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Catherine De Jong
University of Groningen, The Netherlands, Netherlands
Biography
Catherine De Jong is an Anesthesiologist
Abstract
Background: Since the year 2000, oral Naltrexone in combination with Cognitive Behavioral Therapy (CBT) has been implemented at our clinic for relapse prevention after opiate detoxification. Naltrexone implants were introduced in 2003. All patients receive a 6-week or 2-month implant upon detoxification and are offered 6-week, 2-month or 6–month repeat implants, depending on the patient’s wish and availability of implants. A prescription for oral Naltrexone is also an option. The 6-month implants were no longer available after December 2008. Only 2-month Naltrexone implants have been available since that time. Aim: Evaluation of the efficacy of Naltrexone implants in our relapse prevention program after opiate detoxification and to report of complication rate of this treatment. Method: Retrospective descriptive study: all the patients who received a Naltrexone implant after detoxification during the study period (May 2003–January 2009) were included in the study. We used patient notes, the number of implants, the duration of implant treatment. The types of implants were counted, and complications were noted. Results: A total of 186 patients (148 men, 38 women) were detoxified and received at least 1 implant. We used 535 implants (74 Wedgwood 6-week implants, 99 O’Neil 6-month implants and 362 of the 2-month implants). The patients used an average of 3.3 implants each (range 1–18). The duration of implant use averaged 7.66 months (range 1.5–38 months). Patients who had 6-week and 2-month implants (N=122) were under protection of an implant for an average of 5.11 months (range 1.5–36 months). Patients with a 6-month implant (N=64) were under protection of an implant for an average of 12.25 months (range 6–38 months). The difference is significant at p < 0.001. See Table 1. Table 1 Number of patients Average duration implant use in months Range duration implant use in months All implants 186 7.66 1.5–38 6-week and 2-month implants 122 5.11 1.5–36 O'Neil/ 6-month 64 12.25 6–38 p < 0.001 Number of patients using implants at 3, 6, 9 and 12 months after detoxification were 119 (64%), 82 (44%), 56 (30%) and 32 (17%), respectively. The number of patients who switched to oral Naltrexone was 47(9%). The number of patients that relapsed during implant treatment was 7 (1.3%). At one-year follow-up, 107 (58%) patients were opiate abstinent (implant, tablets or no Naltrexone) and still in regular contact with the psychotherapists and/or addiction doctor, or they had finished treatment clean and in good condition 3 months before follow-up. The number of patients who relapsed were 39 (21%), and 40 (21%) patients were lost to follow-up and were considered to have relapsed. Database of urine samples is not complete but is still in the process. Complications are shown in Table 2. Table 2 Number of implants used 535 (100%) Major complications 19 (3.6%) Incision and/or drainage abscess 7 (1.3%) Wound infection, antibiotics prescribed 12 (2.2%) Minor complications 36 (6.7%) Hematoma 11 (2.1%) Itching 21 (3.9%) Swelling 4 (0.7%) Relapse 7 (1.3%) heroin use while on implant weeks 1-4 2 (0.4%) heroin use while on implant > week 4 5 (0.9%) reports of craving while on implant 8 (1.5%) Conclusion: Patients with subcutaneous Naltrexone implants had a very low relapse rate of 1.3% while using implants. Patients who had at least one 6-month implant remained under the protection of implants significantly longer then patients who used 6-week and 2-month implants. Major and minor complications were infrequent. At one-year follow-up, 58% of patients were opiate abstinent. Conflict of interest: nothing to report
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