Daily Archives: 04/10/2014

Drinkers pill for mild alcoholics

This was all over the press yesterday with The Guardian and The Daily Mail running stories and The Wright Stuff discussing it on their phone in.

The Daily Mail used more evocative language with GPs urged to prescribe drug nalmafene to ‘mild alcoholics’ under guidelines whereas The Guardian led with Drinkers offered pill to help reduce alcohol consumption.

From The Guardian:

Drinkers who have half a bottle of wine or three pints a night are to be offered a life-saving pill which helps reduce their alcohol consumption.  Nearly 600,000 people will be eligible to receive the nalmefene tablet to keep their cravings at bay.  Experts claim the drug, which costs £3 a tablet, could save as many as 1,854 lives over five years and prevent 43,074 alcohol-related diseases and injuries.

The National Institute for Health and Care Excellence (NICE) recommended the drug’s use after trials showed it cut drinking by 61% over six months when used with counselling.  Under new plans, GPs would ask patients about their alcohol intake even when they visit them for unrelated health issues.

Professor Carole Longson, for Nice health technology evaluation centre, said: “Alcohol dependence is 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 programmes.  “We are pleased to be able to recommend the use of nalmefene 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.”

A final decision to roll out the drug on the NHS in England at a cost of £288m a year will be taken in November.  It has been provided to patients in Scotland since October last year.  The pill, also known as Selincro, is administered orally once a day and is taken when people feel the urge to drink.  It works by blocking the part of the brain which gives drinkers pleasure from alcohol, stopping them from wanting more than one drink.

Men would qualify to receive the treatment if they consume 7.5 units of alcohol per day – around three to four pints of standard strength lager.  It would be offered to women who consume five units a day, which amounts to around half a bottle of wine.

Nalmefene is the only licensed medicine which helps people reduce their drinking rather than aiding them to stop drinking altogether.  Severe alcoholics and those who are able to cut down without help would not be eligible for the drug.

Alcohol dependence is diagnosed if people show three out of six principal symptoms at the same time within the last year.  They are:

  1. strong desire to take alcohol
  2. difficulties in controlling the use of alcohol
  3. neglect of hobbies due to alcohol use
  4. persisting with alcohol use despite seeing it harm themselves
  5. tolerance to the effects of alcohol
  6. withdrawal symptoms

So I like the fact that ‘under new plans, GPs would ask patients about their alcohol intake even when they visit them for unrelated health issues.’  However is a GP really going to ask this question if you go about your bunions?  Equally is the patient going to answer honestly if you’re going to be labelled as a mild alcoholic?  I wouldn’t.  I have an issue with their terminology too (and I recognise that this may just be the media term).  Calling someone a mild alcoholic is inaccurate and I flippantly want to say ‘is that like being a little bit pregnant?’ Also it undermines the seriousness of the issue of the disease of alcohol dependence.

Oh and here are the side effects from Nalmefene :

Side effects:
More common

  • Abdominal or stomach cramping or pain (mild or moderate)
  • anxiety, nervousness, restlessness or trouble sleeping
  • headache
  • joint or muscle pain
  • nausea or vomiting
  • unusual tiredness

Less common

  • Chills
  • constipation
  • cough, hoarseness, runny or stuffy nose, sinus problems, sneezing, or sore throat
  • diarrhea
  • dizziness
  • fast or pounding heartbeat
  • increased thirst
  • irritability
  • loss of appetite
  • sexual problems in males

Call me a cynic but this is a cheap fix from Big Pharma.  Note that it is supposed to be prescribed in conjunction with therapy.  What’s the betting the therapy part of the NICE guidelines become too expensive so we end up putting  people on the drug only …….

What do you think?