Written by Colin O’Shea
Spoon Feed
This feasibility study found a reduction in alcohol cravings with ED-prescribed naltrexone, but no significant change in alcohol intake. This should not change practice yet but is promising.
Naltrexone – the next suboxone?
Alcohol use disorder (AUD) poses a significant financial and health burden, with 10.6% of Americans >12 years meeting DSM-5 criteria. The ED often becomes a touchpoint for patients with substance use disorders, and there is potential for ED providers to initiate medication assisted therapy, as in opioid use disorder (OUD). What about for AUD?
This was a feasibility study of ED-initiated naltrexone in patients with moderate to severe AUD, without concomitant OUD or need for opioids. Naltrexone was started in the ED, and patients were followed up at 14 and 30 days. Of 762 patients screened, only 21 received naltrexone and 7 were involved in treatment at 30 days, which highlights how narrow this population is. At 30 days, the median number of drinks per day decreased from 4.29 to 0.73, but this was not statistically significant (p=0.078). However, the median daily craving score decreased from 19 to 8.27, which was statistically significant (p<0.01). This study starts to fill a gap in literature on initiation of anti-craving medications in the ED and empowers future studies and local quality improvement projects.
How will this change my practice?
For now, my practice of not prescribing naltrexone to patients with AUD will not change. This study is too preliminary and has too many limitations to change practice. However, this is an innovative idea and, similar to patients with OUD, there is an opportunity to help this vulnerable population. However, that requires changing institutional practices and buy in from local addiction programs. More than anything, this paper helps increase local awareness of this public health issue and serves as a starting point for future interventions.
Editor’s Note: The GRACE-4 guidelines have been recommending naltrexone prescriptions from the ED since last summer! ~Nick Zelt
Source
Emergency department-initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study. Acad Emerg Med. 2025 Jan 8. doi: 10.1111/acem.15059. Epub ahead of print. PMID: 39776077
