BURAK KULAKSIZOĞLU, Hüseyin KARA, Özgen ÖZÇELİK, Murat KULOĞLU

Opioid bağımlılığının tedavisinde naltrekson implant kullanımı: Geriye dönük bir çalışma

Amaç: Türkiye’de her geçen gün artan madde bağımlılığı ve ortaya çıkardığı sorunlar psikiyatrinin en önemli ilgi alanlarından biri olmuştur. Opioid bağımlılığı, mücadelesi en zor olan bağımlılıklardan biridir. Naltrekson, opioidlerin etkilerini engelleyen, kötüye kullanım potansiyeli zayıf olan bir opioid reseptör antagonistidir. Oral naltrekson kullanı- mında aksaklıklar olması ve tedaviyi yarıda bırakma nedeniyle geliştirilen uzun etkili, yavaş salınımlı naltrekson implantların tedavide daha başarılı sonuçlarının olduğu bildirilmiştir. Çalışmamızda Akdeniz Üniversitesi Tıp Fakül- tesi (AÜTF) Alkol ve Madde Bağımlılığı Araştırma Uygulama Merkezi’nde (AMBAUM) derialtı naltrekson implant uygulanmış olan hastaların sosyodemografik özelliklerinin, temiz kalma sürelerinin, hastaların tedaviye uyum ve devamlılıklarının geriye dönük dosya taramasıyla belirlenmesi amaçlanmıştır. Yöntem: Bu çalışma, AÜTF AMBAUM’da Kasım 2016-Kasım 2017 tarihleri arasında naltrekson implantı uygulanmış 120 hastanın sosyodemog- rafik özellikleri ve idrar toksikoloji sonuçlarının dosyaları incelenerek yapılmış geriye dönük bir çalışmadır. Bulgular: Çalışmada değerlendirilen 120 hastaya toplam 152 naltrekson implantı; 27 hastaya ikinci, dört hastaya üçüncü, bir hastaya da dördüncü implant olacak şekilde uygulama yapıldığı belirlenmiştir. Eroin kullanımına başlama yaşının ortalama 20.08±4.29, kullanım miktarının 1.86±1.47 gr/gün ve ortalama eroin kullanım süresinin 6.58±3.08 yıl oldu- ğu saptanmıştır. Bir hastanın implantının kendiliğinden çıktığı, bir hastanın implantının ise alerji nedeniyle çıkarılmış olduğu, kalan 118 hastadan 69’unun (%58.47) 12 hafta boyunca kontrollerine geldiği, bunların 62’sinde 12 hafta boyunca idrar toksikolojisinde opiyatın negatif olduğu, bunların 51’inin idrar toksikolojisinde hiçbir madde saptanma- dığı bulunmuştur. Tartışma: Sonuç olarak opioid bağımlılığı tedavisinde naltrekson implant uygulamasının hastala- rın daha uzun süre tedavide kalmasını sağlaması, madde kullanımlarının ve relapsların düşük olması ve hastaların topluma kazandırılması açısından iyi bir tedavi seçeneği olduğu görülmektedir. (Anadolu Psikiyatri Derg 2019; 20(2):133-138)

The use of naltrexone implants for the treatment of opioid addiction: a retrospective study

Objective: In Turkey, due to the increase of drug addiction, substance abuse is becoming one of the most important areas of psychiatry. Opioid dependence is one of the most difficult addictions. Naltrexone is an opioid receptor anta- gonist with a poor abuse potential, which inhibits the effects of opioids. The use of long-acting, slow-release nal- trexone implants has been reported to be more successful than oral naltrexone because of the discontinuation to the oral treatment. In our study, it was aimed to determine the sociodemographic characteristics of the patients who underwent subcutaneous naltrexone implantation at Alcohol and Substance Abuse Research and Application Center (AMBAUM) of Akdeniz University Medical School. The treatment compliance of the patients and the conti- nuity of the patients were investigated with a retrospective file screening. Methods: This is a retrospective study of 120 patients who underwent naltrexone implantation between November 2016 and November 2017 in AMBAUM by reviewing their sociodemographic characteristics and urine toxicology results. Results: One hundred and fifty- two naltrexone implants in 120 patients evaluated in the study; to 27 patients second implant, to four patients third implant, to one patient fourth implant treatment was applied. Mean age of onset for heroin use was 20.08±4.29, the use amount of 1.86±1.47 gr/day and the average duration of heroin use was 6.58±3.08 years. The implant of a patient from 120 patients was spontaneously protruded, a patient's implant was removed due to allergic reaction, 69 of the remaining 118 patients (58.47%) came to their controls for 12 weeks, 62 of 69 patients had negative opiate in urine toxicology for 12 weeks, 51 of 62 patients who were opiate-negative in urine toxicology for 12 weeks were found no substance in urine toxicology. Conclusion: As a result, in the treatment of opioid dependence, the use of naltrexone implant allows patients to stay in treatment for longer, low substance use and relapses. It seems that it is a good treatment option for patients in terms of joining to the society. (Anatolian Journal of Psychiatry 2019; 20(2):133-138)

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