No available treatment is suitable for all users

COLLISS PARRETT is again advertising the advantages of Naltrexone as a cure for
heroin addiction over other treatments (Letters October 3).

The experts I have spoken to would all like to add Naltrexone to their armoury
of possible treatments, but all acknowledge that none of the available
treatments is suitable for all dependent users.

For instance Naltrexone can be dangerous for users who mix heroin with some
other drugs, as many do.

Naltrexone does not work well for users who are not already motivated to stop
using heroin. Heroin is addictive and drives dependent users to continue its use
with a very effective carrot and stick. Heroin offers pleasure at the moment of
use and extreme pain during the process of withdrawal.

Rapid Opioid Detoxification uses anaesthesia to blank the pain of withdrawal and
Naltrexone to prevent the pleasurable effects of heroin, but only for as long as
the patient continues to use it. Naltrexone is not addictive and continuation of
the treatment depends entirely on the will of the patient to continue its use
until risk of relapse is gone. If heroin is used again after Naltrexone
treatment has finished, addiction recurs.

So some can rid themselves of slavery to heroin through abstinence, and some
fail. For some, methadone maintenance works well, whereas for others it proves a
hell on earth. Rapid Opioid Detoxification works for some, is dangerous for
others and yet others relapse after they stop using the Naltrexone. The Swiss
have now shown that some are helped by heroin maintenance, and there are some
specialists who swear by the efficacy of Ibogaine.

Meanwhile for those who become addicted to heroin and for whom our present
limited range of treatments is not available or is ineffective, we have nothing
to offer. And society as a whole suffers through the criminal efforts to obtain
the money to feed the addiction, through the high cost of imprisonment and law
enforcement, through the ever increasing death toll, and through the spread of
HIV and Hepatitis C, which frequently punish the innocent.

We need as many methods as can be shown to be effective.

PETER WATNEY
Holt