Medication Utilization for Alcohol Use Disorder in a Commercially Insured Population

Abstract

A set of preliminary results using earlier data was presented at the October 2019 Addiction Health Services Research Conference.

U.S. Prescribing of On-and-Off-Label Medications for Alcohol Use Disorder in Outpatient Visits: NAMCS 2014 to 2016

“…From 2014 to 2016, fewer than one in seven outpatient visits to physicians in the U.S. made by patients with AUD were associated with an active prescription for AUD treatments with clinical trial evidence suggestive of safety and efficacy, three-quarters of which were for off-label treatments that had not been formally approved by the FDA as safe and effective for use for AUD. While this evaluation indicates low rates of on-label treatment for AUD, similar to what has been observed among commercially insured and Veterans Health Administration patients, 4,5 it also suggests that most AUD treatment is off-label. It is possible that off-label medications are being prescribed to treat multiple indications and reduce unnecessary polypharmacy (e.g., gabapentin for AUD and anxiety).…”

Response to Letter to Editor from Drs. Barrett and Apodaca

“…A study published in this journal in 2020 examined utilization of medications for AUD in a large commercially insured population using claims data from 2008 to 2018. 1 This study demonstrated that in a large national sample of commercially insured individuals with an index visit for AUD, only 13.3% filled a prescription for an AUD medication after that visit. This study also identified that 38.4% of index visits for this sample occurred in an inpatient or emergency department setting.…”

Medication treatment for alcohol use disorder in special populations

“…Despite the availability of effective pharmacological treatment, the proportion of patients with AUD receiving medications remains low 4,5 . In practice, naltrexone is often the most prescribed medication for patients who do not have co‐existing liver disease and are not on prescription or illicit opioids 20,21 . In patients with these contraindications, acamprosate is an effective alternative.…”

“…Naltrexone, which is the most prescribed medication for AUD 20,21 may affect liver function and the drug label includes a warning about its use in patients with acute hepatitis and liver failure. 22,23 It has traditionally been recommended to obtain liver enzymes and review them before initiating treatment with naltrexone, 17 and consider alternative medication if the liver enzymes are elevated more than three to five times the upper limit of normal.…”