To estimate the number of deaths that would have occurred
among patients receiving oral naltrexone for opioid use under the Special Access
Scheme if these patients had received methadone.
We analysed mortality in cohorts treated with oral
naltrexone and methadone. Data were from 1097 patients of in WA providing oral
naltrexone for opioid use under the SAS,1998-2000, and all participants in WA
(n = 2520) and New South Wales (NSW) (n = 11,174) methadone programs over the
same period. We calculated mortality rates among patients receiving naltrexone
and methadone, and excess mortality among patients receiving naltrexone.
Oral naltrexone patients had higher mortality than those
treated with methadone, even when favourable assumptions were made about the
effects of naltrexone on mortality. Total oral naltrexone mortality was
significantly greater than for methadone in WA (rate ratio 3.5; 95% confidence
interval 2.2-5.8) and NSW (rate ratio 3.5; 95% confidence interval 2.4-5.0).
Among 1097 oral naltrexone patients we estimate that there were 25-29 deaths
over two years that would probably not have occurred if these patients had
received methadone. The major reason was higher mortality rate post-treatment
cessation.
Large-scale use of oral naltrexone to treat opioid users may
not have, as intended, saved lives. Implant naltrexone continues to be
prescribed under the SAS in the absence of reliable efficacy and safety data.
There is a need to review widespread use of unregistered medications under the
SAS, particularly with vulnerable patient groups.
Full article at: http://goo.gl/URGh5z
By:
- 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, USA.
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