Emma Hitt, PhD

April 29, 2012

April 29, 2012 (Atlanta, Georgia) — Only about 25% of alcohol use disorder (AUD) programs prescribe any of the 4 available AUD medications, mostly owing to lack of physician access, according to the findings of a new study.

Amanda J. Abraham, PhD, from the Center for Research on Behavioral Health and Human Services Delivery at the University of Georgia, in Athens, presented the findings here at the American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference.

"A majority of specialty substance use disorder (SUD) treatment programs in the US do not have the medical and financial resources necessary to adopt medications for the treatment of AUDs," Dr. Abraham told Medscape Medical News.

According to Dr. Abraham, the 4 medications indicated for AUD are disulfiram (Antabuse, Odyssey Pharmaceuticals), released in 1951; tablet naltrexone (ReVia, Duramed), released in 1994; acamprosate (Campral, Forest Laboratories), released in 2004; and injectable naltrexone (Vivitrol, Alkermes), released in 2006.

Nationally Representative Study

The current study evaluated a nationally representative sample of specialty AUD treatment programs, with at least 25% of patients having a primary AUD diagnosis.

Halfway houses and transitional living facilities were excluded, as were programs offering exclusively methadone maintenance, court-ordered driver education classes, or detoxification services.

Data were collected via face-to-face interviews with administrators and clinical directors from 2009 to 2012 (n = 293).

Of the facilities, 12.3% used disulfiram, 18.1% used acamprosate, 13.7% used tablet naltrexone, and 7.2% used injectable naltrexone. In addition, 39.6% used selective serotonin reuptake inhibitors.

Of the eligible patients in these facilities, only 11.8% of received disulfiram, 25.5% received acamprosate, 25.8% received tablet naltrexone, and 11.2% received injection naltrexone.

Medication was effective. Of those patients taking medicines, about 75% reported that they were somewhat or very much improved, regardless of treatment type. In addition, about 70% to 95% of counselors were supportive of medication use.

The key barrier to medication use was access, the researchers found. Of the facilities, only 28% had a physician on staff, and 33% had a physician on contract.

Additional Barriers

Other barriers included patient compliance, clinical impact, cost of medications, private insurance coverage, and Medicaid coverage.

"These study findings can be used to address barriers to the adoption and sustained use of AUD medications in the specialty SUD treatment system," Dr. Abraham said.

"For example, one key barrier is the lack of access to physicians in the specialty treatment system, which could be addressed through integration of the SUD treatment system and mainstream healthcare," she said.

According to Dr. Abraham, some of the key questions that remain unanswered are the factors that explain why most physicians employed in the specialty SUD treatment system do not prescribe medications for the treatment of SUDs.

In addition, the types of interventions and dissemination strategies that would be most effective in facilitating the adoption of AUD medications remain unclear.

"Researchers and clinicians must work together to identify and address barriers to adoption and develop implementation strategies that will successfully address this research-to-practice gap," she said.

A "Real Tragedy"

Commenting on the findings for Medscape Medical News, Tom McLellan, PhD, President and CEO of Treatment Research Institute, in Philadelphia, Pennsylvania, and Deputy Director of the Office of National Drug Control Policy, noted that these findings are not surprising, because substance abuse treatment is underused.

"Only about 10% of the 23 million people affected get any care, there are very few physicians in the field, and there has been very little training and support to get these medications used," he said.

"This is a real tragedy because several are quite effective, and those not in treatment now are looking for new options," Dr. McLellan added.

According to Dr. McLellan, the soon-to-be-implemented parity law regulations will for the "first time cover individuals with serious substance use problems that are not as chronic or severe as 'addiction,' and this coverage will be available to general physicians (~550,000)."

"The coverage could include as many as 40 million 'harmful users,' so there is a brand new market coming, and physicians are eager for more effective tools," he added.

"I personally hate the phrase 'medication-assisted treatment,' " he said. "We do not use that phrase with diabetes or asthma or hypertension. Our field needs to embrace new tools such as medications, and we desperately need more physicians taking an interest in the problems of substance use disorders," he said.

The presentation was not commercially funded. The authors and independent commentator have disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference. Symposium 2, presented April 20, 2012.


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