A groundbreaking study led by University of Western Australia PhD candidate Ebony Quintrell has provided the first comprehensive national analysis of alcohol pharmacotherapy dispensing patterns in Australia over nearly two decades. Published in Alcohol and Alcoholism, the research draws on Pharmaceutical Benefits Scheme (PBS) data to reveal significant shifts in the use of key medications for alcohol use disorder (AUD), highlighting both progress and persistent challenges in treatment access.

Alcohol use disorder, defined as a chronic condition characterized by an inability to control alcohol consumption despite adverse consequences, affects millions in Australia. According to the National Drug Strategy Household Survey 2022–2023, approximately 6.6 million Australians consume alcohol at risky levels, contributing to substantial health, social, and economic burdens estimated at over $66 billion annually. Yet, pharmacological interventions like naltrexone and acamprosate—opioid antagonist and glutamate modulator respectively—remain dramatically underutilized, with the study estimating only 2.9% of those with AUD receiving PBS-subsidized treatment.

UWA's Trailblazing PhD Research Illuminates National Gaps

Quintrell's work, supervised by experts including Professor Amy Page and Dr. Erin Kelty at UWA's School of Population and Global Health, analyzed a 10% representative PBS sample from January 2006 to December 2023. This retrospective cohort study identified 22,745 individuals receiving 117,548 prescriptions, marking the inaugural long-term examination of these trends. As a PhD candidate, Quintrell's contribution underscores UWA's leadership in addiction medicine research, building on the university's Wal-Yan Respiratory Research Centre and collaborations with institutions like Curtin University.

"We have some good medications to treat alcohol use disorders in Australia, but they are not being utilised," Quintrell stated. "This means that many people with alcohol use disorders are left untreated, leading to prolonged challenges." Her findings emphasize the need for greater awareness and integration of these therapies via general practitioners.

Methodology: Harnessing PBS Data for Unprecedented Insights

The study employed robust epidemiological methods, defining prevalence cohorts (all adults ≥18 with ≥1 dispensing) and incident cohorts (first dispensing 2013–2023, excluding insufficient supply). Joinpoint regression modeled annual percent changes (APC), stratified by sex, age, and remoteness. Treatment episodes were calculated from supply days, with adherence benchmarked against guidelines recommending 3–6 months minimum. Concurrent use and switching (gap > refill interval, switch within 105 days) were also assessed. This PBS-derived approach offers population-level granularity absent in prior fragmented studies.

Dramatic Rise in Naltrexone, Stagnation for Acamprosate

Overall dispensing prevalence surged 1.7-fold to 1801 per 100,000 adults by 2023 (AAPC 3.1%). Naltrexone drove this, more than doubling (2.6-fold, AAPC 5.9%), plateauing 2008–2014 before accelerating post-2015. Acamprosate remained stable (AAPC 0.8%), declining in younger groups (51% drop ages 18–24). Incident rates echoed this: naltrexone doubled (APC 8.4%), acamprosate unchanged. Disulfiram, while guideline-recommended, lacks PBS subsidy for AUD, limiting its inclusion.Read the full study here.

Demographics and Regional Variations

Recipients were predominantly male (60%) and aged 35–54 (56%), aligning with AUD epidemiology. Urban areas dominated, with major cities 70% higher than remote regions. Incidence trends showed gains across ages for naltrexone, but persistent remoteness gaps highlight access barriers in rural Australia, where UWA's Western Australian focus reveals state-specific underuse.

Low Adherence and Switching Patterns

Despite gains, adherence faltered: only 5.1% sustained ≥3 months, below guidelines. Naltrexone outperformed acamprosate (median longer by 15%, OR 1.89 for persistence). Switches favored acamprosate-to-naltrexone (OR 1.77), concurrent use (11.7%) extended episodes but not adherence. These patterns suggest physician preferences and patient tolerability influence choices.

Barriers to Uptake: Stigma, Awareness, and Access

Underutilization stems from stigma, limited GP training, and unawareness—many AUD patients unaware meds exist via PBS. Guidelines endorse naltrexone/acamprosate post-detox, yet only ~15–25% previously met 3-month benchmarks. UWA experts advocate education campaigns and streamlined authority approvals. Internationally, similar gaps persist, but Australia's PBS model offers scalability.AIHW alcohol data contextualizes the scale.

Implications for Australian Higher Education and Research

Quintrell's PhD exemplifies UWA's role in translational public health, fostering interdisciplinary skills in epidemiology and pharmacoepidemiology. Amid rising AUD burdens—146,000 hospitalizations 2023–24—this informs training for future clinicians. Universities like UWA drive policy via evidence, supporting NHMRC-funded initiatives.

Stakeholder Perspectives and Real-World Impact

Co-author Professor Page notes, "Naltrexone's rise reflects evidence of efficacy, but low persistence demands behavioral supports." Cases illustrate: a 45-year-old male switching post-relapse, sustaining 6 months on naltrexone. Broader views from NDARC (UNSW) echo underuse, urging integrated care.

Future Outlook: Policy Reforms and University-Led Solutions

Enhancing PBS access, digital monitoring, and uni-led trials could boost adherence. UWA's pipeline promises ongoing innovation, positioning Australian higher ed as AUD leaders. Actionable insights: GPs initiate via brief interventions; unis expand pharmacotherapy modules.UWA study news.

Photo by bruce ma on Unsplash

Bolstering Australia's Response Through Academic Excellence

Quintrell's analysis catalyzes dialogue on scaling pharmacotherapies, reducing AUD's toll. UWA's commitment inspires peers, advancing evidence-based higher ed contributions to national health.