Nalmefene for the treatment of alcohol dependence: a mixed-methods study of primary care prescribing patterns, pharmaceutical marketing and other influences

Abstract

Background: Nalmefene is the first pharmacotherapy to be licensed for the reduction of alcohol consumption in patients with alcohol dependence. Marketed mainly for prescribing in primary care, the evidence supporting its efficacy and use in this setting remains contested. This thesis aims to describe and understand patterns of, and influences on, nalmefene prescribing in UK primary care. Methods: A mixed-methods study including (1) a quantitative analysis of prescribing data; (2) a qualitative documentary analysis of nalmefene marketing; and (3) semi-structured interviews (n=19) with alcohol treatment and policy professionals. Findings: (1) Nalmefene prescribing in UK primary care was low, apart from a temporary increase after nalmefene was recommended by the National Institute for Health and Care Excellence (NICE) in 2014, and prescribing was poorly aligned with licensing conditions; (2) An extensive range of marketing activities for nalmefene was undertaken by the pharmaceutical company, Lundbeck, creating opportunities to influence nalmefene uptake in UK alcohol treatment; (3) Whilst marketing activities may have garnered some support for nalmefene, there remained substantial barriers to its use, including poor compatibility with current models of alcohol treatment, and a lack of skills, resources and confidence in primary care to treat alcohol dependence. Conclusion: Despite limitations in existing evidence, nalmefene marketing activities helped generate support for its use in alcohol treatment in the UK. Despite this, several barriers to its use meant that uptake in UK primary care remained low. Alcohol treatment policy should be underpinned by robust evidence and free from commercial influence. The introduction of nalmefene into UK prescribing had neither of these features. Among the implications for future research and policy is a need to support publically-funded research and to engage primary care professionals in developing effective interventions and supporting them to deliver these.