Opioid overdose deaths can occur in patients with naltrexone implants

Colin L Brewer
Med J Aust 2007; 187 (1): 55.

To the Editor: As one of the first clinicians to use naltrexone implants (in 1997) and author of two references cited by Gibson et al,1 I wish to comment on their article.

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  • Colin L Brewer

  • The Stapleford Centre, London, United Kingdom.


  • 1. Gibson AE, Degenhardt LJ, Hall WD. Opioid overdose deaths can occur in patients with naltrexone implants. Med J Aust 2007; 186: 152-153. <MJA full text>
  • 2. Verebey K, Volavka J, Mule S, Resnick R. Naltrexone: disposition, metabolism and effects after acute and chronic dosing. Clin Pharmacol Ther 1976; 20: 315-328.
  • 3. Brewer C. Serum naltrexone and 6-beta-naltrexol levels from naltrexone implants can block very large amounts of heroin: a report of two cases. Addict Biol 2002; 7: 321-323.
  • 4. Brewer C, Streel E. Current issues in the use of opioid antagonists. In: Dean RL III, Bilsky EJ, Negus SS III, editors. Opioid receptors and antagonists: from bench to clinic. Totowa, NJ: Humana Press. In press.
  • 5. Foster J, Brewer C, Steele T. Naltrexone implants can completely prevent early (1-month) relapse after opiate detoxification: a pilot study of two cohorts totalling 101 patients with a note on naltrexone blood levels. Addict Biol 2003; 8: 211-217.
  • 6. O’Neil G, Parsons Z, O’Neil P, et al. A review of mortality of patients entering a naltrexone implant treatment programme over a five year period. 3rd Stapleford-Berlin Conference; 2006 Mar 16–18; Berlin, Germany.
  • 7. Levine B, Wu SC, Dixon A, Smialek JE. Site dependence of post-mortem blood methadone concentrations. Amer J Forensic Med Pathol 1995; 16: 97-100.
  • 8. Milroy CM, Forrest AR. Methadone deaths: a toxicological analysis. J Clin Pathol 2000; 53: 277-281.
  • 9. Strang J, McCambridge J, Best D, et al. Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. BMJ 2003; 326: 959-960.


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