Barriers to Use of Pharmacotherapy for Addiction Disorders and How to Overcome Them

Oliva, Elizabeth M.; Maisel, Natalya C.; Gordon, Adam J.; Harris, Alex H. S.

doi:10.1007/s11920-011-0222-2

Cited by 132 publications

(122 citation statements)

References 70 publications

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“…Although alcohol use disorders (AUDs) are highly prevalent and often disabling, effective pharmacological treatments are underutilised, due partly to clinicians’ lack of knowledge and misperceptions about effectiveness 1 2. This systematic review and meta-analysis examined research literature on the efficacy of pharmacotherapies for AUDs in outpatient settings, providing an updated synthesis of effect sizes for a variety of outcomes.…”

Section: Contextmentioning

confidence: 99%

“…While numerous factors likely contribute to the underutilisation of pharmacotherapy for AUDs, more research is needed to fully understand barriers to widespread use, and to identify and test implementation strategies addressing those barriers 1. In a recent study, clinicians reported that they lacked the skills or knowledge to use pharmacotherapy for AUDs and lacked confidence in the effectiveness of such medications 2.…”

Section: Commentarymentioning

confidence: 99%

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If pharmacotherapies for alcohol use disorders are effective, why are they underutilised?

Oliva¹,

Harris²

2014

Evid Based Med

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Commentary on: Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014;311:1889-900. ContextAlthough alcohol use disorders (AUDs) are highly prevalent and often disabling, effective pharmacological treatments are underutilised, due partly to clinicians' lack of knowledge and misperceptions about effectiveness. 1 2 This systematic review and meta-analysis examined research literature on the efficacy of pharmacotherapies for AUDs in outpatient settings, providing an updated synthesis of effect sizes for a variety of outcomes. MethodsThe study reviewed pharmacotherapy studies for AUDs from January 1970 through March 2014, including randomised clinical trials (RCTs) of at least 12 weeks duration in an outpatient setting with alcohol outcomes (eg, return to any drinking, return to heavy drinking), and head-to-head prospective cohort studies with health or adverse effect outcomes. Studies using FDA-approved medications (ie, naltrexone, acamprosate and disulfiram) were included, as were studies evaluating a total of 23 off-label medications (eg, topiramate and nalmfefene). Numbers needed to treat for benefit (NNT) or harm (NNH) were reported, as were weighted mean differences (WMD). The review adhered to a standard meta-analytic protocol and included graded strength of evidence, assessment for risk of publication bias and tests of statistical heterogeneity. FindingsOne hundred and twenty-two RCTs and one cohort study (n=22 803) met inclusion criteria. Most studies involved naltrexone and/or acamprosate and a psychosocial co-intervention, and included participants in their 40s who met criteria for alcohol dependence and were enrolled after a period of sobriety. Compared to placebo, significant differences were found for prevention of return to any drinking (NNT=12 for acamprosate and 20 for oral naltrexone), to heavy drinking (NNT=12 for oral naltrexone) and for reductions in drinking days (WMD=−6.5% for topiramate), heavy drinking days (WMD=−4.6% for injectable naltrexone and −9% for topiramate), heavy drinking days per month (WMD=−2.0 for nalmefene) and drinks per drinking day (WMD=−1.02 for nalmafene and −1.0 for topiramate). Meta-analysis of RCTs comparing acamprosate with naltrexone found no significant differences in alcohol outcomes. Compared to placebo, patients treated with naltrexone and nalmefene had higher risk of trial withdrawal due to adverse events (NNH=48 and 12, respectively); there were no significant differences between placebo and acamprosate or topiramate. CommentaryThis study updates and synthesises the evidence-base supporting pharmacotherapy for AUDs, including medications-topiramate and nalmfefene-currently used off-label, providing more precision and confidence in current recommendations. Despite strong evidence supporting pharmacotherapy for AUDs, use of these medications is low, with <10% of patients who might benefit receiving them. This is puzzling given that these medications have s...

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Section: Contextmentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

If pharmacotherapies for alcohol use disorders are effective, why are they underutilised?

Oliva¹,

Harris²

2014

Evid Based Med

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“…To put this in perspective, the antidepressant Lexapro â had a sales volume of $1.7 billion in 2004 (~$1.6 billion more than medications for treating alcohol use disorders) even though the number of U.S. adults suffering from major depression is similar to those suffering from alcohol use disorders (Mark et al, 2009). Many reasons exist for the lackluster prescriber acceptance of alcohol medications, including weak marketing efforts, lack of awareness, lack of patient demand, perceived lack of efficacy, patients' refusal to take an alcohol medication, high cost, side effects, shortage of physicians in addiction treatment settings, and lack of organizational support in promoting medications for alcohol treatment (Knudsen et al, 2011;Mark et al, 2003a,b;Oliva et al, 2011;Thomas et al, 2003Thomas et al, , 2008. Prescribing barriers must be addressed and effective strategies developed to offset these obstacles to treatment.…”

Section: What the Pharmaceutical Industry Wants To Knowmentioning

confidence: 99%

Research Opportunities for Medications to Treat Alcohol Dependence: Addressing Stakeholders' Needs

Litten

Falk

Ryan

et al. 2013

Alcohol Clin Exp Res

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During the past decade, significant advances have been made in the development of medications to treat alcohol dependence. Four medications have been approved by the U.S. Food and Drug Administration for treating alcohol dependence-naltrexone, injectable naltrexone, acamprosate, and disulfiram-and several others show promise. The fact remains, however, that because of the heterogeneity of alcohol dependence, these medications will not work for all people, in all circumstances. Moreover, clinicians are not routinely prescribing these medications for alcohol treatment. This commentary poses a number of issues that must be addressed in order to advance the alcohol research field and to make medications a mainstream treatment for problematic drinking. These issues are framed from the perspective of the various stakeholders involved, including clinicians, patients, regulatory agencies, the pharmaceutical industry, and third-party payers. Addressing these issues will not only help to improve treatment but, as further described, will also open up many new research opportunities for alcohol investigators in the coming decade.

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“…Despite the existence of effective treatment options, many individuals with OUDs go untreated (Oliva et al 2011; Volkow et al 2014). In general, a high proportion of people with SUDs do not want or are ambivalent about treatment (SAMHSA 2016).…”

Section: Introductionmentioning

confidence: 99%

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

Reif

Creedon

Horgan

et al. 2017

Journal of Psychoactive Drugs

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Opioid use disorders (OUDs) are receiving significant attention as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans’ commercial products in the continental United States (2003 weighted N= 7,469, 83% response rate; 2010 N=8,431, 89% response rate; and 2014 N=6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.

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Barriers to Use of Pharmacotherapy for Addiction Disorders and How to Overcome Them

Cited by 132 publications

References 70 publications

If pharmacotherapies for alcohol use disorders are effective, why are they underutilised?

If pharmacotherapies for alcohol use disorders are effective, why are they underutilised?

Research Opportunities for Medications to Treat Alcohol Dependence: Addressing Stakeholders' Needs

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

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