Life-saving medications for alcohol use disorder 'hugely under-utilized' in B.C., study finds

Medications to treat alcohol use disorder can save lives and keep people out of hospital, but they remain out of reach for the vast majority of British Columbians living with the medical condition, according to a new study from researchers at the B.C. Centre on Substance Use.

First-line prescriptions naltrexone and acamprosate can reduce alcohol cravings and diminish the pleasurable impacts of drinking for people with alcohol use disorder (AUD), a chronic relapsing disease that Statistics Canada says killed more than 3,200 Canadians in 2019.

A peer-reviewed study published Monday in the journal, Addiction, found that people with AUD who accessed medications in B.C. were nearly half as likely to die or be hospitalized than people who never took the medication.

But while prescription and retention rates increased between 2015 and 2019, fewer than one-quarter of the 7,132 people diagnosed with AUD in B.C. had tried either in 2019.

Of those that did, fewer than five per cent stayed on the medications for the minimum recommended course of three months, the study found.

"We have medications for a disorder that we know is safe and effective, and they are being hugely underutilized," said lead author Eugenia Socias, a research scientist at the BCCSU. 

Access rising but still low

Alcohol use disorder is a medical condition that means someone is unable to stop or control their alcohol consumption despite negative impacts on their health, work and personal lives, according to the National Institute on Alcohol Abuse and Alcoholism.

Monday's study used B.C. health and administrative data to examine the proportion of people diagnosed with AUD who had been prescribed naltrexone or acamprosate between 2015 and 2019.

The overall proportion of people prescribed increased from 11.4 per cent to 24.1 per cent, and retention rates rose slightly as well.

But fewer than one in five were staying on the medication after one month, and only 1.6 per cent of people took the medication for six months.

Access was also highly dependent on where someone lived.

More than half the people prescribed medication lived in large urban centres, compared to 14.2 per cent in rural areas and 2.3 per cent in remote areas.

People who had never taken either medication were also nearly seven times more likely to die during the study period than those who had received a prescription even once.

And medication also reduced the chance someone would be hospitalized, a protective factor that increased the longer someone took it.

Nearly 90 per cent of people who did not take the medication visited the hospital, compared to 59.7 per cent of people who had received it.

"We saw that people who were accessing these medications were less likely to be hospitalized or die from any cost, and this association got even stronger for people who were retained for longer periods," said Socias.

Medication supports recovery: Advocate

Medication can be an important tool in someone's early AUD recovery journey when cravings can be "debilitating," said Evan James, manager of education and training at Victoria's Umbrella Society, a non-profit that supports people with substance use disorders.

"They aren't magic pills. They don't cure alcoholism. There's so much work that has to go into battling that addiction. But what they can do sometimes is help ease those cravings," James told CBC's On The Island Thursday.

But he and Socias share concerns that doctors, particularly outside the Lower Mainland and Vancouver Island, aren't aware of the options or don't feel comfortable prescribing them.

They said stigma around alcohol use and substance use, in general, can also prevent people from learning about their options and asking for help.

"Definitely, we need to work harder in trying to expand access to medications as well as to retain people for longer periods to improve the outcomes of people who suffer from the disease," said Socias.