title: Examination of mortality rates in a retrospective cohort of patients treated with oral or implant naltrexone for problematic opiate use.
abstract: OBJECTIVE
  To examine and compare mortality rates in patients treated with oral and implant naltrexone.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A community not-for-profit drug treatment clinic.
  
  
  METHODS
  Patients treated with oral naltrexone (n = 2155, 17 207 patient-years) and implant naltrexone (n = 2389, 11 678 patient-years) for problematic opiate use between August 1997 and December 2009.
  
  
  METHODS
  Crude gender, age, treatment period and cause-specific mortality rates were calculated using data obtained from the National Death Index.
  
  
  RESULTS
  Crude mortality rates for patients treated with oral naltrexone [8.78 deaths per 1000 patient-years (ptpy), 95% confidence interval (CI): 7.38-10.17] were significantly different to those treated with implant naltrexone (6.59 ptpy, 95% CI: 5.13-8.06) (P = 0.0339). During the first 4 months following treatment, differences in the two groups were particularly apparent, with a mortality rate of 26.28 ptpy in patients treated with oral naltrexone compared to 7.34 ptpy in patients treated with implant naltrexone (P = 0.0003). Differences in initial mortality rates following treatment were associated predominantly with high rates of opiate overdoses in oral naltrexone patients during the first 4 months following treatment (17.22 ptpy compared with 0.67 ptpy in implant naltrexone patients) (P < 0.0001).
  
  
  CONCLUSIONS
  The use of implant naltrexone can reduce all-cause mortality and opiate overdose during the first 4 months following treatment compared with patients treated with oral naltrexone.
authors.affiliation: School of Psychiatry and Clinical Neuroscience, University of Western Australia. erin.kelty@freshstart.org.au
authors.forename: Erin
authors.initials: E
authors.lastname: Kelty
authors.forename: Gary
authors.initials: G
authors.lastname: Hulse
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000701:Analgesics, Opioid / Q000506:poisoning; D002423:Cause of Death; D004343:Drug Implants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000401:mortality*; D017678:Sex Distribution; D015996:Survival Rate; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004343:Drug Implants; D009292:Narcotic Antagonists; D009271:Naltrexone