Use of naltrexone for alcohol use disorders in the Veterans' Health Administration: a national study

This study aimed to determine the proportion of patients with alcohol use disorders who were prescribed naltrexone in Veterans Administration (VA) Healthcare system for fiscal year (FY) 2010 and socio-demographic and clinical factors associated with its use.

VA national administrative data were used to identify all veterans who had an alcohol use disorder diagnosis (ICD-9-CM codes 303.9x or305.0x) in fiscal year (FY 2010) and were not prescribed any opioids (n=224,319). Patients in this group who filled a naltrexone prescription during this period were identified. Bivariate analysis was used to evaluate differences between veterans who received naltrexone prescription and those who did not on baseline characteristics and diagnoses. Multivariate logistic regression analysis identified measures that were independently related to receipt of naltrexone.

6172 (2.75%) of the 224,319 patients with a diagnosis of alcohol use disorder who did not receive a prescription for opioid medications received naltrexone prescription. Bivariate analyses showed that patients taking naltrexone were 69 times more likely to have a co-morbid axis I diagnosis. Multivariate logistic regression analysis showed that a history of any substance abuse outpatient visit, any psychiatric outpatient visit or any mental health inpatient hospitalization, were significantly related to filling a prescription for naltrexone.

The rate of use of naltrexone by clinicians and patients remains low and having a co-morbid axis I diagnosis and receiving specialty mental health care were strong predictors of receiving a naltrexone prescription. Understanding the reasons for these findings may further naltrexone's clinical usefulness.