New drug for 'mild alcoholics' drinking two glasses of wine a night
GPs will prescribe nalmefene and actively ask about patients' alcohol consumption, under new plans by national health watchdog Nice to tackle alcohol abuse
2:53PM BST 02 Oct 2014
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Hundreds of thousands of people drinking half a bottle of wine a night are to be put on the first ever drug to help reduce alcohol consumption, under plans announced by the National Institute for Health and Clinical Excellence.
Men drinking three pints of beer and women drinking two large glasses of wine per night and who do not cut down within two weeks should be prescribed a new drug, Nice has said.
There are an estimated 750,000 people in the UK who would be eligible for nalmefene who show no overt symptoms associated with their drinking.
The plans mean GPs will actively ask patients about their alcohol consumption even when they see them for unrelated health matters such as low mood, inability to sleep, diabetes and high blood pressure.
The drug, which costs £3 per tablet, is taken when people feel the urge to have a drink and stops them from wanting more than one.
The plans will cost £288m per year and it is estimated to save 1,854 lives over five years and prevent 43,074 alcohol-related diseases and injuries over the same period.
The NHS and local authorities will be required to make funding available within three months.
Prof Mark Bellis, alcohol lead for the Faculty of Public Health said there were relatively simple alternatives that would reduce alcohol consumption without the need to medicate the middle classes such as reducing advertising of alcohol and introducing a minimum price per unit.
He said: "Once again this is going to increase pressure on the NHS when there are alternatives that would reduce pressure on health services by cutting alcohol consumption.
"There are plenty of ways that don't require prescribing and the additional pressures on the NHS that could reduce harmful drinking.
"We need to think very carefully about how we use limited resources and prescribe for people who with relatively simple population interventions such as reducing advertising and minimum unit price could quite easily reduce alcohol consumption to safer levels."
He added that nalmefene reduced alcohol consumption by a relatively modest amount when compared with counselling alone and added that medicating people always came with the risks of side effects. He also said that it was not known whether the reduction in drinking was maintained long-term.
Dr Niamh Fitzgerald, a lecturer in Alcohol Studies, Institute for Social Marketing (ISM) at the School of Health Sciences, University of Stirling, said: “The fact that alcohol problems are widespread in society is an important principle for effective policy options such as minimum unit pricing and restrictions on marketing of alcohol.
"It would be unfortunate if the availability of nalmefene led to a sense that the appropriate response to these widespread problems was for the NHS to medicate large numbers of people, rather than initiating these other more effective and less costly approaches to reduce consumption.”
However, other experts welcomed the guidance.
Andrew Langford, chief executive of the British Liver Trust, said: “The range of people who put themselves at risk through their drinking is quite wide. Some have not yet experienced social problems and are functioning well until they develop an alcohol-related physical illness such as high blood pressure, cancer or liver disease; while others lose their social supports and then tend to fit the stereotype of the 'alcoholic'.
"Reducing alcohol consumption can prevent these social and physical damages developing.”
Professor Jonathan Chick, a consultant psychiatrist and honorary professor at Queen Margaret University Hospital Edinburgh said: "The decision by NICE to recommend nalmefene for appropriate patients is important.
"Although for many people dependent on alcohol, abstinence is the preferred and optimal goal, nalmefene represents an alternative step, helping people to cut down drinking to less harmful levels when they are not ready and have no medical need to give up alcohol altogether. This may help us to engage many alcohol dependent patients that we know are not currently receiving help.”
Professor Carole Longson, director of the Nice Health Technology Evaluation Centre, said: “Alcohol dependence is a serious issue for many people.
"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.”
Jackie Ballard, chief executive of Alcohol Concern, said: “It is important that there is a variety of treatments available to support people who want help with their alcohol dependency.
"The introduction of nalmefene will be a useful addition to the clinician’s toolbox, when used in conjunction with other treatment methods to tackle the harmful consequences of alcohol misuse.”
In order to qualify for treatment with nalmefene, also known as Selincro, a drinker would need to be consuming 7.5 UK units per day, which is three pints of 4.4 per cent beer for men and five UK units per day, around half an average 750ml bottle of 12.5 per cent wine, for women. If they cannot reduce this level two weeks after being warned by a doctor or nurse to cut down, then the drug should be prescribed alongside regular advice from a doctor or nurse.
More severe alcoholics and those who can cut down on their own will not be eligible for treatment with nalmefene.
The drug works on the reward part of the brain to reduce the urge to have more than one drink.
It is the only licensed medicine to help people reduce their drinking rather than helping them to stop drinking altogether and does not make drinkers feel sick.
People can be diagnosed with alcohol dependence if they have any three out of these six symptoms together at some time in the last twelve months:
- A strong desire or compulsion to take alcohol
- Difficulties in controlling the use of alcohol
- Neglect of alternative interests due to alcohol use
- Persisting with alcohol use despite evidence of harmful consequences
- Tolerance to the effects of alcohol
- Withdrawal symptoms
In clinical trials the drug helped people to cut their alcohol consumption by about 60 per cent from 13.5 units a day to five units.
However this was only 1.8 units more than those receiving just counselling.