Health & Medicine, Canada (Commonwealth Union) – A new study appearing recently in the journal Addiction reveals that medications for alcohol use disorder (AUD) are not being adequately utilized in British Columbia, despite their proven safety and effectiveness.
According to the study, conducted between 2015 and 2019, under five percent of British Columbians who met the criteria for moderate to severe AUD received medications for the recommended minimum duration of 3 months.
To address this issue, researchers developed a cascade of care for AUD, a visual tool designed to assess the effectiveness of the health system in various aspects. This tool aids in identifying individuals with AUD, engaging and retaining them in treatment and care, and pinpointing gaps in service delivery.
Researchers indicated that alcohol use is a significant risk factor for disease burden, and in 2017, it accounted for the largest proportion of the $46 billion substance use-related costs in Canada. Furthermore, in 2019, nearly 700,000 Canadians (2%) met the criteria for moderate-to-severe AUD, and 5.8 million (18.3 percent) engaged in heavy drinking. Hospitalizations entirely attributed to alcohol were comparable to those for heart attacks, and three to four times higher than those caused by opioids or cannabis. Alcohol was responsible for more than 3,200 deaths that same year.
“These findings suggest that despite clinical guidelines and best practices, alcohol use disorder is under-treated, leaving individuals without access to effective treatments that can improve their health and wellbeing,” explained Dr. Eugenia Socías, who is the lead author of the study and a research scientist for the BC Centre on Substance Use (BCCSU) as well as an assistant professor in the department of medicine at the University of British Columbia (UBC). “We found that most individuals did not access medications, and retention rates on medications remained low overall, leaving much room for improvement for the treatment of alcohol use disorder.”
The researchers utilized linked administrative health data from the Provincinal Overdose Cohort, which is a comprehensive collection of health data maintained by the BC Centre for Disease Control. To conduct their study, they randomly selected a 20 percent sample of British Columbia residents, totaling 1,093,970 individuals, from the years 2015 to 2019. From this sample, they identified 7,231 people, constituting 0.7 percent of the population, who had moderate-to-severe AUD.
The study focused on evaluating trends in access and retention in AUD care to understand the impact of medication accessibility on hospitalizations, emergency department visits, and deaths throughout the cascade of care. Notably, this research is the first of its kind to determine the prevalence of moderate-to-severe AUD in British Columbia.
The study found that access to medication was linked to a decreased likelihood of experiencing any adverse outcomes related to AUD, such as hospitalization, emergency department visits, and death. Additionally, there was a noticeable trend indicating that longer retention on medications was associated with even greater reductions in AUD-related adverse outcomes. However, the study also revealed that individuals living in rural and remote areas had lower rates of medication use for AUD.
Clinical guidelines recognize AUD as a chronic and relapsing condition, and for moderate or severe AUD, medication is recommended as a first-line treatment for at least three to six months. Health Canada considers naltrexone, acamprosate, and disulfiram as the gold standard pharmaceutical interventions for AUD.
To improve outcomes for individuals with AUD, the study authors emphasize the importance of early diagnosis and enhanced access to medications for AUD. By addressing these factors, it is hoped that positive outcomes for those with AUD can be better supported.
“Healthcare providers should be trained to talk to patients about their alcohol use regularly to ensure early diagnosis alongside offering evidence-based medications as part of their treatment,” added Dr. Seonaid Nolan, study co-author, and the head of Providence Health Care’s division of addiction at St. Paul’s Hospital, clinician scientist with BCCSU, as well as the Steven Diamond Professor in Addiction Care Innovation at UBC.
