An update on Naltrexone and Flumazenil in Polydrug and Alcohol Abuse - George O'Neil - ISAM 2013 Kuala Lumpur

Endorphin tolerance develops quickly and needed more
Eg. 42 yo man who was unable to sleep through night having to get up and smoke several times.  Gave naltrexone - patient described increased anxiety - using very small doses of naltrexone - all of these people stopped smoking completing - using naltrexone and benzo - little doses in the pre use phase and on chronic user putting big does of both drugs under skin.  Very different ways of using drugs.
Mellanby showed that tolerance developed with first drug
PHREE program - pharmacology and overall care
Accelerated detox 48 hour, versus 7 days detox. accelerated had 89% versus 30%
Moving patients to long acting implant naltrexone
Medications are to get people in quickest possible time into community and back to family
Norway study RCT- Implant trial,  Russian RCT with implants too
Implant Naltrexone is 25 times more efficient than oral natrexone at preventing opiate overdose dates in the  first 120 days post detox
Perth Overview
 4000 opioid patients
- average 8-10 month
 500 amphetamine patietns
500 alcohol patients
Flumazenil implant  used for benzodiazpeine addiction, with alcohol and other detoxifications, anxiety and sleeping disorders, parkinson's disease
Nasal delivery systems and sublingual for naltrexone and flumazenil.
Treating cravings of nicotine with naltrexone and flumazinel.  250 ug naltrexone


(These are my rough notes. I apologize for any errors. George was one of the most interesting speakers and one of the most experienced. His questions  and discussion after presentations was always most interesting. He had a number of Perth colleagues present as well. I had the pleasure of talking to several of the individuals and was impressed with their medical knowledge and their compassion for their patients.  There is really a place for this type of work and these solutions to specific problems. There's a terrific sense that this is tailored to individuals and their wants and needs rather than the one shoe fits all approach.  I was most impressed and would encourage anyone who can give serious consideration to these options for treatment. I will be discussing these studies with colleagues. )