Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada

1. Pharmacotherapy prescriptions for naltrexone, acamprosate, and disulfiram have been proven safe and effective treatments for alcohol use disorder (AUD)

2. Despite this evidence, pharmacotherapy remains underutilized in Manitoba as a treatment plan for AUD. 

Evidence Rating Level: 2 (Good)

Alcohol use disorder (AUD) is a potentially devastating condition leading to significant morbidity and mortality rates in North America. The disorder is characterized by compulsive alcohol use and can lead to various physical diseases, adverse psychosocial and mental health outcomes, and death. Previous studies have found that medications such as naltrexone have been proven to be safe and effective pharmacotherapies for AUD. However, despite the clinical and societal health burden caused by AUD and the existence of these evidence-based medications, the rates of prescription for pharmacotherapy remains low. This population based, longitudinal cohort study examined the use of pharmacotherapy, specifically naltrexone, acamprosate, and disulfiram among individuals with AUD. In order to do so, data was collected between 1996 and 2014 through the Manitoba Population Research Data Repository databases. These databases supplied information on all residents of Manitoba diagnosed with an alcohol use disorder. Next, individuals with AUD were compared between those who received and filled a pharmacotherapy prescription compared to those individuals with AUD who did not. Overall, 2.9% (n=37,388) of the Manitoban population were diagnosed with AUD between 1996 and 2015. Of this cohort, 1.3 % (n=493) of individuals diagnosed with AUD filled a prescription for an AUD medication. The majority of these individuals were males, in urban settings,  receiving their prescriptions from family doctors (53.6%) or psychiatrists (22.3%). The most common medication prescribed for AUD was naltrexone (58%) followed by acamprosate (36.3%) and disulfiram (5.7%). Each of these evidence-based medications were underutilized in Manitoba over the 20-year study period for individuals with AUD. However, a limitation of this study is that it focused solely on pharmacotherapy as a treatment for AUD. In reality, there are many other resources, holistic treatments, support programs, and rehabilitation therapy which may be beneficial to individuals with AUD. When looking specifically at medications, it may appear as though anyone not receiving a prescription is not seeking or receiving aid when in fact, this data was not collected in this study. On the other hand, a strength of this study was its additional analyses of comorbidities such as anxiety disorders or depression. This allowed for a better understanding of the medication’s efficacy in combination with other drugs as well as any contraindications which may decrease prescription rates. Overall, pharmacotherapy drugs such as naltrexone, acamprosate, and disulfiram have been deemed a safe and effective treatment plan for alcohol use disorder. Despite this evidence, individuals living with alcohol use disorder in Manitoba underutilize this treatment option. Alcohol use disorder can have devastating impacts on individuals, their families, and their communities and therefore, more resources, treatment plans, and support is required. Finally, the study highlighted the need for further education for physicians to ensure informed prescribing in order to take an interdisciplinary approach in order to reduce AUD.

Click to read the study in PLOSONE

Image: PD

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