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Tourchian N, McCormack D, Leece P, Tadrous M, Gomes T. Patterns of publicly funded naltrexone use among patients diagnosed with alcohol use disorder in Ontario. Alcohol Alcohol 2024; 59:agad091. [PMID: 38300604 PMCID: PMC10833073 DOI: 10.1093/alcalc/agad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 02/02/2024] Open
Abstract
AIMS Naltrexone is recommended first-line to manage alcohol use disorder (AUD). With previous studies indicating poor retention on naltrexone, we determined duration of naltrexone use and assessed the association between prescription setting and time to discontinuation in Ontario. METHODS We conducted a retrospective population-based cohort study among Ontario public drug beneficiaries diagnosed with AUD who initiated publicly funded naltrexone from June 2018 to September 2019. The primary outcome was time to naltrexone discontinuation, with a secondary analysis assessing receipt of at least one prescription refill. We used Cox proportional hazards models and logistic regression to test the association between prescription setting and each medication persistence outcome. RESULTS Among 2531 new naltrexone patients with AUD, the median duration of naltrexone use was 31 days and 394 (15.6%) continued naltrexone for 6 months or longer. There was no association between setting of initiation and duration of naltrexone use; however, those initiating naltrexone following an acute inpatient hospital stay were more likely to fill a second prescription (aOR 1.43, 95% CI 0.96-2.14), while those initiating after an ED visit were less likely to be dispensed a second prescription (aOR = 0.69, 95% CI 0.52-0.90) compared to those starting in a physician's office. CONCLUSION Persistence on naltrexone to treat an AUD is low, regardless of the setting of initiation. Further research is needed to elucidate the barriers encountered by patients with AUD that lead to poor treatment persistence in order to develop interventions that facilitate patient-centered access to evidence-based treatment for AUD in the province.
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Affiliation(s)
- Nima Tourchian
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | | | - Pamela Leece
- Public Health Ontario, 480 University Ave. #300, Toronto, Ontario, M5G 1V2, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave.,Toronto, Ontario, M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M7, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
- ICES, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
- Women’s College Hospital, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
- ICES, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
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López-Olmedo N, Muciño-Sandoval K, Canto-Osorio F, Vargas-Flores A, Quiroz-Reyes A, Sabines A, Malo-Serrano M, Bautista-Arredondo S, Colchero MA, Barrientos-Gutiérrez T. Warning labels on alcoholic beverage containers: a pilot randomized experiment among young adults in Mexico. BMC Public Health 2023; 23:1156. [PMID: 37322503 PMCID: PMC10268389 DOI: 10.1186/s12889-023-16069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Little is known about the potential impacts of visible and up-to-date health warning labels on alcoholic beverage containers on a range of outcomes in low- and middle-income countries. We conducted an experimental study to test the potential impacts of visible health warning labels (on the principal panel of the package) on thinking about health risks, product attractiveness, visual avoidance, and intention to change alcohol use among students in Mexico aged 18-30 years. METHODS A double-blind, parallel-group, online randomized trial was conducted from November 2021 to January 2022 in 11 states in Mexico. In the control group, participants were presented with the image of a conventional beer can with a fictional design and brand. In the intervention groups, the participants observed pictograms with a red font and white backgrounds (health warning label in red-HWL red) or with a black font and yellow backgrounds (health warning label in yellow-HWL yellow), located at the top, covering around one-third of the beer can. We used Poisson regression models -unadjusted and adjusted for covariates- to assess differences in the outcomes across study groups. RESULTS Using intention-to-treat analysis (n = 610), we found more participants in groups HWL red and HWL yellow thought about the health risks from drinking beer compared to the control group [Prevalence Ratio (PR) = 1.43, CI95%:1.05,1.93 for HWL red; PR = 1.25, CI95%: 0.91, 1.71 for HWL yellow]. A lower percentage of young adults in the interventions vs control group considered the product attractive (PR 0.74, 95%CI 0.51, 1.06 for HWL red; PR 0.56, 95%CI 0.38, 0.83 for HWL yellow). Although not statistically significant, a lower percentage of participants in the intervention groups considered buying or consuming the product than the control group. Results were similar when models were adjusted for covariates. CONCLUSIONS Visible health warning labels could lead individuals to think about the health risks of alcohol, reducing the attractiveness of the product and decreasing the intention to purchase and consume alcohol. Further studies will be required to determine which pictograms or images and legends are most contextually relevant for the country. TRIAL REGISTRATION The protocol of this study was retrospectively registered on 03/01/2023: ISRCTN10494244.
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Affiliation(s)
- Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Karla Muciño-Sandoval
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Adriana Vargas-Flores
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Alai Quiroz-Reyes
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Arturo Sabines
- Pan American Health Organization in Mexico, Mexico City, Mexico
| | | | - Sergio Bautista-Arredondo
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - MArantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Barbosa JDSP, Pereira LC, Salgado FXC, da Silva RM, Karnikowski MGDO. An Assessment of Mortality among Elderly Brazilians from Alcohol Abuse Diseases: A Longitudinal Study from 1996 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13467. [PMID: 36294044 PMCID: PMC9603807 DOI: 10.3390/ijerph192013467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Alcohol use disorder (AUD) is a worldwide public health problem, being an important aggravating factor of comorbidities found in the elderly, with the potential to increase mortality indicators for this age group. OBJECTIVE To analyze alcohol-induced deaths in elderly people with alcohol-related disorder in Brazil between 1996 and 2019. METHODS An ecological study was conducted with secondary data obtained from the Brazilian Unified Health System (SIM) Mortality Information System from 1996 to 2019. TabNet/DATASUS, Excel® 2016 and SPSS 21® were used to prepare the results. RESULTS Between 1996 and 2019, 85,928 alcohol-induced deaths were recorded among the elderly (>60 years); in 1996, the lowest number of deaths was recorded (n = 1396), and in 2018, there were the highest number of deaths (n = 5667). In the profile of the elderly, there was a predominance of men (88%). Mortality from AUD was due to alcoholic liver disease (62.2%), followed by mental disorders due to alcohol use (37.3%). CONCLUSIONS Coping with AUD is a public health problem that aims to reduce the number of deaths from diseases, conditions and injuries in which alcohol consumption is the causative agent, in addition to preventing deaths to which alcohol contributes.
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Affiliation(s)
- João de Sousa Pinheiro Barbosa
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia, University of Brasilia, Metropolitan Center, Brasilia 72220-275, Brazil
- Faculty of Education and Health Sciences—FACES—Medicine Course, University Center of Brasília—UniCEUB, 707/907, Asa Norte, Brasilia 70790-075, Brazil
| | - Leonardo Costa Pereira
- Faculty of Health, Euroamerican University Center—UniEURO, Avenida das Nações, Trecho 0, Conjunto 05, Asa Sul, Brasilia 70200-001, Brazil
| | - Fabiana Xavier Cartaxo Salgado
- Faculty of Education and Health Sciences—FACES—Medicine Course, University Center of Brasília—UniCEUB, 707/907, Asa Norte, Brasilia 70790-075, Brazil
| | - Rodrigo Marques da Silva
- Faculty of Education and Health Sciences—FACES—Medicine Course, University Center of Brasília—UniCEUB, 707/907, Asa Norte, Brasilia 70790-075, Brazil
| | - Margô Gomes de Oliveira Karnikowski
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia, University of Brasilia, Metropolitan Center, Brasilia 72220-275, Brazil
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De Boni RB, Mota JC, Coutinho C, Bastos FI. Would the Brazilian population support the alcohol policies recommended by the World Health Organization? Rev Saude Publica 2022; 56:66. [PMID: 35792799 PMCID: PMC9239545 DOI: 10.11606/s1518-8787.2022056004093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS Data from 16,273 Brazilians, aged 12-65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0-1.3), not having a religion (AOR = 1.4; 95%CI: 1.1-1.8), being catholic (AOR = 1.3; 95%CI: 1.1-1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1-2.4). CONCLUSIONS The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.
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Affiliation(s)
- Raquel B De Boni
- Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil
| | - Jurema C Mota
- Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil
| | - Carolina Coutinho
- Fundação Getúlio Vargas. Escola de Administração de Empresas. São Paulo, SP, Brasil
| | - Francisco I Bastos
- Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil
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Konrad G, Leong C, Bolton JM, Prior HJ, Paillé MT, Nepon J, Singal D, Ekuma O, Enns JE, Nickel NC. Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study. PLoS One 2021; 16:e0257025. [PMID: 34478448 PMCID: PMC8415582 DOI: 10.1371/journal.pone.0257025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. METHODS Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication. RESULTS Only 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83-2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98-2.90) in the five years before being diagnosed with alcohol use disorder. CONCLUSION Despite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.
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Affiliation(s)
- Geoffrey Konrad
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M. Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael T. Paillé
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josh Nepon
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept. of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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