Unplanned admissions to two Sydney public hospitals after naltrexone implants.
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.
Lintzeris
Nicholas
N
Drug Health Services, Sydney South West Area Health Service, Sydney, NSW. nicholas.lintzeris@sswahs.nsw.gov.au
Lee
Soung
S
Scopelliti
Lucinda
L
Mabbutt
James
J
Haber
Paul S
PS
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
D004343:Drug Implants; D009292:Narcotic Antagonists; D009271:Naltrexone