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Alcohol and opioid dependence medications: Prescription trends, overall and by physician specialty

https://doi.org/10.1016/j.drugalcdep.2008.07.018Get rights and content

Abstract

Over the past decade, advances in addiction neurobiology have led to the approval of new medications to treat alcohol and opioid dependence. This study examined data from the IMS National Prescription Audit (NPA) Plus™ database of retail pharmacy transactions to evaluate trends in U.S. retail sales and prescriptions of FDA-approved medications to treat substance use disorders. Data reveal that prescriptions for alcoholism medications grew from 393,000 in 2003 ($30 million in sales) to an estimated 720,000 ($78 million in sales) in 2007. The growth was largely driven by the introduction of acamprosate in 2005, which soon became the market leader ($35 million in sales). Prescriptions for the two buprenorphine formulations increased from 48,000 prescriptions ($5 million in sales) in the year of their introduction (2003) to 1.9 million prescriptions ($327 million in sales) in 2007. While acamprosate and buprenorphine grew rapidly after market entry, overall substance abuse retail medication sales remain small relative to the size of the population that could benefit from treatment and relative to sales for other medications, such as antidepressants. The extent to which substance dependence medications will be adopted by physicians and patients, and marketed by industry, remains uncertain.

Introduction

Few medications exist to treat substance dependence. Until 1994, only disulfiram was approved by the Food and Drug Administration (FDA) to treat alcoholism. Pharmacotherapies for opioid dependence consisted solely of methadone maintenance and naltrexone treatment. Methadone is strictly regulated federally, and naltrexone has not been widely prescribed for this indication. Over the past decade, however, advances in addiction neurobiology have led to the approval of two new medications to treat alcohol dependence and one medication to treat opioid dependence (available through prescription by community physicians with appropriate federal approval). This study aimed to gain a broader understanding of the market diffusion of these medications in the United States. Although the results are not generalizable internationally, because the availability and use of medications to treat alcoholism and opioid dependence differs across countries, the findings may have implications for industry investment in substance abuse medications which may ultimately influence their availability in a variety of countries.

Trends in U.S. sales volume, number of prescriptions, and prices for retail medications that are FDA-approved for the treatment of alcohol dependence (i.e., disulfiram, naltrexone and acamprosate), and opioid dependence (i.e., buprenorphine) are presented. Because previous studies have shown that physician specialty is associated with early adoption of new alcoholism medications, market size potential, the receipt of ancillary psychotherapeutic services, and the level of adherence (Mark et al., 2003, Powers et al., 2002, Robinson et al., 2006), we also examined prescription volume by medical specialty of the provider.

Section snippets

Methods

This study is based on data from the IMS National Prescription Audit (NPA) Plus™ database of retail pharmacy transactions for the period of 2002 through August 2007. NPA Plus provides information on the volume of new and refilled prescriptions categorized by the specialty of the prescribing physician. The NPA Plus consists of transaction records from retail pharmacies, including those at chain, independent, food store and mass merchandiser pharmacy retail outlets. When weighted, these sources

All substance dependence medications

In 2007, the number of prescriptions for alcohol and opioid dependence medications totaled 2.6 million, more than a six-fold increase from 2002 (Table 1). In 2007, nearly three times as many prescriptions were filled for opioid medications as for alcoholism medications (1,911,000 vs. 720,000, respectively). From 2003 to 2007, total dollar sales volume for retail substance dependence medications grew at a 62.2% average annual growth rate (from $36 million to $406 million) (Table 1). Although

Discussion

The IMS data represent one of the most comprehensive sources available to track retail prescription medication sales at the national level. Nevertheless, the data have limitations. Because they are prescription-level data, the number of users for each medication and their adherence to the medication regimen are unknown. IMS data do not include information on the diagnosis for which the prescriptions were written, and it is possible that some of the prescriptions included in this analysis were

Conflicts of interest

Tami L. Mark is an employee of Thomson Healthcare and as an employee provides consulting services to pharmaceutical and biotechnology companies, some of which may manufacturer and/or sell the products described in the study. Henry R. Kranzler has served as a consultant for elbion Pharmaceuticals, Sanofi-Aventis Pharmaceuticals, Solvay Pharmaceuticals, Lundbeck Pharmaceuticals, Bristol-Myers Squibb Company, Alkermes, Inc., and Ortho-McNeil Pharmaceuticals. He has received research support from

Acknowledgments

We thank Elizabeth Stranges and Katheryn Ryan for assistance in analyzing the data and developing the tables.

Role of funding source: This study was funded through a contract from the Substance Abuse and Mental Health Services Administration (SAMHSA). The study is part of a larger study to estimate and describe trends in mental health and substance abuse spending by payer and provider. SAMHSA staff are co-authors on the paper. They approved the study concept, reviewed and commented on drafts of

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