1. GEOFFREY KONRAD PGY2 DR. A HYNES DR. J NEPON Naltrexone Therapy for Alcohol Use Disorder

2. Objectives? Discuss briefly the background and epidemiology of Alcohol Use Disorders Review the evidence for Naltrexone, Acamprosate Discuss the Fact Sheet and broader project

3. Background Alcohol Use Disorders are associated with substantial morbidity, mortality, and economic costs Effects are wide spread WHO  2012: 5.9% of all deaths, and 5.1% of global burden of disease related to alcohol

4. Background In Canada  2002: Economic burden of alcohol related harm was 14.6 Billion  2005: 7.7% of all deaths attributed to alcohol

5. Epidemiology NESERCIII DSM5 Criteria  12M prevalence: 13.9%  Lifetime prevalence: 29.1%  7.7% 12M and 19.8% lifetime respondents sought treatment DSM4 Criteria (2001/2  2012/13)  12M: 8.5%  12.7%  Lifetime: 30.3%  43.6%

6. AUD

7. Evidence Systematic Review and Meta-analysis published in JAMA, 2014 For Naltrexone:  NNT to prevent return to any drinking = 20  NNT to prevent return to heavy drinking = 12 For Acamprosate  NNT to prevent return to any drinking = 12

8. Guidelines Guidelines:  NIAAA  NICE  APA  CANMAT All support use of Naltrexone, Acamprosate, Disulfiram

9. Use of Pharmacotherapy Several studies have looked at prescribing habits and trends for AUD Rx VHA:  2007: 3.0%  2009: 3.4% IMS National Prescription Audit  2002: At most 9% filled (any) Rx Primary Care  “No studies to date have assessed Rx use in primary care settings”

10. Fact Sheet Initial project to prove Naltrexone and Acamprosate under prescribed  MCHP Information important now Developed a fact sheet highlighting evidence for Naltrexone and Acamprosate, and how to prescribe

11. Fact Sheet Sent out to psychiatry department  Incorporated feedback Presented at the Annual Scientific Assembly for Family Physicians  Immediate, direct feedback

12. Future Direction Distribution through CPD Medicine at the University of Manitoba Looking into possible ways to remove from EDS

13. Conclusions Alcohol Use Disorders is a BIG problem Naltrexone and Acamprosate WORK These medications are greatly underutilized Raising awareness and removing barriers to prescription is important for robust patient care

14. Thank You CODI team  Dr. A Hynes  Dr. J Nepon Dr. J Sareen Dr. J Bolton Christine Leong

15. Resources Rehm J., Baliunas D., Brochu S., Fischer B., Gnam W., Patra J.et al. The Costs of Substance Abuse in Canada 2002. Ottawa, ON:Canadian Centre on Substance Abuse; 2006.c World Health Organization. Global Status Report on Alcohol and Health. Geneva, Switzerland: World Health Organization; 2014. Grant B, Goldstein R, Saha T, Chou S, Jung J, Zhang H, Pickering R, Ruan W, Smith S, Huang B, Hasin D. Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry. Published online June 3, 2015. Doi:10.1001/jamapsychiatry.2015.0584. Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: recommendations for policy and prevention. Journal of Studies on Alcohol and Drugs. 2007;68:36-47.

16. Resources Jonas D, Amick H, Feltner C, Bobashev G, Thomas K, Wines R, Kim M, Shanahan E, Gass E, Rowe C, Garbutt J. Pharmacotherapy for Adults with alcohol use disorder, in outpatient settings, a systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900. Iheanacho T, Issa M, Marienfeld C, Rosenheck R. Use of naltrexone for alcohol use disorders in the Veterans’ Health Administration: a national study. Drug and Alcohol Dependence. 2013;132:122-126. Wessell A, Nemeth L, Jenkins R, Ornstein S, Miller P. Medications for alcohol use disorders in a primary care practice-based research network implementation study. Alcoholism Treatment Quarterly. 2014;32:58-66. Mark T, Kassed C, Vandivort-Warren R, Levit K, Kranzler H. Alcohol and opioid dependence medications: prescription trends, overall and by physician specialty. Drug Alcohol Depend. 2009; 99(1-3):345-349.

17. Time for coffee!