Assessing Naltrexone Prescribing and Barriers to Initiation for Alcohol Use Disorder: A Multidisciplinary, Multisite Survey

Abstract

ObjectiveTo survey barriers in prescribing naltrexone for alcohol use disorder.MethodsA 12-question survey related to naltrexone prescribing patterns, perceptions, and knowledge was sent to 770 prescribers in the departments of internal medicine, family medicine, and psychiatry across a health system with sites in Arizona, Florida, and Minnesota.ResultsResponses were obtained and included for 146/770 prescribers (19.0% response rate). Most respondents were in the department of internal medicine (n = 94, 64.4%), but the departments of psychiatry (n = 22, 15.1%) and family medicine (n = 30, 20.5%) were also represented. Only 34 (23.3%) respondents indicated they had prescribed naltrexone in the previous 3 months. The most common reasons for not prescribing naltrexone were “unfamiliarity with naltrexone for treatment of alcohol use disorder” and “patients do not have appropriate follow-up or are not in a formal treatment program.” Compared with those representing internal/family medicine, psychiatry respondents were more likely to prescribe naltrexone and answer knowledge questions correctly.ConclusionIn this survey among primarily non-addiction-trained prescribers, a disparity was shown for prescribing naltrexone and in knowledge barriers between staff in internal/family medicine and psychiatry. There exist opportunities for education and quality improvement that promote the prescribing of naltrexone for alcohol use disorder by non-addiction specialists.

Implementation and analysis of a multifaceted intervention for alcohol use disorder from a single academic urban emergency department

“…Our study indicated that lack of knowledge of these guidelines was a driving reason behind low prescribing rates of naltrexone from ED providers. These findings are similar to those of another study that assessed barriers to naltrexone prescribing among internal and family medicine specialists, where unfamiliarity with naltrexone for the treatment of AUD was the leading reason for fewer prescriptions 19 …”

“…These findings are similar to those of another study that assessed barriers to naltrexone prescribing among internal and family medicine specialists, where unfamiliarity with naltrexone for the treatment of AUD was the leading reason for fewer prescriptions. 19 The initial baseline assessment of ED providers' perspectives revealed interest in increasing education surrounding naltrexone, reducing cost to patients, and providing educational materials to patients. Interestingly, many providers also commented that the existing ED culture does not focus on long-term care for patients with SUD.…”

Medication treatment for alcohol use disorder in special populations

“…[6][7][8] Some of the obstacles that may hinder prescribing of medications for this indication may include prescriber unfamiliarity with these medications, poor information dissemination, and concern for adverse effects. [9][10][11] While medications are underutilized in patients with AUD, 4,5 their use in special patient populations is even lower, 12,13 likely due to unfamiliarity and fear of the potential risks or complications. In this article, we review the current evidence on medication use in special populations with the hope of addressing knowledge gaps and broadening their use.…”

“…Although effective treatments are available, including psychosocial interventions and medications for AUD (MAUD), only a small proportion of patients with AUD seek treatment, 4 and even a lower percentage receive MAUD, 5 despite clear evidence supporting the role of pharmacotherapy in AUD treatment 6–8 . Some of the obstacles that may hinder prescribing of medications for this indication may include prescriber unfamiliarity with these medications, poor information dissemination, and concern for adverse effects 9–11 …”

Commentary on Socias et al.: It is time to be serious about AUD treatment disparities

“…These disparities exist both at the provider and system levels. There are differences in MAUD prescribing by physician type [10], and qualitative studies suggest that this may be due to differences in provider education as well as persisting negative beliefs about MAUD [11]. At the systems level, publicly funded treatment programs—those programs that serve economically disadvantaged clients in the US—have been less likely to prescribe MAUD than privately funded treatment programs [12].…”