Using naltrexone implants in the management of the pregnant heroin user

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.