Transcript Background on Alcoholism Medications

Substance abuse medications:
Trends and prescribing patterns by
physician specialty
American Public Health Association
Annual Meeting
November 5, 2007
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Authors
Tami Mark, PhD1
Rita Vandivort-Warren, MSW2
1Thomson
Healthcare
2Center for Substance Abuse Treatment, Substance Abuse and
Mental Health Services Administration
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Funding
• Substance Abuse and Mental Health Services
Administration
• Views expressed do not necessarily reflect those of
SAMHSA or DHHS
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Presentation Objective
Recently, several new medications have been
approved to treat substance abuse conditions.
We will present data on retail prescribing trends of
medications whose primary indication is for substance
abuse treatment (i.e., alcoholism, opioid abuse).
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Questions Addressed
• How have new medications to treat alcoholism and opioid
addiction diffused?
• Have new alcoholism medications replaced older medications or
added to overall use?
• Which types of specialists are adopting new mediations the
fastest?
• How does the rate of use of substance abuse medications
compare to medications to treatment other psychiatric illnesses
such as depression?
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Background on Alcoholism Medications
• Currently four products marketed in the US for the
treatment of alcoholism
–
–
–
–
Naltrexone (Revia)
Naltrexone IM (Vivitrol)
Disulfiram (Antabuse)
Acamprosate (Campral)
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Alcoholism Medications Approval Time Line
Disulfiram
Marketed …..
▼
1940s….
Oral Naltrexone
Approved for
Alcoholism
Treatment
(Revia)
Acamprosate
(Campral)
Approved in
U.S.
▼
……….
1995
Extended release
injectable
naltrexone
approved (Vivitrol)
▼
1996 1997 1998 1999 2000 2001 2002 2003
2004
▼
2005
2006
2007
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Study Design
We obtained estimates of prescriptions and sales in
retail pharmacies and mail order, overall and by
physician specialty
• IMS’ National Prescription Audit (NPA) PlusTM database for
– Weighted sample: 36,368 retail pharmacies
– Volume of new and refilled prescriptions for drugs primarily
used to treat substance abuse
• Physician specialty information assigned by IMS
(based on DEA #)
• Note that medications dispensed in clinics or inpatient settings
are not included
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Alcoholism Prescription Trends. 1998-2007
(000s)
800
700
600
500
DISULFIRAM/ANTABUSE
VIVITRO
400
NALTREXONE/REVIA
CAMPRAL
300
200
100
0
1998
1999 2000
2001 2002
2003 2004
2005 2006
2007
Source: IMS Health
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Alcoholism Prescription Trends, 1993-2007
(000s)
1993
Disulfiram = 175,000
2003
Naltrexone = 185,000
Disulfiram = 208,000
Total
= 393,000
2006
Naltrexone = 196,000
Disulfiram = 182,000
Campral
= 293,000
Total
= 671,000
Source: IMS Health
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Market Share of Alcoholism Prescriptions, YTD
August 2007
VIVITROL, 2%
DISULFIRAM, 26%
CAMPRAL, 44%
NALTREXONE,
28%
Source: IMS Health
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Market Share of Alcoholism Medication Sales
($), YTD August 2007
VIVITROL , 9%
DISULFIRAM, 18%
NALTREXONE,
28%
CAMPRAL, 45%
Total = $52 million (about $78 million projected)
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Source: IMS Health
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Sales in Perspective
• Blockbuster drugs have over $1 billion in sales
• No alcoholism drug is a blockbuster yet
• 2006 Sales figures
– Campral:
$31.5 million
– Naltrexone: $20.4 million
– Vivitrol:
$1.6 million
– Disulfiram:
$8.8 million
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Prescriptions by Specialty
Campral prescription by specialist type, 2007
Other
14%
Naltrexone (with Revia) prescriptions by specialist type, 2007
Osteopathic
Medicine
6%
Other
15%
Osteopathic
Medicine
8%
Unspecified or
Unknow n
3%
Psychiatry
45%
Addiction
Medicine
1%
Family, Internal,
General
29%
Unspecified or
Unknow n
3%
Addiction
Medicine
1%
Psychiatry
52%
Family, Internal,
General
23%
Antabuse (with Disulfiram) prescriptions by specialist type,
2007
Osteopathic
Medicine
9%
Other
15%
Psychiatry
30%
Unspecified or
Unknow n
3%
Addiction
Medicine
1%
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Family, Internal,
General
42%
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Summary of Trends
•
Naltrexone doubled the market of alcoholism prescriptions, although prescription
rates were still very low
•
Campral diffusion has been much faster than naltrexone
•
Within three years Campral prescriptions exceeded those of naltrexone and it
became the most widely prescribed alcoholism medication
•
Naltrexone and Campral do not appear to replace existing medications but rather
to add to available choices for alcoholism medications
•
No alcoholism drug is close to being a blockbuster ($1 billion in sales) despite
large potential market
•
What will current sales figures portend for future pharmaceutical company efforts
to develop and market alcoholism medications?
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Summary of Trends
• Psychiatrists and GPs are main prescribers of alcoholism
medications, as expected
• Variation in prescribing by psychiatrists: Naltrexone > Campral >
Disulfiram
• Reflection of marketing and familiarity with medications?
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Background Suboxone and Subutex
• Subutex (buprenorphine hydrochloride)
• Suboxone (buprenorphine hydrochloride and naloxone
hydrochloride)
• Approved for the treatment of opiate dependence (in 2002)
• Prevent symptoms of withdrawal from heroin and other opiates
• Subutex is given during the first few days of treatment, while
Suboxone is used during the maintenance phase of treatment
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Background Suboxone and Subutex
• Previously opiate dependence treatments like methadone could
be dispensed only in a limited number of clinics that specialize in
addiction treatment.
• Subutex and Suboxone are the first narcotic drugs available
under the Drug Abuse Treatment Act (DATA) of 2000 for the
treatment of opiate dependence that can be prescribed in a
doctor’s office.
• Only qualified doctors with the necessary DEA (Drug
Enforcement Agency) identification number are able to start inoffice treatment and provide prescriptions for ongoing
medication.
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Prescription Trends for Suboxone and
Subutex (000s)
2000
1800
1,721
1600
1400
1200
1,039
Suboxone
1000
Subutex
800
593
600
400
200
259
39
9
49
84
136
192
0
2003
2004
2005
2006
2007 Projected
Source: IMS Health
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Trends in Sales of Suboxone and Subutex
($ Millions)
$200
$190
$180
$162
$160
$140
$120
Suboxone
$100
$87
Subutex
$80
$60
$34
$40
$20
$27
$29
$14
$4
$1
$7
$0
2003
2004
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2005
2006
2007 Prorated
Source: IMS Health
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Prescriptions for Suboxone and Subutex by
Physician Specialty
Suboxone prescription by specialist type, 2007
Osteopathic
Medicine
12%
Psychiatry
29%
Other
14%
Osteopathic
Medicine
10%
Psychiatry
28%
Other
22%
Unspecified or
Unknow n
2%
Addiction
Medicine
2%
Subutex prescription by specialist type, 2007
Family, Internal,
General
41%
Unspecified or
Unknow n
2%
Addiction
Medicine
4%
Family, Internal,
General
34%
Source: IMS Health
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Summary Opiate Medication Trends
• Prescriptions and sales are showing rapid growth
• 2007 sales of Suboxone projected to be about $190
million
• Mix of GPs and Psychiatrists are prescribing
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