Long-acting Naltrexone Implant and Disulfiram Implant are available for the treatment of various kinds of Addiction. They are discussed in greater detail here.
DISULFIRAM IMPLANTS
Disulfiram produces a sensitivity to alcohol that results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol. Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism, after disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body. Disulfiram plus even small amounts of alcohol produces flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions, there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The intensity of the reaction may vary with each individual but is generally proportional to the amount of disulfiram and alcohol ingested. In the sensitive individual, mild reactions may occur when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 mL. At a concentration of 50 mg/100 mL symptoms are usually fully developed, and when the concentration reaches 125 to 150 mg/100 mL unconsciousness may occur. The duration of the reaction is variable, from 30 to 60 minutes in mild cases, up to several hours in more severe cases or as long as there is alcohol remaining in the blood. Disulfiram is slowly absorbed from the gastrointestinal tract and is slowly eliminated from the body. Ingestion of alcohol may produce unpleasant symptoms 1 or even 2 weeks after a patient has taken his last dose of disulfiram. Prolonged administration of disulfiram does not produce tolerance. The longer a patient remains on therapy the more sensitive he becomes to alcohol. Used alone, without proper motivation and without supportive therapy, disulfiram is not a cure for alcoholism, and it is unlikely that it will have more than a brief effect on the drinking pattern of the chronic alcoholic. However, as an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage, Disulfiram has a valuable role to play.
We now offer a Disulfiram implant, which appears to give effective blood levels for twelve weeks on an average. It is usually inserted under local anaesthetic after detoxification is over and 2 – 3 doses of the oral Disulfiram have been given. It is inserted through a 1 cm incision in the lower abdomen or at the back of the upper arm. The implant is inserted 3-4mm under the skin.
ADVANTAGES OF IMPLANTS
- Makes relapse almost impossible while the implant is effective.
- Avoids the need to supervise Disulfiram and the arguements it can cause.
- Makes it impossible to ‘forget’ to take Disulfiram.
- Reduces craving even more than oral Disulfiram because there is no point in craving for what you can’t have.
DISADVANTAGES OF IMPLANTS
- Involves (minor) surgery and a small scar with temporary tenderness and bruising.
- Occassional local infection or inflammation of implant site, usually responding to antibiotics.
- Initially more expensive than oral Disulfiram.
- Risk of turning to other drugs as a substitute. (Applies as much to oral Disulfiram)
It must be emphasised that the need for aftercare counselling to allow thorough social integration is not reduced when implants replace oral Disulfiram. Aftercare counselling is essential to ensure that healthy and appropriate coping behaviours are learnt, rather than substituting other drugs for alcohol.
NALTREXONE IMPLANTS
Naltrexone is a narcotic antagonist. It works by blocking the opioid receptors in the brain and therefore blocking the effects of heroin and other opioids. Those who take it know that they cannot achieve a ‘high’ from using heroin and that any money therefore spent on heroin will be wasted. It does not directly stop a person wanting to use heroin, although it may reduce or prevent cravings in some people. Naltrexone implants appear to give effective blood levels for EIGHT WEEKS TO ONE YEAR. The implant is usually inserted under local anaesthesia after detoxification is over and 2 – 3 doses of the oral Naltrexone have been given. It is inserted through a 1 cm incision in the lower abdomen or at the back of the upper arm. The implant is inserted 3-4mm under the skin.
ADVANTAGES OF IMPLANTS
- Makes relapse almost impossible while the implant is effective.
- Avoids the need to supervise Naltrexone and the arguments it can cause.
- Makes it impossible to ‘forget’ to take Naltrexone.
- Probably reduces craving even more than oral Naltrexone because there is no point in craving for what you can’t have.
DISADVANTAGES OF IMPLANTS
- Involves (minor) surgery and a small scar with temporary tenderness and bruising
- Occasional local infection or inflammation of implant site, usually responding to antibiotics.
- Initially more expensive than oral Naltrexone.
- Risk of turning to non-opiate drugs – including alcohol – as a substitute. (Applies as much to oral Naltrexone)
It must be emphasised that the need for aftercare counselling to allow thorough social integration is not reduced when implants replace oral Naltrexone. Aftercare counselling is essential to ensure that healthy and appropriate coping behaviours are learnt, rather than substituting other drugs for heroin and methadone.
