Naltrexone for Alcohol Use Disorder

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Alcohol-related emergency department (ED) visits are common – estimated to be comprise nearly 4% of all ED visits and up to 6% of hospitalizations. Historically, EDs have had little engagement in harm reduction around alcohol use disorder (AUD) and provision of medication for AUD. Often efforts to help patients with dangerous or harmful alcohol consumption have encouraged abstinence-only, or referral to detoxification centers. However, recent studies have demonstrated the feasibility of ED-initiated medication for AUD, specifically naltrexone (Anderson ES et al. Ann Emerg Med. 2021 Dec;78(6):752-758. PMID: 34353648. Murphy et al. Ann Emerg Med. 2023 Apr;81(4):440-449 PMID: 36328851).

Jonas DE et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014 May 14;311(18):1889-900. doi: 10.1001/jama.2014.3628. PMID: 24825644. Murphy CE 4th, Wang RC, Montoy JC, Whittaker E, Raven M. Effect of extended-release naltrexone on alcohol consumption: a systematic review and meta-analysis. Addiction. 2022 Feb;117(2):271-281. PMID: 34033183.

Example emergency department algorithm below, also see UCSF protocol

Anderson ES et al. Implementation of Oral and Extended-Release Naltrexone for the Treatment of Emergency Department Patients With Moderate to Severe Alcohol Use Disorder: Feasibility and Initial Outcomes. Ann Emerg Med. 2021 Dec;78(6):752-758. Aug 2. PMID: 34353648.