To the Editor: I read with interest the article by Gibson and colleagues,1 who purport to have evaluated the claim that naltrexone “prevent[s] relapse to opioid use and therefore fatal opioid overdose”. The article fails in its stated intent, as it neglects to provide adequate context and comparison in its evaluation of the five deaths between 2000 and 2004 identified through Australia’s National Coroners Information System. The significance of the data cannot be assessed, as the authors omitted the number of naltrexone implants made available through the Therapeutic Goods Administration Special Access Scheme and comparison with other opioid users. This is extraordinary, given the high risk of death in this group both in and out of treatment.2
- 1. Gibson AE, Degenhardt LJ, Hall WH. Opioid overdose deaths can occur in patients with naltrexone implants. Med J Aust 2007; 186: 152-153. <MJA full text>
- 2. Degenhardt L, Roxburgh A, Black E, et al. Accidental drug-induced deaths due to opioids in Australia, 2004. Sydney: National Drug and Alcohol Research Centre, 2005.
- 3. Zador DA, Sunjic SD. Methadone-related deaths and mortality rate during induction into methadone maintenance, New South Wales, 1996. Drug Alcohol Rev 2002; 21: 131-136.
- 4. Digiusto E, Shakeshaft A, Ritter A, et al. Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Addiction 2004; 99: 450-460.
- 5. Saint S, Christakis DA, Saha S, et al. Journal reading habits of internists. J Gen Intern Med 2000; 15: 881-884.
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