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- Title
Patterns of publicly funded naltrexone use among patients diagnosed with alcohol use disorder in Ontario.
- Authors
Tourchian, Nima; McCormack, Daniel; Leece, Pamela; Tadrous, Mina; Gomes, Tara
- Abstract
Aims Naltrexone is recommended first-line to manage alcohol use disorder (AUD). With previous studies indicating poor retention on naltrexone, we determined duration of naltrexone use and assessed the association between prescription setting and time to discontinuation in Ontario. Methods We conducted a retrospective population-based cohort study among Ontario public drug beneficiaries diagnosed with AUD who initiated publicly funded naltrexone from June 2018 to September 2019. The primary outcome was time to naltrexone discontinuation, with a secondary analysis assessing receipt of at least one prescription refill. We used Cox proportional hazards models and logistic regression to test the association between prescription setting and each medication persistence outcome. Results Among 2531 new naltrexone patients with AUD, the median duration of naltrexone use was 31 days and 394 (15.6%) continued naltrexone for 6 months or longer. There was no association between setting of initiation and duration of naltrexone use; however, those initiating naltrexone following an acute inpatient hospital stay were more likely to fill a second prescription (aOR 1.43, 95% CI 0.96–2.14), while those initiating after an ED visit were less likely to be dispensed a second prescription (aOR = 0.69, 95% CI 0.52–0.90) compared to those starting in a physician's office. Conclusion Persistence on naltrexone to treat an AUD is low, regardless of the setting of initiation. Further research is needed to elucidate the barriers encountered by patients with AUD that lead to poor treatment persistence in order to develop interventions that facilitate patient-centered access to evidence-based treatment for AUD in the province.
- Subjects
ONTARIO; DIAGNOSIS of alcoholism; RESEARCH funding; POPULATION health; HEALTH policy; TREATMENT duration; RETROSPECTIVE studies; DESCRIPTIVE statistics; LONGITUDINAL method; PATIENT-centered care; ENDOWMENT of research; ALCOHOLISM; LENGTH of stay in hospitals; CONFIDENCE intervals; NALTREXONE
- Publication
Alcohol & Alcoholism, 2024, Vol 59, Issue 2, p1
- ISSN
0735-0414
- Publication type
Article
- DOI
10.1093/alcalc/agad091