The National Institute for Clinical Excellence (NICE) in the UK has the final say on what drugs are given away for free via the National Health Service (NHS).

In June 2010 they published a draft 500-page report – that included references to 27 research experiments on naltrexone.

http://www.nice.org.uk/nicemedia/live/11875/49448/49448.pdf

However, it didn't mention the Sinclair Method - and the conclusions are not aligned with the thinking of this group.

I read the most of the report. Chapter 7 is the relevant one for us:

Pharmacological interventions for treatment and management of alcohol misuse - Page 338 to 413.

There are some great quotes:


Naltrexone saves healthcare system £83,432 per patient over a 20-year period.

Alcohol increases levels of endorphins or opiates in the brain, but there is increasing evidence that drugs that block the opioid neurotransmitters, such as naltrexone, can reduce the reinforcing or pleasurable properties of alcohol and so reduce relapse in alcohol dependent patient s (Anton, 2008).

The comparison of oral naltrexone versus placebo showed a small but significant effect favouring naltrexone on rates of relapse to heavy drinking

But worryingly this is the conclusion (page 375):

"When using naltrexone for relapse prevention, patients should be abstinent."

The report mistakenly recommends that naltrexone be prescribed on a daily basis. Here are the prescribing guidelines - page 396:

If using oral naltrexone, start treatment after assisted withdrawal and typically prescribe at a dose of 50 mg per day.

Provide the service user with an information card about oral naltrexone and its impact on opioid-based analgesics, as part of a comprehensive medical assessment before prescribing. Oral naltrexone should:
• Typically be prescribed for up to 12 months, or longer for those benefiting from the drug who want to continue with it
• Be stopped if drinking persists 4–6 weeks after starting the drug.

The report is an excellent source of information but concludes:

Some doctors can be reluctant to prescribe pharmacological interventions such as naltrexone, due to lack of knowledge or familiarity. Barriers to prescribing naltrexone have been described as including a ‘lack of awareness, a lack of evidence of efficacy in practice, side effects, time for patient management, a reluctance to take medications, medication addiction concerns, Alcoholics Anonymous (AA) philosophy, and price.

So due to a "due to lack of knowledge or familiarity" doctors are not prescribing Nal... and those that do prescribe it to ensure abstinence rather than control.

Yes, as the book points out, because naltrexone has a temporary anti-craving effect, the drug was originally patented with instructions that it should be used with abstinence. In fact, the insert with the medication still incorrectly directs that patients use it with abstinence. It was only by accident -- after the fact -- that TSM was discovered. People who continued to drink against instructions to do so, actually had their cravings reduced by extinction. Also, the patent for naltrexone expired -- originally to be used with abstinence -- and now no company can reap a big profit from its use. Without the profit motive, you have what we have: a world in the dark (except for the lucky few on this board).

Andy, I like your enthusiasm. You are delving into this deeply the way I did when I started this. If I was covered by NHS and didn't have to worry about being denied future coverage I might go to my doctor and tell them I have a drinking problem and that I have been abstinent for 4 weeks but I was having intense cravings and get a prescription for naltrexone. I would then take it Sinclair Method style and record my units carefully over the 3-12 months it might take if I was a responder. When I reached cured or regained control levels I would then go back to my addiction specialist and show them my results.

Now, it looks like oral nalmefene will get approval in Europe in the near future and this will be marketed to physicians as a opioid antagonist to be used as needed to control drinking (essentially the Sinclair Method, although don't expect to see his name mentioned in Lundbeck's materials). When this happens we may see a market driven increase in interest in opioid antagonists for alcoholism treatment. Somebody has to have a profit motive for this to catch on. I feel the best hope for widespread adoption of the Sinclair Method will come if Lundbeck can successfully market this to European physicians.

Thanks for that post Andy. You're contributing so much to this board.

Your post gives me an idea though I don't know how feasible it is. Insurance companies always want to save money right? So if we can get them to back TSM instead of sending people to rehab, then they'll save a ton of money. There's your profit motive.

I have no clue how medical insurance companies choose the procedures they'll support, but it's an idea to get TSM in the mainstream.

Great idea Tambo. It's like in the movies, "follow the money." If someone can make money off TSM, the word will definitely get out.