Naltrexone implants backed by zealotry but not evidence

Less than a month after Sydney coroner Mary Jerrum referred a provider of naltrexone implants to the NSW Health Care Complaints Commission, the Christian Democrats’ Reverend Fred Nile revealed he wants them used as compulsory treatment for opioid addicts.

Naltrexone implants are not backed by any convincing evidence but the rapid opioid detoxification [ROD], opioid blocking properties they offer appeal greatly to anti-drug crusading Christian evangelists. Long opposed to harm reduction measures and evidence based treatment of addiction, such as methadone maintenance, far right Christians and conservatives see naltrexone implants as a moral masterstroke. Muscling into the action in recent years are the profit-focused, such as Sydney’s Ross Colquhoun, director of Psych ‘n’ Soul.

I’ve previously written about Dr. Stuart Reece, who features in the video below with the same title as this post. His abuse of patients with naltrexone and Jesus saw 25 of them die in 20 months. His career is the epitome of callous faith based pseudoscience which uniquely targets evidence based harm reduction measures. When I posted on a faux “research” paper he had co-authored with other members of Drug Free Australia, I referred to an exchange on an email list hosted by the Alcohol and Drug Council of Australia. It was on this list years ago that I first read Ross Colquhoun defend naltrexone implants as “common sense”. Indeed his evidence free defence of implants led me to conclude that his “common sense” was the equivalent of the religious zealots’ “belief”.

Both individuals are signatories to Drug Free Australia’s so-called position statement which includes funding of naltrexone implants as an “urgent pro-active change to our illicit drug policies”.

DFAposition_statement_sigs1

Handing down scathing findings into three deaths, the coroner recommended that the HCCC consider proceedings against a doctor working at Colquhoun’s Pysch ‘n’ Soul, Dr. Jassim Daood. According to the ABC she noted, “a number of disciplinary cases have already been completed about some of the clinic’s other staff”. The scale of potential problems becomes clear when one considers the implants have never been approved for use, eager staff have little or no training and post-implant support regimes are entirely absent. For over a decade these implants have been available via the TGA’s Special Access Scheme, which is designed to allow patients access to otherwise unavailable drugs to treat conditions deemed potentially fatal in the absence of that drug.

In this case the Scheme is being exploited as a loophole whilst the implant option itself has left in it’s wake a litany of failure and fatalities. Colquhoun is unlicenced to perform ROD but ignored requests from the NSW Health Department in mid 2010. SMH wrote on October 20:

Despite this direction, Colquhoun resumed the treatments while still unlicensed between July and September of that year, only desisting when Grace Yates, a 23-year-old with a five-month-old baby, was given ROD and naltrexone at the clinic on September 29, 2010. She suffered a heart attack and died two months later, having never regained consciousness.

It’s worth considering this failed treatment option is likely to be expanded under a coalition government. As health minister in the Howard Government, Tony Abbott provided the funding for the launch of the evangelical Drug Free Australia from the Tough on Drugs/Assets of Crime kitty. Describing themselves as “Australia’s Peak Drugs Body” they failed to meet the conditions of the funding, choosing instead to sabotage related health policy basics. Without doubt they have proven to be to addiction treatment what the Australian (anti) Vaccination Network is to the management of vaccine preventable disease.

Abbott also sent $50,000 they way of Psych ‘n’ Soul in the same year, showing exceptionally poor judgement. There is little doubt with enemies of Harm Minimisation such as Bronwyn Bishop, Sophie Mirabella and Christopher Pyne on his proposed front bench, Australia’s strong evidence based approach to addiction management would suffer. As the coroner noted:

It appears that a patient only had to present at the clinic to be enthusiastically recommended for rapid opioid detoxification, no matter what their history or situation, without alternatives being discussed or considered or any information given out of the risks involved.

Another death related to the attempts at ROD Psych ‘n’ Soul is now infamous for, involved Michael Poole, 48. He was described as “delirious and delusional” after ROD and died at the Prince of Wales Hospital in Sydney two days later. The third death involved James Unicomb, 23 who died from drug toxicity following a poly-drug overdose, which followed the ROD and occurred whilst an implant remained active. This lack of appropriate follow up of patients is perhaps the most appalling failure related to the practice of ROD and implants.

Rapid detox’ doesn’t treat addiction. It removes cravings and leaves patients open to the possibility of overdose. Often they are dependent upon high doses of benzodiazapines which raises the risk of opioid induced respiratory depression. As addiction is not treated, behaviour cannot be expected to change. It is for this reason follow up should form the most important aspect of rapid detoxification. It is for the same reason that implants have such a high failure rate in “curing” addiction.

One can only imagine the profit made and moral crusading accomplished from treating now dead addicts who were essentially exploited, not treated. Of course, testimonials abound. Whether it’s those who adore Reece for showing them the way to Jesus or Colquhoun’s (third time lucky) performer in the below video, let’s not kid ourselves. The dead cannot speak.

Alex Wodak, director of Sydney’s St. Vincents Hospital Alcohol and Drug Service observed:

How they are allowed to be used for routine purposes in several states in this country beats me. It goes against all the normal regulations and I think the only explanation I can understand is that this is allowed in this case because they’re only drug addicts. […] We really need a national independent inquiry into the regulatory failure, the serious regulatory failure that’s gone on with Naltrexone implants for over a decade.

Indeed we do.

Naltrexone implants backed by zealotry but not evidence


Psych ‘n’ Soul Naltrexone Deaths Inquest Findings