Eric Abetz (Tasmania, Liberal Party, Shadow Minister for Employment and Workplace Relations) Share this | Hansard source

asked the Minister representing the Minister for Health and Ageing, upon notice, on 16 August 2011:

With reference to the National Health and Medical Research Council (NHMRC) document, Naltrexone implant treatment for opioid dependence: Literature Review:

(1) Given that the paper by Professor Hulse (Hulse, 2005), reported that hospital presentations for opioid overdose stopped in the 6 months following implants, with a reduction from 21 (6 months pre implantation) to zero overdoses (6 months post), a change that Professor Hulse believes to be significant, with a p value of 0.0001: Why then did the NHMRC document state that Hulse 'found no significant change in risk of opioid overdose from six months pre treatment to six months post treatment for implant or control groups', and if this statement is false or misleading, will the NHMRC rescind this document and re-establish the rights of those at risk of premature death.

(2) Given that experimental medicine can be used for either: (a) producing new information; or (b) patient treatment to reduce the risk of premature death (Special Access Scheme, Therapeutic Goods Administration): (a) Why then does the document make recommendations that Naltrexone implants 'should only be used in the context of a well conducted RCT', which has had the effect of removing Naltrexone patient services in Melbourne due to the loss of insurance cover for Naltrexone treatment; and (b) will the NHMRC therefore rescind this document and re-establish the rights of those at risk of premature death.

(3) Can the NHMRC explain why they did not follow their own guidelines (http://www.nhmrc.gov.au/guidelines/how-nhmrc-develops-its-guidelines) in the development of this document, specifically: (a) '4. The draft guidelines are put out for public consultation, as required by the NHMRC Act; and (b) '7. NHMRC may choose to have a peer review of the guidelines. If so, they are sent to a number of experts in the subject area for their opinion, primarily on the evidence base used for the guidelines'; and given that this should have included experts in the field of Naltrexone medicine, will the NHMRC rescind this document and re-establish the rights of those at risk of premature death.

(4) Given that, under the NHMRC guidelines, 'the main principles of guideline development is that they should be based on the best available evidence' and that: (a) Professor Hulse's RCT confirmed that Naltrexone implants were significantly better than oral Naltrexone at preventing return to heroin use (Hulse, 2009); and (b) opioid overdose deaths are reduced by 25 times when comparing implant Naltrexone to oral Naltrexone in the    4 months post detox; if the NHMRC document had explained that oral naltrexone failed when compared with implant naltrexone to prevent return to opiate use under the heading on effectiveness and findings would then the removal of rights of patients at risk of premature death to the more effective treatment (implants) not have been promoted, and will the NHMRC therefore rescind this document in light of this new information.

(5) Given that the current cost to the Western Australian Government for detox services is $7 000 to $8 000 per patient and the Fresh Start Recovery Programme currently receives $6 150 from the Western Australian Government for the treatment of Western Australian patients receiving detox services, with the closure of detox services in other parts of Australia as a result of the findings of this document, will the Commonwealth provide funding for non-Western Australian patients seeking detox treatment, who now have to travel to Perth to be treated at the Fresh Start Recovery Programme.