Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study.

James M Bolton,Jennifer E Enns,Michael T Paillé,Josh Nepon,Christine Leong,Geoffrey Konrad,Deepa Singal,Heather J Prior,Okechukwu Ekuma,Nathan C Nickel,Sabeena Jalal

doi:10.1371/journal.pone.0257025

Abstract

ObjectiveUpdate the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population.MethodsUsing whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication.ResultsOnly 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83–2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98–2.90) in the five years before being diagnosed with alcohol use disorder.ConclusionDespite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.

Highlights

Alcohol use disorder (AUD) is characterized by compulsive alcohol use and loss of control over alcohol intake, and it is associated with substantial morbidity and mortality in North American populations [1,2,3]
1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram)
Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment or had a mood/ anxiety disorder diagnosis vs no diagnosis in the five years before being diagnosed with alcohol use disorder

Summary

Introduction

Alcohol use disorder (AUD) is characterized by compulsive alcohol use and loss of control over alcohol intake, and it is associated with substantial morbidity and mortality in North American populations [1,2,3]. Alcohol drinking affects individuals, but has a negative impact on society as a whole, as it is often associated with increased rates of child abuse and/or neglect [7,8,9], intimate partner violence [10, 11], and hospitalization and mortality rates [12,13,14]. Societal, and global public health burden of AUD, it appears to be largely untreated [1, 15]. In another study enrolling low-income AUD patients in Ontario, Canada, the rate of AUD medications dispensed was low [23]. While these low rates are concerning, questions as to the generalizability of previous findings remain, since many of the existing studies examining AUD pharmacotherapy enrolled non-representative samples. The rate of treatment uptake in the general population is still largely unknown

Results

Discussion

Conclusion