This NPR story explores a drug known as naltrexone for treating moderate to severe alcohol use disorder (formerly called “alcohol dependence”), and how some providers feel it is underutilized as a treatment option.
The story does a lot of things well–there are multiple sources included, and lots of general discussion on the evidence that supports the use of naltrexone, along with discussion on the complex nature of treating this problem.
However, we wish the story had done more to explain how well the medication works (or, in some cases, doesn’t work). The cost of the medication and its side effects could also have been addressed more thoroughly.
Many people aren’t aware that this medication can be used effectively to help people with alcohol use disorder. This story shines a light on the issue, though it could have been a bit more thorough, exploring some of the caveats.
This was a close call. The story mentions that an analysis found the drug “cost effective” for treating alcohol use disorders. But it doesn’t mention any specific numbers, nor if insurance covers it.
The story talks about a meta-analysis that looked at a large grouping of studies on the effectiveness of naltrexone and another drug, and it mentions general take-aways from the analysis. But, we’re not given much on what the evidence showed, such as how many people are helped by this drug, and to what extent they’re helped.
Looking at the meta-analysis cited in the story, one might be disappointed to learn that 9 people would need to be treated with naltrexone to prevent one additional person from returning to heavy drinking. The effects are modest, but real.
The story briefly mentions the drug is “safe,” but does not discuss any side effects of the drug, nor notable interactions or contraindications. For example, this drug can’t be used if the person is prescribed or otherwise taking opioids, too, or has certain types of liver damage.
We get a sense that there is quite a bit of medical evidence on this drug, such as a meta-analysis of 64 clinical trials, and that the bigger issue is how, in spite of this, many providers feel it’s underutilized. This claim too is backed up by evidence presented in the story.
However, we wish that the story hadn’t focused exclusively on the story one of patient who was helped by the drug, when the evidence shows that most patients don’t derive the same benefits. Presenting a wider range of experiences would have been more useful for readers.
The story may inadvertently overstate the portion of the population that is a candidate for treatment with this drug. The story says that 28% of the adult population are heavy drinkers or drink more than is recommended. It also says that heavy drinkers are not getting the help they need, implying that naltrexone might be an appropriate treatment for this group. However, naltrexone is indicated for the treatment of moderate to severe alcohol use disorder, formerly “alcohol dependence,” and not for drinking more than is recommended or heavy drinking. So undoubtedly, the pool of drinkers who might benefit from this drug is smaller than the 28% figure cited in the story.
This is a close call. A careful reader will be able to tell that the drug isn’t an option for more than a quarter of the adult population (as the 28% figure might suggest). Then again, we think some extra caution and qualification was needed to ensure that readers don’t get the wrong idea.
The story included a number of independent sources, and we could detect no potential conflicts of interest that should have been disclosed.
This was a tricky one–the story briefly discusses a variety of other methods that can help treat alcohol dependence, but it doesn’t compare them head-to-head. That said, we do get a sense of the options available.
This is a strong point of the story:
Any health care provider who is licensed to prescribe medicine can prescribe naltrexone — not just mental health professionals or addiction specialists. As as long ago as 1997, a published study showed that treatment of alcohol dependence with naltrexone by primary care doctors can be effective; follow-up research has confirmed that the primary care approach not only works, but makes treatment much more accessible.
The story makes it clear that this drug has been around a long time, and what’s novel here is a recent analysis showing that it is underutilized.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
We’ve written about the hype of liquid biopsies for years (see link in comment below). And now this…. https://www.statnews.com/2022/01/12/medicare-shouldnt-cover-liquid-biopsies-early-cancer-detection/
Case counts still matter. “(There) are stories that may not be told adequately if only hospitalizations and deaths are emphasized.” @garyschwitzer interviewed by @dbauder of @AP. https://apnews.com/article/omicron-changing-news-outlets-covid-data-da9272f7c4c8a109c3bfb56bed9e9c76
My friend Gary @garyschwitzer wrote to his city council representative in a Minnesota town about a Viva Las Vegas event scheduled for January.
The response he got seems to perfectly capture where we are now.
https://www.healthnewsreview.org/2021/12/2021-ends-with-covid-craziness-in-sports-and-politics/
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