Management of an opioid‐impaired anaesthetist by implantable naltrexone

Abstract

Compared with the general population, physicians are at increased risk for abuse of prescription opioids. This use can interfere with work function and has potential negative implications for patient safety. The case example in this brief communication describes an opioid‐dependent anaesthetist who, following 10 years of opioid abuse/dependency and a number of unsuccessful treatments, including oral naltrexone, and relapses, received a number of sequential naltrexone implants as part of his management. The case involved a close collaboration between the treating doctor, employer and the General Medical Council (GMC), with ongoing monitoring and follow‐up, a GMC requirement of return to medical employment. This case study is used to illustrate that by sequential implant treatment blood levels of naltrexone can be maintained at levels required for antagonism of opioid‐based drugs for significant periods of time. The GMC, employer and treating physician were able to monitor blood naltrexone levels, with the treating physician able to palpate the implant and thereby confirm that the previously opioid‐dependent physician had remained on treatment. The authors conclude that with implantable naltrexone, opioid abstinence can virtually be guaranteed. Naltrexone implants therefore offer a level of protection not achieved with any previous treatment.