Medications for alcohol use disorder are underutilized in British Columbia, despite their safety and effectiveness, according to a new study by UBC researchers at the BC Centre Centre on Substance Use (BCCSU).
The study, published today in the journal Addiction, found that between 2015 and 2019 fewer than five per cent of British Columbians who met the criteria for moderate to severe alcohol use disorder (AUD) received medications for the minimum recommended time of three months.
Alcohol use is a leading risk factor for disease burden. In 2019, almost 700,000 (2.0 per cent) Canadians met criteria for moderate-to-severe AUD in 2019, with another 5.8 million (18.3 per cent) meeting the criteria for heavy drinking. That same year, the rate of hospitalizations entirely caused by alcohol was similar to those for heart attack and 3-4 times higher than those caused by opioids or cannabis, with alcohol being entirely responsible for more than 3,200 deaths.
Dr. Eugenia Socías
“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,” says lead author Dr. Eugenia Socías, assistant professor in the department of medicine at UBC and research scientist with BCCSU. “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.”
For the study, the research team developed a cascade of care for AUD — a visual tool that describes the effectiveness of the health system in identifying people with AUD, engaging and retaining them in treatment and care, and in identifying gaps in service delivery.
“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.”
Dr. Eugenia Socías
The researchers used linked administrative health data from the Provincial Overdose Cohort, a collection of health data maintained by the BC Centre for Disease Control. A random 20 per cent sample of B.C. residents (1,093,970 people) between 2015-19 were selected and people with moderate-to-severe AUD (7,231 people or 0.7 per cent of the population) were identified. Trends in access and retention in AUD care were evaluated to assess the impact of access to medication on hospitalizations, emergency department visits, and death across the cascade of care. This is the first study to identify prevalence of moderate-to-severe AUD in B.C.
Additional key study findings include:
- Access to medication was associated with reduced odds of experiencing any AUD-related adverse outcomes, including hospitalization, emergency department visits, and death.
- There was a trend to longer retention on medications being associated with greater reductions in AUD-related adverse outcomes.
- Those living in rural and remote areas had lower rates of use of medications for AUD.
Dr. Seonaid Nolan
AUD is recognized as a chronic and relapsing condition, with clinical guidelines recommending at least 3-6 months of treatment with medication as a first-line treatment for moderate or severe AUD. Front-line pharmaceutical interventions include naltrexone, acamprosate, and disulfiram, which are considered the gold standard for treatment of AUD by Health Canada.
To support positive outcomes for those with AUD, the study authors suggest a need for early diagnosis and improved access to medications for AUD.
“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,” says co-author Dr. Seonaid Nolan, the Steven Diamond Professor in Addiction Care Innovation at UBC, clinician scientist with BCCSE, and head of Providence Health Care’s division of addiction at St. Paul’s Hospital.
A version of this story was originally published by BCCSU.