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Heroin Addiction and Related Clinical Problems: 2011, 13, 4 (pages: 35 - 38)

Requiring stabilized heroin addicts to stop successfull agonist opioid treatment before liver transplantation can shift patients over a cross-acting (alcohol) substance abuse

Piz L., Maremmani A. G. I., Rugani F., Pacini M., Rovai L., Dell'osso L., Maremmani I.

Summary: Methadone Maintenance Treatment patients are significantly under-represented in most liver transplant programmes, but the number of patients receiving agonist opioid treatment (AOT) is increasing, and few data are available at the moment when patients are selected for surgery. We present a case in which an Italian patient affected by heroin dependence and successfully treated with AOT had to stop opioid medical treatment to be able to enter a liver transplantation programme. He successfully discontinued AOT, received a liver transplant and continued not to abstain from heroin in the post-transplant period. Unfortunately, he engaged in alcohol use, so shifting over into another cross-acting substance abuse disorder, and endangering his newly restored liver functions. He was a non-responder to alcohol abuse treatment and, while he was abstaining from alcohol, he reported a craving for heroin. We reintroduced opioid agonist treatment, so obtaining a non-relapsing condition regarding heroin and a significant patient recovery on alcohol abuse, with a complete liver function normalization. We suggest that successful agonist opioid treatment should be continued even when transplantation is needed, not only to avoid the risk of relapse into heroin use, but also to avoid the risk that the patient may shift over into another substance abuse disorder (in this case, alcoholism). The shift from heroin to alcohol also means the transition from a highly curable disease, as heroin addiction is, to one that is hard to cure, as alcoholism is, which implies a greater risk to endangering the new liver function with respect to the continuation of AOT.