• Nicholas Lintzeris, Soung Lee, Lucinda Scopelliti, James Mabbutt, and Paul S Haber.
• Drug Health Services, Sydney South West Area Health Service, Sydney, NSW. nicholas.lintzeris@sswahs.nsw.gov.au
• Med. J. Aust. 2008 Apr 21; 188 (8): 441-4.

ObjectiveTo describe hospital presentations related to the use of naltrexone implants, an unlicensed product used in Australia for treating heroin dependence.DesignRetrospective case file audit.SettingTwo Sydney teaching hospitals.PatientsIdentified through referrals to Drug and Alcohol Consultation-Liaison services over a 12-month period, August 2006 to July 2007.Main Outcome MeasuresDiagnosis, management and duration of admission.ResultsTwelve cases were identified: eight were definitely or probably related to naltrexone implants or the implantation procedure (rapid detoxification). Of these, six patients had severe opiate withdrawal and dehydration, with an average hospital stay of 2.3 days. One patient had an infection at the implant site, and one an underlying anxiety disorder requiring psychiatric admission. Three patients had analgesia complications, and one had unrelated cardiac arrhythmia.ConclusionsThese severe adverse events challenge the notion that naltrexone implants are a safe procedure and suggest a need for careful case selection and clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population.

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