Clinicians Missing Opportunity to Medicate Patients for Alcohol Use Disorder

A new study has found that very few patients hospitalized with alcohol use disorder are prescribed appropriate medications such as naltrexone.

Hospitalizations for alcohol use disorder (AUD) are an opportunity to begin treatment with medications for AUD (MAUD) but only a small percentage of patients receive MAUD within 30 days of discharge, a new study found.

About 29 million U.S. adults have AUD, and alcohol is a factor in more than 140,000 deaths per year, according to the National Institute on Alcohol Abuse and Alcoholism. Several AUD medications, including naltrexone, acamprosate, and disulfiram, have had U.S. Food and Drug Administration approval for decades.

The new study, which was published today in Annals of Internal Medicine, is based on AUD hospitalization data in 2016. The researchers examined more than 28,000 AUD hospitalizations for more than 20,000 unique patients.

The study features three key data points:

• Only 0.7% of patients began MAUD treatment within two days of discharge
   
• Only 1.3% of patients began MAUD treatment within 30 days of discharge
   
• The most predictive demographic factor for MAUD treatment linked to an AUD hospitalization was younger age—18 to 39 years old versus more than 75 years old (adjusted odds ratio 3.87)

"In this national sample of eligible Medicare Part D beneficiaries who had not been treated recently and were hospitalized for AUD in 2016, MAUD treatment was rarely initiated during hospital discharge or follow-up care and was more likely among younger patients and those with involvement of psychiatry or addiction medicine," the study's co-authors wrote.

Interpreting the data

Clinicians are missing an opportunity to treat AUD patients, the study's co-authors wrote. "Hospitalizations allow for engagement with healthcare resources, such as clinicians and social workers, that may otherwise be difficult to access, and health vulnerability experienced by patients during hospitalizations may provide motivation for behavior change. Initiation of MAUD treatment should involve a long-term treatment plan, and if this is not feasible during hospitalization then referral for outpatient treatment may be a preferred alternative. However, the low rate of MAUD treatment initiation within 30 days of discharge indicates that initiation during follow-up rarely occurs."

MAUD is an effective treatment for AUD, the co-authors of an editorial accompanying the study wrote. "Currently recommended medications include naltrexone and acamprosate, which were approved by the U.S. Food and Drug Administration in 1994 and 2004, respectively, after showing benefits to patients with moderate to severe AUD. In recent meta-analyses, compared with placebo, naltrexone reduced the risk for return to heavy drinking (51% vs. 61%), whereas acamprosate reduced relapse in patients who had recently become abstinent (62% vs. 75%)."

The reported rates of MAUD treatment for patients hospitalized with AUD is "startling low," the editorial co-authors wrote. "Might there be legitimate reasons for this result? We do not think so. Although 90% of the patients had secondary diagnoses of AUD, the researchers recognized that AUD diagnoses affect hospital care and excluded patients identified as being in remission. Patients with a primary diagnosis of AUD had higher rates of initiation, but initiation rates were in the single digits."

Related: How to Treat Substance Use Disorder in the Emergency Department