O'Neil, George Go Medical
Over a four-year period, 410 patients with opiate dependence presented for management of their opiate addiction with a series of two or more Long-Acting O’Neil Naltrexone implants. In addition, other patients have been treated with one implant with the total number of patients presenting for Naltrexone implants being 1,204. The intervals between implants varied from two to 44.4 months. Patients were encouraged to consider a second implant prophalactically to prevent relapses between 6-12 months. The following table illustrates the intervals between implants. Interval 1-3 months: 23 (5.61%) Interval 12-15months: 48 (11.71%) Interval 4-6 months: 99 (24.15%) Interval 15-18 months: 65 (15.85%) Interval 7-9 months: 67 (16.34%) Interval 19-21 months: 20 (4.88%) Interval 10-12 months: 60 (14.63%) Interval 22-24 months: 15 (3.66%) Approximately 70% were opiate-free, and approximately 30% had commenced opiate use, but in the majority, this was for <3weeks at the time of re-treatment. Opiate detoxification was noted to be less severe than expected for patients with active implants (less than 12 months). The Naltrexone levels (described by Hulse and O'Neil, Addiction Biology, 2004) suggest levels of Naltrexone to be expected (>2 ng/ml) for the first 6 months, and>1 ng/ml for 280 days. Patients gave a history of excellent and virtually complete control of their opiate dependence in the first 6 months for the majority, and expressed an extremely high level of confidence that their second implant would control their disease for an equally long time. This confidence in treatment had a profound affect on the patient's behavior. All of the patients treated with Naltrexone implants were able to predict for themselves and their family that they could eliminate or control the disease for at least another 6 months as soon as the second implant was inserted. At re-implant, approximately 70%were opiate-free, and approximately 30% had commenced opiate use, but in the majority, this was for <3 weeks at the time of re-treatment. Opiate detoxification was noted to be less severe than expected for the quantity of opiates used if the initial implant was less than 12 months old (Naltrexone blood level >1 ng/ml). With long-term management of Naltrexone implants (average 26months), virtually all of the patients eliminated opiate use in the first three months (opiate positive rate, three positive results out of 830 tests) and when opiate use returns, it is usually quickly and efficiently treated with a repeat implant. Those patients presenting for standard repeat second implants between 6-9 months virtually eliminate their relapses. The risk of death in the population from opiate overdose that we have observed is 0/2600 patient years, contrasting with an expected risk of death of 2/100 patient years. This represents a new form of pharmacotherapy with significant promise. Further large studies with longitudinal follow-up are required to validate these preliminary findings.