A study reports that targeted oral naltrexone results in a significant reduction in drinking outcomes in sexual and gender minority men (SGM) with mild to moderate alcohol use disorder (AUD) during treatment. This beneficial effect persists up to 6 months after treatment.
“Naltrexone may be an important pharmacotherapy for addressing binge drinking in the population with mild to moderate AUD,” said the researchers.
This double-blind, placebo-controlled trial included 120 SGMs with mild to moderate AUD who were binge eating. They randomly assigned him 1:1 to receive targeted oral naltrexone 50 mg or placebo for her weekly counseling for 12 weeks.
The researchers assessed binge drinking intensity, defined as the number of times they drank alcohol in the past 30 days, the number of binge drinks in the past week, the number of binge drinking days in the past week, and the number of binge drinking days in the past week. They also measured changes in alcohol use with two alcohol biomarkers: ethylglucuronide in urine samples and phosphatidylethanol (PEth) in dried blood spot samples.
Ninety-three percent of participants completed the trial and 85% completed weekly follow-up visits. [Am J Psychiatry 2022; 179:915-926]
An intention-to-treat analysis revealed an association between naltrexone and a significant reduction in reported binge drinking days (incidence ratio [IRR]0.74, 95% confidence interval [CI]0.56–0.9; number needed for treatment [NNT]=2), binge week (IRR, 0.83, 95% CI, 0.72–0.96; NNT=7.4), number of drinks per month (IRR, 0.69, 95% CI, 0.52–0.91; NNT=5.7 for 10) Alcohol craving score (coefficient, -9.25, 95% CI, -17.20 to -1.31).
A post-treatment analysis of SGM who took the drug on average at least 2.5 days per week also showed a benefit of naltrexone in reducing binge drinking (IRR, 0.84, 95% CI, 0.71–0.99), number of binge drinking days (IRR) . , 0.67, 95% CI, 0.47–0.95), and PEth concentration (factor, ‒55.47, 95% CI, ‒110.75 to ‒0.20).
Beneficial effects of naltrexone on number of alcohol drinks per month (IRR, 0.69, 95% CI, 0.50–0.97), days of heavy drinking (IRR, 0.67, 95% CI, 0.47–0.95), and voluntary binge drinking. The past week (RR, 0.79, 95% CI, 0.63–0.99) was maintained 6 months after treatment.
“In summary, targeted use of oral naltrexone was effective in reducing alcohol use and cravings in SGM who were heavy drinkers and had mild to moderate AUD, and was sustained for 6 months after treatment. “We found that it had a positive effect,” the researchers said. “Retention rates and engagement with treatment were also high.”
These findings support the results of previous studies in the adult population with AUD, reporting a significant association between naltrexone treatment and reduction in heavy alcohol use and cravings. [CNS Neurol Disord Drug Targets 2010;9:13-22;
Addiction 2013;108:275-293]
“Together, these data support the use of targeted administration of oral naltrexone to address SGM binge drinking with mild to moderate AUD,” said the researchers. “Efforts to expand access to this treatment approach can strengthen public health efforts to address binge drinking and the harm that comes with it.”