There are an estimated 2.3 billion alcoholics in the world and alcohol is linked to at least 3 million deaths a year. so a drug capable of treating problematic drinking could be encouraging news.
The drug is called “naltrexone”, an opioid antagonist that blocks the receptors for this type of substance in the brain without activating them, dampening the euphoria caused by drugs such as heroin, morphine and alcohol. It is a kind of red light for the brain.
This is why many consider that naltrexone is an optimistic treatment for alcohol use disorder.
But this drug is not easily obtainedsince there is no consensus in the medical community about its usefulness and benefits, although there are studies that support its use.
In 2012, a meta-analysis of nearly 40 years of clinical trials concluded that for every nine people treated with naltrexone, one would never drink to excess.
Naltrexone is approved for use in Australia, where it is prescribed in comprehensive treatments for alcohol dependence. This involves taking a dose, every day, as part of a broader strategy to maintain abstinence. Since 2001, the drug has been listed in the Pharmaceutical Benefits Plan, currently at an out-of-pocket cost of $42.50 per month.
Alcohol consumption is rife throughout Australia and is considered the most widely used drug in the country. An analysis by the National Center for Education and Training on Addictions (NCETA) found that, in 2019, about 5% of the Australian population over the age of 14 drank every day, a rate that represents about 1.01 million people.
Naltrexone, with its accessibility and relative effectiveness, would be a brilliant treatment for a condition like alcoholism. Nevertheless, medications approved to treat these conditions are not accepted by the medical community.
According to government data, approximately 59,000 naltrexone prescriptions were provided under the PBS in 2021. Acamprosate, another subsidized drug for alcoholism, was reported to have been prescribed around 43,000 times during the same period.
Dr Philip Crowley, a Melbourne-based addiction medicine specialist, says there is no medical reason why GPs refuse to prescribe it.
“Alcohol pharmacotherapy actually works quite well,” he told VICEexplaining that the benefits roughly equate to how antidepressants can treat significant depression.
“You don’t get addicted to naltrexone or abuse it. It’s relatively cheap.” he added.
The expert suggests that external influences are behind the lack of prescriptions, such as a misunderstanding of the chronic nature of alcoholism and a lack of knowledge of these drugs among users and medical professionals.
“There is probably a cultural aspect”, said. “Australian doctors are very good at treating alcohol withdrawal. I think they see a lot of alcohol withdrawal in hospitals, and they tend to see it as the treatment that people are offered.”
Accessing naltrexone is a mixed experience in Australia. Some find it relatively easy and others face difficulties or are rejected altogether. The reluctance to prescribe the drug could be related to the lack of consensus on its efficacy.
Alcohol use disorder is still considered a heavily stigmatized condition worldwidewith a 2014 study from the University of Queensland concluding that nearly a third of participants saw alcoholism as a result of “bad temper.”
That stigma is another element that makes it difficult to treat this condition with medication, say experts, who prefer to be cautious about the promising drug.
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