The Singapore naltrexone community-based project for heroin addicts compared with drugfree community-based program:...

The cornerstone of heroin rehabilitation in Singapore from 1991 to 1993 was the Three Phase Program (3PP). This was a multimodal approach embracing job placement, individual and family counselling, home placement and restriction of movement by electronic monitoring. Opioid addicts in Singapore are detained by executive order. Inmates volunteer to be on the community program. The completion rate (i.e. the number of inmates presumptively drug-free after 1 year) was 24%. In August 1993, naltrexone, an opiate antagonist without euphorigenic properties was added to the 3PP creating the Naltrexone Pilot Project (NPP). Sufficient similarity existed between the 3PP and NPP for some comparison between the two. The missing link was the chemical blockade offered by naltrexone to provide a deconditioning experience for the decay of learned responses to heroin. The subject can confidently be exposed to drug cues without fear of relapse. Subjects on naltrexone for the first year had a completion rate of 76.3%. In the second year without naltrexone, electronic tagging and counselling, 32.2% were still drug-free. The subject type who was successful was married, older and better educated with late onset in heroin abuse.