licensed here, but more than 300 doctors have been given special
authority to prescribe naltrexone, although the distributor says it has
supplied only about 110 doctors.

As well, there are widespread reports from doctors, politicians and heroin
users of naltrexone being sold on the black market, which doctors warn
could be extremely dangerous.

Doctors in Sydney, Melbourne and Perth have reported at least 13 deaths in
patients who had stopped naltrexone treatment, most of which were due to
heroin overdoses.

A spokesman for the Minister for Health, Dr Refshauge, last night confirmed
that two Sydney deaths were before the Coroner, including one patient
involved in a trial at Sydney Hospital.

Some experts fear naltrexone increases sensitivity to heroin, raising
patients' risk of overdose if they use it again after undergoing
detoxification.

Others have warned that naltrexone is being prescribed without the right
counselling, support and monitoring.

The National Drug and Alcohol Research Centre, which plans to investigate
the deaths, is developing guidelines for the drug's use, according to its
research director, Associate Professor Richard Mattick.

He said naltrexone should no longer be prescribed outside clinical trials.

"It shouldn't be being used in a broad fashion until it's properly
evaluated and registered for use," he said.

"We argued that all the excitement was going to lead to an explosion in the
use of the medication which was quite inappropriate, and unfortunately
we're right."

There was widespread concern, he said, that an effective intervention "may
be thrown into disrepute because it's being oversold by people in favour of
it and people aren't being adequately advised about the risks and dangers
particularly if they return to drug use".

Dr George O'Neil, a Perth gynaecologist involved in a trial, said there had
been six deaths out of 750 people treated in Western Australia over a year,
although only three of these were within two months of naltrexone use.

He said there was insufficient data to know whether the death rate
associated with naltrexone was higher than that with methadone, and
emphasised that it was lower than that in heroin users not on treatment.

Dr Michael Kozminsky, a Melbourne GP specialising in alcohol and drug
treatment, said four patients had died out of about 600 prescribed by his
clinic since last September.

But this risk had to be balanced against a great improvement in quality of
life, with many of his patients returning to work and normal lives.

Dr Siva Navaratnam, a consultant anaesthetist at Liverpool who has treated
over 100 patients, said he was concerned that not all patients were
receiving appropriate counselling and monitoring.

The chair of a NSW Health Department committee on accreditation of
methadone prescribers, Dr Deborah Zador, suggested that an accreditation
system may be needed for naltrexone prescribers when the drug is licensed.

The NSW Government last year announced two pilot projects, at Westmead and
Sydney hospitals, which are to be evaluated before a $600,000
government-funded trial of 560 addicts is expected to begin.

Patients on the hospital programs sign a consent form, which warns: "Among
people who discontinue naltrexone there is increased sensitivity to opioids
and an increased risk of death by accidental overdose."