Chapter 4 (Page 17)
Naltrexone has demonstrated efficacy as an important adjunct to the treatment of alcohol dependence, and it is available for general practitioners to prescribe. Yet it has not been widely accepted or tried. The media promoted naltrexone intensively when it was initially approved by the FDA for use in the treatment of alcoholism. The drug’s manufacturer used standard, but limited, marketing techniques to publicize the drug. Yet the field has been slow to adopt the use of naltrexone.
There may be several reasons for this. First, because the initial studies were relatively small and ongoing research was pending, some practitioners have adopted a wait-and-see approach. The additional costs associated with naltrexone may also serve to limit its use. Finally, it has been extensively documented that there is typically a long lag between an invention or a new research finding and its adoption and widespread use by individual practitioners or programs and organizations in the field (Backer, 1991; National Institute of Mental Health [NIMH}, 1971.)
Even though the Federal Government spends millions of dollars annually to support carefully selected research and service demonstrations as well as medications development, many practical, effective, and innovative new technologies and procedures languish in published articles in scientific journals without further application.
Barriers to Treatment and to Combination Treatment
In completed or ongoing research, naltrexone has been used successfully as an adjunct to day hospital treatment, supportive psychotherapy, cognitive-behavioral relapse prevention therapy, primary care counseling, and 12-Step facilitation therapy and support groups. Yet there is much resistance to pharmacotherapy from third-party payers, some addiction clinicians, and some self-help-oriented individuals who view the use of medications in addictions treatment as substituting a pill for self-empowerment and taking responsibility for the disease.
Some consider the cost of naltrexone a barrier. Naltrexone costs
approximately $4.50 per day, or $400 for a 3-month period. Additional costs
include followup LFTs. In settings where patients do not routinely get physical
examinations, the costs of these examinations are added to the treatment costs.
The daily cost of naltrexone, however, may be less than the cost of alcohol used
by most patients, depending on which of the above costs are incurred by the
patient.
Naltrexone and the Formulary
The formulary and the formulary system are tools that health care organizations use to improve the quality and control the cost of drug therapy (American Society of Hospital Pharmacists, 1991). A health care organization’s pharmacy and therapeutics (P&T) committee has a key role in maintaining the formulary system, which constitutes a continually revised compilation of drug products that have been approved for use within a health care organization or system (American Society of Hospital Pharmacists, 1983.) Pharmacies do not stock products that are not on their formularies. If a physician prescribes such a drug, a pharmacist is responsible for discussing the request with the prescriber and determining whether an alternative formulary product can be used.
Naltrexone may not be on the formulary in many health care settings. After a drug has received FDA approval for treatment of a particular condition or disease, any licensed physician may prescribe it for that purpose, and any licensed pharmacist may dispense that prescription, on a patient-by-patient basis. Naltrexone is thus theoretically available to any patient who demonstrates a need for it.
[Note: This publication is part of the Substance Abuse Prevention and Treatment
Block Grant technical assistance program. All material appearing in this volume
except that taken directly from copyrighted sources is in the public domain and
may be reproduced or copied without permission from the Substance Abuse and
Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse
Treatment (CSAT) or the authors. Citation of the source is appreciated.]
Order a FREE copy of Tip 28 from SAMHSA.
BACK
to previous page.
BACK to Home Page
Or select another button from the Blue Menu Bar at the top of your screen.
This page last updated on 10-18-2002.