US clinical guidelines recommend pharmacotherapy as a first-line treatment for alcohol use disorder (AUD), yet few people who could benefit from AUD medications receive them. Researchers used 2008–2018 claims data from a large US insurer to investigate how many individuals filled prescriptions, how long it took to fill prescriptions, and clinical factors associated with filling prescriptions for AUD medications (naltrexone, acamprosate, disulfiram, and topiramate).
- Of 151,128 individuals with a medical encounter for AUD, 13% subsequently filled a prescription for AUD medications.
- A median of 33 days passed between the AUD medical encounter and a prescription fill.
- Men made up two-thirds of the sample, but women were more likely to fill prescriptions for AUD medications.
- Individuals with a medical encounter for an acute alcohol-related condition (e.g., acute pancreatitis) were less likely to fill prescriptions for AUD medications, compared with those without such a medical encounter (hazard ratio [HR], 0.79).
- Individuals with moderate or severe AUD (versus mild) or with (versus without) chronic alcohol-related conditions were more likely to fill prescriptions for AUD medications (HR, 2.05 and 1.08, respectively).
Comments: Only one in eight commercially insured individuals with a medical encounter for AUD subsequently received medications for AUD. Clinicians could initiate medications for AUD during many medical encounters, including those for acute alcohol-related problems, but these opportunities often go unrealized. Increasing clinicians’ comfort and competence in prescribing these safe and effective medications would likely result in substantial health benefits.
Aaron D. Fox, MD
Reference: Huskamp HA, Reif S, Greenfield SF, et al. Medication utilization for alcohol use disorder in a commercially insured population. J Gen Intern Med. 2020;35(11):3262–3270.