Pharmacotherapy for heroin dependence, translation of healthcare service provision to research

Abstract

A novel example of healthcare service provision translation into a research framework within a community based drug and alcohol treatment facility.

Retrospective patient clinical file examination was used. Curves modelled to routinely collected blood samples were used to ascertain the time it took blood levels to fall below therapeutic levels following naltrexone implant treatment. Linkage of patient information to the Western Australian Data Linkage System (DLS) at the Department of Health enabled follow-up of overdose presentations in patients after treatment. Patient case studies were used to delineate treatment of special cases (eg drug impaired physicians).

Results of modelled data showed that naltrexone implants are capable of maintaining low blood naltrexone levels within the ascribed therapeutic range. Coverage can be extended by use of sequential implants. Case studies supported this, in that following sequential implant treatment blood naltrexone was maintained at levels required for antagonism of opioid based drugs for significant periods of time. Longer term follow-up of a cohort of treated patients through the DLS showed that there was a reduction in the number of opioid overdose deaths during the period of implant coverage.

Routinely collected patient data from a treatment clinic together with mathematical modelling has been used to identify a major advantage of a pharmacotherapy (naltrexone implant), ie maintenance of low therapeutic blood naltrexone levels for extended periods. This suggests that successive implantation can be opportunistic with any subsequent clinical contact during the initial implant coverage period taken advantage of to perform a subsequent implant without fear of unduly elevating blood naltrexone levels.

For treatment of the long term heroin dependent person continuity of treatment is an important consideration. Naltrexone implants offer a level of continuous protection not achieved with any previous treatment.

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