G Hulse1, G O'Neil. 1. Unit for Research and Education in Drugs and Alcohol, University Department of Psychiatry and Behavioural Science, University of Western Australia, QE II Medical Centre, Nedlands, Australia.
Abstract
OBJECTIVES: To describe the case history and associated obstetric and neonatal outcomes of eight women who had their heroin dependency managed over pregnancy by naltrexone implant (two x 1.8 g of naltrexone embedded in poly-DL-lactide acid) treatment. METHOD: Case data on maternal management associated with naltrexone implant were collected at the Australian Medical Procedures Research Foundation, Perth, Australia and three Perth hospitals. RESULTS: Despite earlier instability on oral naltrexone and repeated relapses back to dependent heroin use these women, following treatment with naltrexone implant, remained heroin free throughout their pregnancies. Neonatal and obstetric outcomes were unremarkable. CONCLUSIONS: This case series provides preliminary evidence that the pregnant heroin user can be managed by naltrexone implant without obvious risk to the mother or developing foetus. Importantly, the current case series suggests that the pregnant woman who finds it difficult to stabilise on oral naltrexone maintenance and returns to dependent heroin use may be managed using implantable naltrexone, thereby removing from her the onus for daily naltrexone medication compliance. The authors conclude that naltrexone implant may represent an important procedure for managing the pregnant heroin dependent patient who finds it difficult to shift away from her heroin use patterns. These preliminary findings require confirmation using a much larger controlled study.
OBJECTIVES: To describe the case history and associated obstetric and neonatal outcomes of eight women who had their heroin dependency managed over pregnancy by naltrexone implant (two x 1.8 g of naltrexone embedded in poly-DL-lactide acid) treatment. METHOD: Case data on maternal management associated with naltrexone implant were collected at the Australian Medical Procedures Research Foundation, Perth, Australia and three Perth hospitals. RESULTS: Despite earlier instability on oral naltrexone and repeated relapses back to dependent heroin use these women, following treatment with naltrexone implant, remained heroin free throughout their pregnancies. Neonatal and obstetric outcomes were unremarkable. CONCLUSIONS: This case series provides preliminary evidence that the pregnant heroin user can be managed by naltrexone implant without obvious risk to the mother or developing foetus. Importantly, the current case series suggests that the pregnant woman who finds it difficult to stabilise on oral naltrexone maintenance and returns to dependent heroin use may be managed using implantable naltrexone, thereby removing from her the onus for daily naltrexone medication compliance. The authors conclude that naltrexone implant may represent an important procedure for managing the pregnant heroin dependent patient who finds it difficult to shift away from her heroin use patterns. These preliminary findings require confirmation using a much larger controlled study.
Authors: Karol Kaltenbach; Kevin E O'Grady; Sarah H Heil; Amy L Salisbury; Mara G Coyle; Gabriele Fischer; Peter R Martin; Susan Stine; Hendrée E Jones Journal: Drug Alcohol Depend Date: 2018-02-01 Impact factor: 4.492