Naltrexone in the treatment of heroin dependence: relationship with depression and risk of overdose.
OBJECTIVE
This article examines the use of naltrexone in the treatment of heroin dependence. The relationship between naltrexone and depression as well as risk of overdose is examined.


METHODS
The existing literature is reviewed along with recent interim data from clinical trials underway in Victoria.


RESULTS
Naltrexone is a recent addition to treatment for heroin dependence in Australia. The relationship between depression and naltrexone has been examined in previous literature. Underlying rates of depression in heroin users are high and treatment may resolve or exacerbate depression. Research to date demonstrates that the addition of naltrexone does not necessarily increase depression in patients. The risk of non-fatal heroin overdose is significantly elevated after naltrexone treatment as a result of reduced tolerance. Data from clinical trials underway in Victoria demonstrate a significantly elevated rate of non-fatal overdose in naltrexone patients compared to those in substitution maintenance treatment. The mortality rate subsequent to naltrexone treatment appears to be equivalent to or greater than that for untreated heroin users. Further research is required.


CONCLUSIONS
Clinicians need to carefully monitor depression in patients, and warn patients of the risks of reduced tolerance to opiates following naltrexone treatment. Agonist treatments such as methadone, LAAM and buprenorphine carry much less risk of overdose.
Ritter
Alison J
AJ
Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia. Alisonr@turningpoint.org.au
D003866:Depressive Disorder / Q000150:complications*; D062787:Drug Overdose / Q000209:etiology*; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D009271:Naltrexone / Q000009:adverse effects* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D012307:Risk Factors
D009292:Narcotic Antagonists; D009271:Naltrexone