Managed care

Dr Amal Beaini, Clinical Lead
Dr Noufel Aljushaah, Medical Officer
June 2011
• 1996: The first patient successfuly completed the compressed opiate detoxification programme.
• 2000: Our peer reviewed paper gets published in • 2004: Extended services become available for those patients with concomitant addictions or underlying mental health problems.
• 2006: Channel 4 series “Going Cold Turkey” broadcast • 2007: Naltrexone Implant Service launched.
 2001: Published cohort study of 501 patients showed that 51% were opiate-free at 12 months.
 2011: Almost 8000 patients have successfully  To date: we have managed to obtain information on 50% of our service users at 12 post discharge; of them 59% on average have remained opiate-  Since the addition of the implants to Detox 5 in 2007 we have seen a positive impact on our Detox 5 service users booked vs admitted
 It was abundantly clear from the start that the world of implants was going to be confusing, contradictory and at times misleading.
 Our plan was to proceed carefully and  From the outset al implant procedures were evidenced from the manufacturer to the service user.
 A clear audit pathway is available.
 O’Neill implants = 146 (June 2007 to June 2008) Sherman implants = 859 (June 2008 to present) Combination of first implants and repeat  Total implant procedures carried out Our findings: Implant may take up to 2 years plus to  6 month implant may be effective for 3 to  12 month implant may be effective for 6 Figures for the first 12 months
Oral Naltrexone
Repeat implant at
Detox 5
Repeat implant
elsewhere
No further
treatment (OK)
Readmission to
Detox 5
Relapsed
Lost to follow up
Our findings: User friendly  Reliable for 3 months  Dissolves within 6 months  Scar is small  Significant anti-craving  Double pellet implant Single pellet in exceptional cases Figures for the first 12 months
Oral Naltrexone
Repeat implant at
Detox 5
Repeat implant
elsewhere
Readmission to
Detox 5
Relapsed
Refunded
Lost to follow up
Naltrexone comparison – oral v implant: It is very difficult to compare the two 10 years of tablets v 3 years of implants Latterly we have seen an increase in:  the number of people we are able to fol ow up the numbers of people who are opiate-free at 3, 6  service user satisfaction, particularly in relation to

Source: http://www.gplabslimited.com/_webedit/uploaded-files/All%20Files/Detox%205%20Naltrexone.pdf