Transcript Naltrexone Therapy for Alcohol Use Disorder

Naltrexone Therapy for Alcohol
Use Disorder
GEOFFREY KONRAD PGY2
DR. A HYNES
DR. J NEPON
Objectives?
 Discuss briefly the background and epidemiology of
Alcohol Use Disorders
 Review the evidence for Naltrexone, Acamprosate
 Discuss the Fact Sheet and broader project
Background
 Alcohol Use Disorders are associated with
substantial morbidity, mortality, and economic costs
 Effects are wide spread
 WHO

2012: 5.9% of all deaths, and 5.1% of global burden of disease
related to alcohol
Background
 In Canada
 2002: Economic burden of alcohol related harm was 14.6
Billion
 2005: 7.7% of all deaths attributed to alcohol
Epidemiology
 NESERCIII DSM5 Criteria
 12M prevalence: 13.9%
 Lifetime prevalence: 29.1%
 7.7% 12M and 19.8% lifetime respondents sought treatment
 DSM4 Criteria (2001/2  2012/13)
 12M: 8.5%  12.7%
 Lifetime: 30.3%  43.6%
AUD
Evidence
 Systematic Review and Meta-analysis published in
JAMA, 2014
 For Naltrexone:


NNT to prevent return to any drinking = 20
NNT to prevent return to heavy drinking = 12
 For Acamprosate
 NNT to prevent return to any drinking = 12
Guidelines
 Guidelines:
 NIAAA
 NICE
 APA
 CANMAT
 All support use of Naltrexone, Acamprosate,
Disulfiram
Use of Pharmacotherapy
 Several studies have looked at prescribing habits and
trends for AUD Rx
 VHA:


2007: 3.0%
2009: 3.4%
 IMS National Prescription Audit
 2002: At most 9% filled (any) Rx
 Primary Care
 “No studies to date have assessed Rx use in primary care
settings”
Fact Sheet
 Initial project to prove Naltrexone and Acamprosate
under prescribed

MCHP
 Information important now
 Developed a fact sheet highlighting evidence for
Naltrexone and Acamprosate, and how to prescribe
Fact Sheet
 Sent out to psychiatry department
 Incorporated feedback
 Presented at the Annual Scientific Assembly for
Family Physicians

Immediate, direct feedback
Future Direction
 Distribution through CPD Medicine at the University
of Manitoba
 Looking into possible ways to remove from EDS
Conclusions
 Alcohol Use Disorders is a BIG problem
 Naltrexone and Acamprosate WORK
 These medications are greatly underutilized
 Raising awareness and removing barriers to
prescription is important for robust patient care
Thank You
 CODI team
 Dr. A Hynes
 Dr. J Nepon
 Dr. J Sareen
 Dr. J Bolton
 Christine Leong
Resources
 Rehm J., Baliunas D., Brochu S., Fischer B., Gnam W., Patra J.et al.
The Costs of Substance Abuse in Canada 2002. Ottawa, ON:Canadian
Centre on Substance Abuse; 2006.c
 World Health Organization. Global Status Report on Alcohol and
Health. Geneva, Switzerland: World Health Organization; 2014.
 Grant B, Goldstein R, Saha T, Chou S, Jung J, Zhang H, Pickering R,
Ruan W, Smith S, Huang B, Hasin D. Epidemiology of DSM-5 alcohol
use disorder: results from the national epidemiologic survey on alcohol
and related conditions III. JAMA Psychiatry. Published online June 3,
2015. Doi:10.1001/jamapsychiatry.2015.0584.
 Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable
morbidity and resulting health care costs in Canada in 2002:
recommendations for policy and prevention. Journal of Studies on
Alcohol and Drugs. 2007;68:36-47.
Resources
 Jonas D, Amick H, Feltner C, Bobashev G, Thomas K, Wines R, Kim M,
Shanahan E, Gass E, Rowe C, Garbutt J. Pharmacotherapy for Adults
with alcohol use disorder, in outpatient settings, a systematic review
and meta-analysis. JAMA. 2014;311(18):1889-1900.
 Iheanacho T, Issa M, Marienfeld C, Rosenheck R. Use of naltrexone for
alcohol use disorders in the Veterans’ Health Administration: a
national study. Drug and Alcohol Dependence. 2013;132:122-126.
 Wessell A, Nemeth L, Jenkins R, Ornstein S, Miller P. Medications for
alcohol use disorders in a primary care practice-based research
network implementation study. Alcoholism Treatment Quarterly.
2014;32:58-66.
 Mark T, Kassed C, Vandivort-Warren R, Levit K, Kranzler H. Alcohol
and opioid dependence medications: prescription trends, overall and by
physician specialty. Drug Alcohol Depend. 2009; 99(1-3):345-349.
Time for coffee!