Assessing Naltrexone Implant Or Methadone Maintenance Treatment On Mental And Physical Health Outcomes In Heroin Users
Funder
National Health and Medical Research Council
Funding Amount
$216,200.00
Summary
The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral na ....The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral naltrexone has proved problematic, with medicine non compliance and relapse common. Surgical insertion of subcutaneous implants is an alternative method of naltrexone delivery. 441 heroin users have received naltrexone implants (3.4g) under Special Access in WA. Although naltrexone implants have yet to be comprehensively assessed, early results are encouraging. Pilot study data has shown a significant reduction in hospital emergency department (ED) attendance for accidental overdose, and mental health events following implant. The aim of this study is to more rigorously assess outcomes associated with implants compared to heroin dependent persons treated by MMT . The DLS collates general hospital and mental health admissions plus mortality data for individuals. This allows the health of an individual to be monitored over time. An electronic version of hospital ED data has recently become available. The study will validate these records by comparing the electronic data against hospital ED records for the implant group. We will then combine the electronic ED and DLS data. Morbidity and mortality rates for heroin users are significantly greater than those for the general population. If the preliminary findings are replicated, naltrexone implants may offer significant benefits over current pharmacotherapies in reducing general and psychiatric morbidity in dependent heroin users.Read moreRead less
The Role Of Pharmacotherapy In Prevention Of Relapse In Alcohol Dependence
Funder
National Health and Medical Research Council
Funding Amount
$422,310.00
Summary
The physical, psychological and social consequences of alcohol abuse remain a critical health problem. Every year in Australia, excessive consumption is responsible for 3,000-6,000 deaths and costs the community $6 billion. Approximately 15% of Australians abuse alcohol and 5% of men and 3% of women are alcohol dependent (addicted to alcohol). Young men are particularly affected, with 10% of all men aged 18-35 dependent on alcohol. Better treatment for alcohol dependence is urgently needed. Less ....The physical, psychological and social consequences of alcohol abuse remain a critical health problem. Every year in Australia, excessive consumption is responsible for 3,000-6,000 deaths and costs the community $6 billion. Approximately 15% of Australians abuse alcohol and 5% of men and 3% of women are alcohol dependent (addicted to alcohol). Young men are particularly affected, with 10% of all men aged 18-35 dependent on alcohol. Better treatment for alcohol dependence is urgently needed. Less severe forms of alcohol abuse frequently respond to brief screening and intervention programs. Treatment of alcohol dependence remains unsatisfactory. Most treatments lead to abstinence in only 1-3, and approximately 50% of these will relapse within 3 months of completing treatment. Two drugs (naltrexone and acamprosate) appear to interfere with the effects of alcohol on the brain that promote addiction. There is evidence that both drugs are beneficial in the treatment of alcohol dependence and both are now available in Australia. At present, no data have been reported comparing the effectiveness of these two drugs. The proposed project will compare naltrexone and acamprosate in a large carefully performed study. The study will help determine which subjects are likely to benefit from one or other of these agents. Compliance is a major problem with many medications, but is a particular problem with medications for substance abuse. The second aim of this study is to test a novel intervention to increase compliance with medications for alcohol dependent subjects. This intervention comprises 'compliance therapy', which resembles a short training course, a medication alarm, and an assertive reminder program for scheduled medical appointments. The present study will be the first to apply this type of therapy to subjects with alcohol dependence.Read moreRead less
A Randomised Double Blind Placebo Controlled Clinical Trial Of Naltrexone Implants For The Treatment Of Heroin Addiction
Funder
National Health and Medical Research Council
Funding Amount
$558,675.00
Summary
GoMedical Industries has developed a formulation of sustained release naltrexone, suitable for subcutaneous depot administration (International Patent Application Number: PCT-AU01-01107, GoMedical Industries Pty Ltd, Australia). Currently, implants are inserted by minor surgery under local anaesthetic in high risk patients under the Therapeutic Goods Administration (TGA) Special Access Category A scheme (SAS) through the Australian Medical Procedures Research Foundation (AMPRF), Western Australi ....GoMedical Industries has developed a formulation of sustained release naltrexone, suitable for subcutaneous depot administration (International Patent Application Number: PCT-AU01-01107, GoMedical Industries Pty Ltd, Australia). Currently, implants are inserted by minor surgery under local anaesthetic in high risk patients under the Therapeutic Goods Administration (TGA) Special Access Category A scheme (SAS) through the Australian Medical Procedures Research Foundation (AMPRF), Western Australia. Although there is a preliminary basis for believing that this naltrexone implant treatment may offer significant benefits over oral and other naltrexone depot preparations thus far reported for managing the heroin dependent patient, this needs to be verified through an empirically designed study such a clinical trial. Lack of complete Commonwealth TGA approval to date has been a major impediment to widespread adoption of this naltrexone preparation as an alternative treatment. Hence, the main objective of this study is to provide rigorous clinical data on the efficacy of this naltrexone implant compared to oral naltrexone in the management of heroin dependent persons by primarily monitoring: Maintenance of blood naltrexone and 6-b-naltrexol concentrations above therapeutic levels Retention in treatment assessed by detection of blood naltrexone or 6-b-naltrexol Reduced frequency and quantity of opiate use Prevention of accidental opiate overdose Reduced opiate related morbidity and mortality Reduced craving for heroin and secondarily monitoring: Frequency and quantity of other drug use Other drug related accidental overdose, other morbidity or mortality Level of social functioning . General health Monitoring of implant insertion site healingRead moreRead less
Effect Of Naltrexone Treatment On Mental Health And Other Health Outcomes : A Record Linkage Study.
Funder
National Health and Medical Research Council
Funding Amount
$111,625.00
Summary
Research has shown that heroin use is an increasing habit of Australia's youth with morbidity and mortality rates for regular heroin users significantly greater than that for the general population. Despite the introduction of a number of treatment options to combat the problem, the management of dependent heroin use has proved problematic. This application addresses an issue of considerable importance and controversy in recent years, namely, the impact of naltrexone and methadone treatment on m ....Research has shown that heroin use is an increasing habit of Australia's youth with morbidity and mortality rates for regular heroin users significantly greater than that for the general population. Despite the introduction of a number of treatment options to combat the problem, the management of dependent heroin use has proved problematic. This application addresses an issue of considerable importance and controversy in recent years, namely, the impact of naltrexone and methadone treatment on morbidity and mortality among persons who are heroin dependent. The study will be carried out using a unique system of linked hospital records from the Western Australian Health Services Research Linkage Unit at the Department of Health Western Australia (DHWA). Through this system hospital, mental health and death records derived from different sources, but related to the same individual are electronically linked. Hence, record linkage provides an independent method for obtaining information on treatment outcomes which is free from subjective bias. In the current study records from heroin users who entered naltrexone maintenance and a smaller group who entered methadone maintenance will be linked to the DHWA database. Collectively these data will be used to quantify morbidity, hospital episodes, mental health issues and mortality in heroin users following commencement of naltrexone maintenance treatment. Data will also be used to compare positive and negative outcomes for individuals on naltrexone with those on methadone. The results will be used to advocate on behalf of this vulnerable population in a country that prides itself on universal access to high quality health services. It is anticipated that this study will have a substantial beneficial impact on the management of illicit drug use policy and as well as contributing new research methods, findings and international knowledge.Read moreRead less
Clinical Outcomes Following Lumbar Spine Surgery Using The DIAM Non-fusion Interspinous Implant
Funder
National Health and Medical Research Council
Funding Amount
$72,343.00
Summary
This investigation will focus on a single minimally-invasive surgical intervention used in the treatment of disorders of the lumbar spine. The Device for Intervertebral Assisted Motion (DIAM) is a novel system for stabilizing the disc and joints of the low back which is promoted over fusion for improving stability while restoring normal vertebral alignment. This new device has limited research evaluation of efficacy and will be examined with the aim of providing clinical guidelines for its use.
Cell-based Neurotrophin Delivery With Cochlear Implantation For Long-term Rescue Of Auditory Neurones Following Deafness
Funder
National Health and Medical Research Council
Funding Amount
$437,212.00
Summary
This project aims to develop safe and effective techniques for long-term delivery of drugs to the ear by genetically modifying cells so they release the theraputic agents over extended periods of time, and then to use encapsulation techniques to safely deliver these cells to the inner ear in combination with a cochlear implant.
Artificial joint implants are widely used to replace diseased or damaged joints. Despite the impressive success of joint replacement many artificial joints do not last indefinitely. In many patients joints last for 25 years or more but in about 15% the artificial joints will fail prematurely. Artificial joints need to be replaced because of loosening resulting from the loss of bone from around the artificial joint. The bone loss is caused by large numbers of small particles generated by excessiv ....Artificial joint implants are widely used to replace diseased or damaged joints. Despite the impressive success of joint replacement many artificial joints do not last indefinitely. In many patients joints last for 25 years or more but in about 15% the artificial joints will fail prematurely. Artificial joints need to be replaced because of loosening resulting from the loss of bone from around the artificial joint. The bone loss is caused by large numbers of small particles generated by excessive wear of the artificial joint. We now know that specialised cells in the body react to the wear particles and try to destroy them. During this process they produce molecules which lead to bone destruction. This project seeks to investigate the way particles cause bone loss and to develop drug treatments that will either prevent the loss of bone or promote new bone to replace that which has been lost. The increasing use of joint replacement and an aging population means that the number of patients with artificial joint failure will increase. This will mean that an increasing amount of medical recourses will be needed to replace failed and painful artificial joints. It is planned that the findings obtained from this project will eventually result in drug treatments which can reduce the need for the replacement of artificial joints.Read moreRead less
Evaluating Perceptual Benefits Of Bilateral Cochlear Implants For Young Children And Infants
Funder
National Health and Medical Research Council
Funding Amount
$452,843.00
Summary
The cochlear implant (bionic ear) has revolutionised communication for children with profound hearing loss. Nevertheless, children with the standard single implant still face huge challenges in educational and social settings. Difficulties include understanding speech that is soft, or speech in noisy environments, such as the classroom. Also, with one implant, children cannot locate the source of sound, such as the speaker in a group conversation, team-mates during sport, or an oncoming car. Res ....The cochlear implant (bionic ear) has revolutionised communication for children with profound hearing loss. Nevertheless, children with the standard single implant still face huge challenges in educational and social settings. Difficulties include understanding speech that is soft, or speech in noisy environments, such as the classroom. Also, with one implant, children cannot locate the source of sound, such as the speaker in a group conversation, team-mates during sport, or an oncoming car. Research with other normal hearing and hearing impaired groups suggests that two (bilateral) implants may possibly improve performance in these conditions. Although hundreds of children worldwide have received bilateral implants, very limited evidence is available to indicate whether two implants are significantly better than one, especially for young children. The main aim of the research is to evaluate the improvement in listening performance when young children and infants use two implants as compared with one. An additional aim is to gain clinical knowledge of bilateral implant use in order to develop selection criteria and management protocols for young bilateral candidates in the future. Results of this research will determine if bilateral implants should become a standard option for young children at the RVEEH-University of Melbourne Implant Clinic. The results will be published and presented internationally to influence clinical practice worldwide. All children using a cochlear implant, or in need of one in the future, will benefit as the study outcomes will indicate the best choice of hearing devices for individual children, and help to determine best-practice management if bilateral implants become an option for all children.Read moreRead less