Aboriginal Health

Adolescent Medicine

Anaesthetics

Complementary Medicine

Dermatology

Emergency

ENT

Geriatrics

ICU

Internal Medicine

Musculoskeletal

Paediatrics

Palliative Care

Psychiatry

Sexual Health

Surgery

Women's Health

Drugs and Alcohol

Medicinal Cannabis Survey

Benzodiazepine Dependence

Confessions of an English Opium Eater

Common Questions about Methadone

Heroin Detox - A panacea?

Methadone Maintenance Treatment

Rapid Heroin Detoxification

The Heroin Trial

Observations on Naltrexone Rx

Naltexone prescription for heroin addiction

"Interested GP's are recommended to purchase the excellent summary of current knowledge in NDARC Monograph 34 on the role of Naltrexone in Heroin addiction. This costs $10 including postage and may be ordered from
National Drug And Alcohol Research Centre
University of NSW
NSW 2052"

On the Gold Coast we are trying to get a network of community support and volunteers to keep in touch with families and ex-addicts, similar to the AMPRF programme style that George Oneil has. (Ed note: AMPRF stands for Australian Medical Procedures Research Foundation, a non-profit organisation associated with Perth-based Dr George Oneil and his team approach to the recovery of heroin addicted patients.) Ron Allen worked with the Perth programme and has come across to assist in getting a caring network working.

My oldest friend in Perth is George Oneil, and I visited his "naltrexone church programme" as he calls it, on a trip to see my family back in September. Prior to that I had felt that methadone was the best bet, and had been most grateful for all that I learned from Dr Andrew Byrne's excellent books.

On my return I saw a 19 year old patient who said - I stopped using methadone because I was still using heroin, so I thought I might as well stick with one thing, then I wiped out my car with my two year old on board, and decided to just dry out at home, and I haven't used for 10 days and I am dreaming about heroin and craving and can't stop thinking about it - can you help me? So I faxed Dr Allan Black in TGA and described her story and he approved naltrexone. She tolerated narcan and took a tablet, and immediately stopped craving heroin and stopped dreaming about it! She has had one slip for a few days and is OK again now.

Since then I have treated about 50 patients. This includes a couple of Israel UROD (ultra rapid opiate detoxification patients who fell off the bus, and people with habits ranging from $25 to $1000 daily. I have learned from treating them (backed up by studies on Cochrane Database) that:

1. There is no point in using NTX unless the patient brings a personal carer (preferably family), and there is a counselling process for ex-addict as well as family. Pre detox psychotherapy, particularly relating to trauma processing (using EMDR if a trained person is available), is very important.
2. It is probably unethical to make people detox for seven days before introducing NTX. A couple of studies in Cochrane show that (a) success in achieving detox, and (b) long term benefit as measured by compliance with groups and counselling at six months, is much greater in those whose detox was accelerated with tiny doses of naltrexone.
3. Teaching people to detox (using clonidine, +/- melleril, temazepam, quinine, loperamide) using an eyedropper with 50mg naltrexone dissolved in 5ml of water, using 1 drop (=3D0.4mg) every hour (having breaks when necessary), gives them a simple way of restarting naltrexone without having to wait for an ICU bed in a teaching hospital or Israel, if they happen to have a "fall" later.
4. UROD, and even ROD in an institution, disempowers families. That doesn't make sense, when we know long term outcomes depend on family engagement. Family based, medically assisted, naltrexone micro-dose accelarated detox seems to get strong approval from participants who have been through all the other ways before.
5. Mental craving will often disappear within 12 hours on the naltrexone micro-dosing detox. Physical withdrawal scores usually settle within 48 hours. Perhaps it should be called AAOD - accelarated ambulatory opiate detoxification.

Dr Hugh Nelson has developed a database design on naltrexone management, which he believes could be used by GPs using naltrexone for treating opiate dependence. Dr Nelson would value any criticism and contributions on the database design with a view both to helping the clinician and naltrexone tablet manager, and also the epidemiologist who looks at the data. GPs interested in a copy of the draft protocol should contact Katherine Breen Kurucsev, kbreenk@om.com.au.