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Examination of mortality rates in a retrospective cohort of patients treated with oral or implant naltrexone for problematic opiate use

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Aims  To examine and compare mortality rates in patients treated with oral and implant naltrexone.

Design  A retrospective cohort study.

Setting  A community not‐for‐profit drug treatment clinic.

Participants  Patients treated with oral naltrexone (n = 2155, 17 207 patient‐years) and implant naltrexone (n = 2389, 11 678 patient‐years) for problematic opiate use between August 1997 and December 2009.

Measurements  Crude gender, age, treatment period and cause‐specific mortality rates were calculated using data obtained from the National Death Index.

Findings  Crude mortality rates for patients treated with oral naltrexone [8.78 deaths per 1000 patient‐years (ptpy), 95% confidence interval (CI): 7.38–10.17] were significantly different to those treated with implant naltrexone (6.59 ptpy, 95% CI: 5.13–8.06) (P = 0.0339). During the first 4 months following treatment, differences in the two groups were particularly apparent, with a mortality rate of 26.28 ptpy in patients treated with oral naltrexone compared to 7.34 ptpy in patients treated with implant naltrexone (P = 0.0003). Differences in initial mortality rates following treatment were associated predominantly with high rates of opiate overdoses in oral naltrexone patients during the first 4 months following treatment (17.22 ptpy compared with 0.67 ptpy in implant naltrexone patients) (P < 0.0001).

Conclusions  The use of implant naltrexone can reduce all‐cause mortality and opiate overdose during the first 4 months following treatment compared with patients treated with oral naltrexone.
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Document Type: Research Article

Affiliations: School of Psychiatry and Clinical Neuroscience, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australian, Australia

Publication date: 2012-10-01

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