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Subcutaneous Naltrexone Implants: A one-year follow-up study

Subcutaneous Naltrexone Implants: A one-year follow-up study. Catherine J. de Jong MD Stichting Miroya (Miroya foundation) Amersfoort, the Netherlands. Miroya Foundation. The Miroya Foundation specializes in the treatment of opiate addiction

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Subcutaneous Naltrexone Implants: A one-year follow-up study

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  1. Subcutaneous Naltrexone Implants:A one-year follow-up study Catherine J. de Jong MD Stichting Miroya (Miroya foundation) Amersfoort, the Netherlands

  2. MiroyaFoundation • The Miroya Foundation specializes in the treatment of opiate addiction • Anaesthesia Assisted Rapid Opiate Detoxification (AAROD) • Medically Assisted Detoxification At Home (MADAH) • Patient from other clinics • Relapse prevention: • 1 year CBT • 1 year Naltrexone

  3. Naltrexone implants used since May 2003 • Wedgwood, 6-week implants • 2-month implants • O’Neil 6-month implants • not available after December 2008 • Patients have free choice of implant type • Price 3 x 2 months = price 1 x 6 months • Naltrexone tablets are always an alternative

  4. Aim • To evaluate the effect of Naltrexone implants and oral Naltrexone in our relapse prevention program after opiate detoxification. • To report complications.

  5. Method • Retrospective descriptive study. • All the patients who received a Naltrexone implant after detoxification (May 2003 – January 2009) were included in the study.

  6. Patients Men / Women Number of implants Average number of implants used per patient Average duration implant treatment N=186 148 / 38 535 3.3 7.66 months Results

  7. Wedgwood 6-week implants O’Neil 6-mo. implants 2-mo. implants 74 99 362 Different sorts of implants usedDifferent combinationsDepending on availability and patient wish

  8. 1 N=69 2 N=54 3 N=17 4 N=13 5 N=10 6 N=8 7 N=5 8 N=8 >8 N=9 (10-18) Number of implants used per patient

  9. At detox At 3 months At 6 months At 9 months At 1 year 186 100% 119 64% 82 44% 56 30% 32 17% Number of patients using implants

  10. % of patients using implants

  11. Does type of implant influence duration of treatment?

  12. Incision and/or drainage of abscess Wound infection, antibiotics prescribed 7 1.3% 12 2.2% Major Complications N=535

  13. Hematoma Itching Swelling 11 2.1% 21 3.9% 4 0.7% Minor Complications N=535

  14. Heroine use while on implant weeks 1-4 Heroin use while on implant > week 4 Reports craving while on implant N=2 0.4 % N=5 0.9 % N=8 1.5 % Relapse during implant treatmentN = 535

  15. Severe infection in 1 patient with O’Neil implant: Psychiatric patient with a history of auto mutilation. Patient tried to scratch the implant out with severe infection as a result, surgical treatment and intravenous antibiotics needed. Major Complication:

  16. Other complications • 1 patient tried to remove a 6-month implant. Patient had relapsed and experienced withdrawal symptoms after the implant was inserted. He tried to remove the implant but did not succeed. No infection.

  17. Relapse into heroine use with effective implant • 5 patients relapsed after 4th week while on 6-week or 2-month implant. • One patient with 6-month implant smoked heroin without experiencing any effect. He is a dealer and smokes heroine while socializing with his clients.

  18. Relapse rateduring implants use • N=7 1.3%

  19. Conclusion • Relapse rate while on Naltrexone implant treatment is very low: 1.3% • The use of a 6-month Naltrexone implant provides significant longer duration of treatment compared to repeat 2-month implants • Major complications: 3.6% • Minor complications: 6.7%

  20. Plan for the future • Based on this success we intend to expand the use of Naltrexone implants. • We intend to publish a one-year follow-up study with urine tests for opiate abstinence.

  21. Thank you for your attention Catherine J. de Jong, MD Stichting Miroya (Miroya Foundation) Amersfoort, the Netherlands www.miroya.nl c.j.dejong@euronet.nl

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