title: Unplanned admissions to two Sydney public hospitals after naltrexone implants.
abstract: OBJECTIVE
  To describe hospital presentations related to the use of naltrexone implants, an unlicensed product used in Australia for treating heroin dependence.
  
  
  METHODS
  Retrospective case file audit.
  
  
  METHODS
  Two Sydney teaching hospitals.
  
  
  METHODS
  Identified through referrals to Drug and Alcohol Consultation-Liaison services over a 12-month period, August 2006 to July 2007.
  
  
  METHODS
  Diagnosis, management and duration of admission.
  
  
  RESULTS
  Twelve cases were identified: eight were definitely or probably related to naltrexone implants or the implantation procedure (rapid detoxification). Of these, six patients had severe opiate withdrawal and dehydration, with an average hospital stay of 2.3 days. One patient had an infection at the implant site, and one an underlying anxiety disorder requiring psychiatric admission. Three patients had analgesia complications, and one had unrelated cardiac arrhythmia.
  
  
  CONCLUSIONS
  These severe adverse events challenge the notion that naltrexone implants are a safe procedure and suggest a need for careful case selection and clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population.
authors.affiliation: Drug Health Services, Sydney South West Area Health Service, Sydney, NSW. nicholas.lintzeris@sswahs.nsw.gov.au
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: Soung
authors.initials: S
authors.lastname: Lee
authors.forename: Lucinda
authors.initials: L
authors.lastname: Scopelliti
authors.forename: James
authors.initials: J
authors.lastname: Mabbutt
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
mesh_terms: D000328:Adult; D004343:Drug Implants; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009517:New South Wales / Q000453:epidemiology; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
chemical_list: D004343:Drug Implants; D009292:Narcotic Antagonists; D009271:Naltrexone