Naltrexone may be a wonder drug but getting patients to take it is a challenge.
KEY POINTS
- Naltrexone, like its cousin naloxone (Narcan), is a wonder drug but getting patients to take it is not easy.
- Lack of treatment adherence may be genetic, but women and men also respond differently
- Alcohol (AUD) and opioid use disorders (OUD) are two diagnoses, but the same treatment suggests commonalities.
Excess drinking and alcohol use disorder (AUD) is common, not easily diagnosed, and often undertreated, with less than 15% of individuals with a lifetime diagnosis receiving any treatment. While medication-assisted treatments (MATs) have been the major therapeutic approach for opioid use disorders, alcohol use disorders have gone mostly untreated. Yet alcohol misuse is believed to be responsible for more than 140,000 deaths annually in the United States. In addition, nearly 1 in 6 Americans reportedly binge drink, and binge drinkers may be male or female.
Benjamin Rush, father of modern American psychiatry and a signer of the Declaration of Independence, published his landmark “Inquiry Into the Effects of Ardent Spirits Upon the Human Body and Mind” in 1785. Dr. Rush, whose interest in mental illness included alcohol misuse, described it as a disease: “The use of strong drink is at first the effect of free agency. From habit, it takes place from necessity.” Rush had experience observing alcohol problems because, during the revolutionary period, Americans had an average annual consumption of 5.8 gallons of absolute alcohol per adult. Rush learned early in his career it was not logical to blame patients or their morals when treating someone with an alcohol problem.
Gender Matters
In the Rush tradition, researchers like Rajita Sinha, Foundations Fund Professor of Psychiatry and Director, Yale Interdisciplinary Stress Center, also don’t blame patients for failing to respond to treatments and instead have searched for means to make treatment more successful. Recently, Sinha has turned the addiction treatment field upside down by publishing data showing that gender matters in alcohol effects on the brain and craving and also appears to determine AUD medication treatment responses.
References:
ReMaggioni E, et.al Brain volumes in alcohol use disorder: Do females and males differ? A whole-brain magnetic resonance imaging mega-analysis. Hum Brain Mapp. 2023 Sep;44(13):4652-4666. doi: 10.1002/hbm.26404. Epub 2023 Jul 12. PMID: 37436103; PMCID: PMC10400785.ferences
Sinha R. Alcohol’s Negative Emotional Side: The Role of Stress Neurobiology in Alcohol Use Disorder. Alcohol Res. 2022 Oct 27;42(1):12. doi: 10.35946/arcr.v42.1.12. PMID: 36338609; PMCID: PMC9621746.
Srivastava AB, Gold MS. Naltrexone: A History and Future Directions. Cerebrum. 2018 Sep 1;2018:cer-13-18. PMID: 30746025; PMCID: PMC6353110.
Ellison M, et. al. Reversal of Opioid-Induced Respiratory Depression in Healthy Volunteers: Comparison of Intranasal Nalmefene and Intranasal Naloxone. J Clin Pharmacol. 2024 Mar 4. doi: 10.1002/jcph.2421. Epub ahead of print. PMID: 38436495.