Starting treatment for alcohol use disorder (AUD) with extended-release naltrexone injections in the emergency department (ED) produced a dramatic reduction in alcohol consumption, according to findings presented at the American College of Emergency Physicians (ACEP) 2022 Scientific Assembly.
The results show the feasibility of such a program and underscore the importance of the ED in combating AUD, said the researchers, from the University of California, San Francisco (UCSF).
“According to the National Institute on Alcohol Abuse and Alcoholism, 18% of ED visits had alcohol as a contributing factor — the volume of alcohol-related ED visits has been climbing every year, and it is a significant public health problem,” said Maria Raven, MD, MPH, professor of emergency medicine at UCSF. “Right now, we do very little for people who come to the ED with AUD, so it is a missed opportunity to intervene, especially given the volume of visits we see and that our patient population is one that often has significant barriers to accessing outpatient treatment.”
The findings come from a 12-week, prospective, single-arm study of ED patients who were actively drinking adults with known or suspected AUD and who had positive scores on a screening test. Of 179 patients who were approached, 32 agreed to enroll; the enrollment yield was 18%. Participants were given monthly extended-release naltrexone and case management services.
Twenty-five of the 32 participants completed all their study visits, and 22 (69%) continued taking naltrexone after the 12 weeks.
The researchers say the results surprised them. The average daily alcohol consumption at baseline was 7.6 drinks a day, and it fell by 7.5 drinks a day — in other words, to almost no consumption.
“The median alcohol consumption when measured over the last 2 weeks of the study was zero,” Raven said. “This doesn’t mean everyone was at zero, but this was the median and reflects that many participants stopped drinking altogether. We were pleasantly surprised by this. I don’t know that we thought so many people who participated would actually fully abstain.”
On the Kemp Quality of Life Scale — with scores from 1 to 7, with 1 being “life is very distressing,” 4 being “life is so-so,” and 7 being “life is great” — the average baseline score was 3.6. That score rose by 1.2 points by the study’s end.
Raven said she hoped more would enroll but that “a number of people actually did not want the injection or were not ready to think about stopping.” Still, she said, the 18% enrollment is “a major improvement,” considering that no attempt was made to initiate treatment with naltrexone prior to the study. Oral naltrexone, rather than the injection, could be offered to improve participation, but oral naltrexone has to be taken daily, she said.
She said a larger study is planned at UCSF and that other institutions are interested in starting a similar program.
“When someone is in the ED for an AUD-related issue, it can serve as a turning point for them in some cases,” she said.
Erik S. Anderson, MD, associate research director at Oakland, California–based Alameda Health System, who has studied naltrexone in the ED, said the findings dovetail with what his team has found at his center. He said that psychosocial support is important as well and that his team has found that navigation services are the most important factor in connecting patients with follow-up care — even more so than providing medications.
“In my mind, this is a situation where we have treatment options and approaches that work, and it’s really about implementing these services in a novel care setting,” he said. “ED patients are at higher risk of complications for AUD simply because they are in the ED in the first place — initiating AUD treatment in this setting is the right thing to do.”
Raven and Anderson have disclosed no relevant financial relationships.
American College of Emergency Physicians (ACEP) 2021 Scientific Assembly: Abstract 6. Presented October 2022.
Tom Collins is a freelance writer in South Florida who has written about medical topics from nasty infections to ethical dilemmas, runaway tumors to tornado-chasing doctors. He travels the globe gathering conference health news and lives in West Palm Beach.
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