Even though there are medications recommended for treating moderate to severe alcohol use disorder, many people aren’t getting access to them, according to a new study by researchers in British Columbia.
The study, published on Tuesday in the journal Addiction, found that only about a third of people in B.C. who were diagnosed with moderate to severe alcohol use disorder were given these medications at least once between 2015 and 2019. And less than 5 per cent continued to use the medications for three months, the minimum time period recommended.
“It is highly problematic, because we know that these medications are very effective and safe,” said Eugenia Socias, the study’s lead author. She is a research scientist with the British Columbia Centre on Substance Use (BCCSU) and an associate professor in the department of medicine at the University of British Columbia.
Harmful alcohol use is one of the leading factors in death, disease and disability, according to the Canadian Institute for Health Information. In 2021, the institute found that alcohol had contributed to more than half of all hospital stays for harms caused by any type of substance abuse in the previous year.
In 2019, the BCCSU published provincial guidelines that recommended offering medications, including naltrexone or acamprosate, to adults with moderate to severe alcohol use disorder, a medical term for when a patient can’t control their drinking even when it interferes with their work or home life.
The guidelines say naltrexone can help reduce or eliminate alcohol consumption, and that acamprosate is recommended for people whose goal is abstinence. Dr. Socias’s study, which looked at more than 7,200 B.C. residents with moderate to severe alcohol use disorder, found that those who had access to these medications were less likely to die, or be admitted to hospital, than those without.
The kind of medication that is prescribed to an alcohol-use patient, and the duration of its use, depends on whether the patient wants to stop using alcohol or simply reduce their consumption, according to Dr. Socias. She said these medications are usually taken for at least three to six months, but could be taken for longer.
Dr. Socias said there could be several reasons the drugs are infrequently used in B.C., including a lack of addiction medicine training among health professionals and a lingering misconception that substance use disorders are a choice, rather than a disease.
Some patients may initially be prescribed them while in detox programs, but then not have those prescriptions renewed when they are discharged. This could partly explain why such a small proportion of patients continued using the drugs for the recommended three months, Dr. Socias explained.
Alexander Caudarella, chief executive of the Canadian Centre on Substance Use and Addiction, who was not involved in the study, said the medications can be “a life-changer” for some people but can have more subtle effects on others, or not work at all. But even when one medication doesn’t work, he said, there are others that can be tried.
While some health care providers may not feel comfortable using medications to treat alcohol use disorder, these drugs need to be considered part of doctors’ and nurses’ toolkits, Dr. Caudarella said.
In addition, he said, more public education is needed, so that patients know such medications are available.