U.S.A : Initiating Alcohol Use Disorder therapy with XR-naltrexone and case management in an ED setting is achievable, according to a study published in Annals of Emergency Medicine.
At any given moment, 7 to 8% of the population, or roughly 15 to 20 million persons, are affected by alcohol use disorders, including alcohol abuse and dependence. According to the World Health Organization, the third most common source of disease burden in developing nations worldwide is alcohol dependence. Agents such as naltrexone inhibit opioid receptors, especially the μ-opioid receptor. Naltrexone has also been proven to reduce alcohol usage in clinical laboratory settings.

The main objective of the study was to evaluate the viability of starting treatment for alcohol use disorder in the emergency department (ED) with extended-release naltrexone (XR-Naltrexone) and case management services, as well as to calculate the intervention's effects on daily alcohol consumption (DAC) and quality of life (QOL).
For this purpose, a 12-week prospective open-label single-arm research was started at a single metropolitan academic ED using a multimodal approach to treating alcohol dependence that included monthly XR-naltrexone injections and case management services. Participants were adult ED patients who were actively drinking and had a AUDIT-C score of greater than 4. 179 patients were approached and 32 enrolled (18%). The percentages of participants who enrolled/approached, completed/enrolled, and continued naltrexone beyond the trial/were enrolled were the major feasibility outcomes. The 14-day timeline follow back was used to quantify the change in DAC (drinks/day, 14g ethanol/drink), and the single-item Kemp QOL scale was used to measure the change in QOL.
Key findings of the trial:
25/32 (78%) of the participants finished the study; 22/32 (69%) remained taking naltrexone.
On a scale of 1 to 7, the baseline DAC was 7.6 drinks per day (IQR 4.5 to 13.4), while the mean QOL was 3.6 (SD 1.7).
After 12 weeks of therapy, the median daily alcohol consumption (DAC) change was -7.5 (Hodges-Lehman 95% CI -8.6, -5.9).
The average change in QOL was 1.2 points (95% CI: 0.5 to 1.9; P < 0.01).
The authors concluded that this treatment has been shown to significantly reduce drinking and enhance quality of life over the short term and to further validate these findings, multi-center RCTs are required.
REFERENCE
C. Murphy ,R. Wang, J.C. Montoy,Z. Coralic, B. Ramirez,M. Raven; 6 Extended-release Naltrexone and Case Management for Treatment of Alcohol Used Disorder in the Emergency Department; https://doi.org/10.1016/j.annemergmed.2022.08.028; VOLUME 80, ISSUE 4, SUPPLEMENT , S3, OCTOBER 01, 2022.