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Data were from 1097 patients of in <jats:styled-content style=\"fixed-case\">WA<\/jats:styled-content> providing oral naltrexone for opioid use under the <jats:styled-content style=\"fixed-case\">SAS<\/jats:styled-content>,1998\u20132000, and all participants in <jats:styled-content style=\"fixed-case\">WA<\/jats:styled-content> (<jats:italic>n<\/jats:italic>\u2009<jats:italic>=<\/jats:italic>\u20092520) and <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ew <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>outh <jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>ales (<jats:styled-content style=\"fixed-case\">NSW<\/jats:styled-content>) (<jats:italic>n<\/jats:italic>\u2009<jats:italic>=<\/jats:italic>\u200911,174) methadone programs over the same period. We calculated mortality rates among patients receiving naltrexone and methadone, and excess mortality among patients receiving naltrexone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Oral naltrexone patients had higher mortality than those treated with methadone, even when favourable assumptions were made about the effects of naltrexone on mortality. Total oral naltrexone mortality was significantly greater than for methadone in <jats:styled-content style=\"fixed-case\">WA<\/jats:styled-content> (rate ratio 3.5; 95% confidence interval 2.2<jats:italic>\u2013<\/jats:italic>5.8) and <jats:styled-content style=\"fixed-case\">NSW<\/jats:styled-content> (rate ratio 3.5; 95% confidence interval 2.4<jats:italic>\u2013<\/jats:italic>5.0). Among 1097 oral naltrexone patients we estimate that there were 25<jats:italic>\u2013<\/jats:italic>29 deaths over two years that would probably <jats:italic>not<\/jats:italic> have occurred if these patients had received methadone. The major reason was higher mortality rate post\u2010treatment cessation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Large\u2010scale use of oral naltrexone to treat opioid users may not have, as intended, saved lives. Implant naltrexone continues to be prescribed under the <jats:styled-content style=\"fixed-case\">SAS<\/jats:styled-content> in the absence of reliable efficacy and safety data. There is a need to review widespread use of unregistered medications under the <jats:styled-content style=\"fixed-case\">SAS<\/jats:styled-content>, particularly with vulnerable patient groups. <jats:italic>[Degenhardt L, Larney S, Kimber J, Farrell M, Hall W. Excess mortality among opioid\u2010using patients treated with oral naltrexone in Australia.<\/jats:italic> Drug Alcohol Rev<jats:italic> 2015;34:90\u20136]<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.12205","type":"journal-article","created":{"date-parts":[[2014,10,10]],"date-time":"2014-10-10T12:24:23Z","timestamp":1412943863000},"page":"90-96","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Excess mortality among opioid\u2010using patients treated with oral naltrexone in <scp>A<\/scp>ustralia"],"prefix":"10.1111","volume":"34","author":[{"given":"Louisa","family":"Degenhardt","sequence":"first","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney Australia"},{"name":"School of Population and Global Health University of Melbourne  Melbourne Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Australia"},{"name":"Department of Global Health School of Public Health University of Washington  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Larney","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney Australia"},{"name":"Alpert Medical School Brown University  Providence USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Kimber","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney Australia"},{"name":"Centre for Research on Drugs and Health Behaviour London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Farrell","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Hall","sequence":"additional","affiliation":[{"name":"Centre for Youth Substance Abuse Research University of Queensland  Brisbane Australia"},{"name":"National Addiction Centre King's College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,10,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61138-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.12551"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61530-5"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511543692"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000171407.30866.22"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2002.00079.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.6.984"},{"issue":"3","key":"e_1_2_8_9_1","first-page":"56","article-title":"Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS","volume":"82","author":"Degenhardt L","year":"2006","journal-title":"Sex Transm Infect"},{"key":"e_1_2_8_10_1","first-page":"1109","volume-title":"Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors","author":"Degenhardt L","year":"2004"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2012.03910.x"},{"key":"e_1_2_8_12_1","volume-title":"WHO model list of essential medicines","author":"World Health Organization","year":"2005"},{"key":"e_1_2_8_13_1","volume-title":"Methadone maintenance treatment and other opioid replacement pharmacotherapies","author":"Ward J","year":"1998"},{"issue":"2","key":"e_1_2_8_14_1","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","author":"Mattick RP","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004145.pub4"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03140.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c3172"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c5475"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.05.021"},{"key":"e_1_2_8_20_1","unstructured":"National Health and Medical Research Council.Naltrexone implant treatment for opioid dependence: literature review. 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