National Health Service (NHS) patients in the UK will soon have access to a drug designed to reduce alcohol consumption. Already being prescribed in Scotland, the drug nalmefene, also known as selincro, is taken in pill form once daily and reduces the urge to drink alcohol. The National Institute for Health and Care Excellence, (NICE) state that nalmefene should be made available to people who regularly drink high amounts of alcohol. The drug is licensed for use along with psychosocial support.
Nalmefene is an opiate derivative similar in both structure and activity to the opiate antagonist naltrexone. Advantages of nalmefene relative to naltrexone include a longer half-life, greater oral bioavailability and no observed dose-dependent liver toxicity. As with other drugs of this type, nalmefene can precipitate acute withdrawal symptoms in patients who are dependent on opioid drugs, or more rarely when used post-operatively to counteract the effects of strong opioids used in surgery.
Final guidance is set to be published next month and NICE says 600,000 people would be eligible for the drug. The cost is just over three pounds sterling per tablet ($4.81 US.) If final approval is received, nalmefene will be made available by the NHS in England and Wales. Northern Ireland will review the final guidance before making a decision.
Professor Carole Longson, NICE Health Technology Evaluation Centre director, said alcohol dependence was a serious issue for many people. “Those who could be prescribed nalmefene have already taken the first big steps by visiting their doctor, engaging with support services and taking part in therapy programs. We are pleased to be able to recommend the use of namelfene to support people further in their efforts to fight alcohol dependence. When used alongside psychosocial support, nalmefene is clinically and cost effective for the NHS compared with psychosocial support alone.”
The World Health Organization (WHO) defines high alcohol consumption as drinking more than 7.5 units per day for men and more than 5 units per day for women. In the UK that is three pints of beer or cider at 5 percent strength, for women, two pints of similar strength alcohol would put them into the high consumption category. (In the UK a pint is 20 oz.)
Doctor Niamh Fitzgerald, lecturer in alcohol studies at the University of Stirling, said there were reasons to be concerned about what the introduction of nalmefene would mean in practice. “The fact that alcohol problems are widespread in society is an important principle for effective policy options such as minimum unit pricing and restrictions on marketing of alcohol,” she said. “It would be unfortunate if the availability of nalmefene led to a sense that the appropriate response to these widespread problems was for the NHS to medicate large numbers of people, rather than initiating these other more effective and less costly approaches to reduce consumption.
Professor Matt Field, Professor of Addiction at Liverpool University, said the effectiveness of nalmefene was controversial. “All of the clinical trial data are from people who were motivated to reduce their drinking,” he said, “It simply hasn’t been tested on people who are not interested in reducing their alcohol consumption and most clinicians believe that no treatment can be effective unless people are motivated to change.
Nalmefene was approved for use in the United States in 1995 as a therapy for opioid overdose; oral formulations have not been approved. Nalmefene is not a controlled substance in the US but its use is sometimes restricted to medical staff trained in emergency medicine or anesthesia.
All addicts are different and while many require medications, some do not. It really does rely on the willingness of the addict and how much badly they want to become free of their addiction. At Sovereign Health Group, we provide our patients with every opportunity to start on the road toward recovery by offering therapy that is tailored toward the needs of the individual.
Written by Veronica McNamara, Sovereign Health Group writer