Should naltrexone be the first-line medicine to treat alcohol dependence in Aboriginal and Torres Strait Islander populations? An Australian perspective

Abstract

Background: There is a pressing need to improve alcohol treatment services for Aboriginal and Torre Strait Islander peoples with alcohol dependence. One component of treatment is the use of medicines including naltrexone and acamprosate. Access to these medicines among the general drinking population is poor and, anecdotally, even worse for Aboriginal and Torre Strait Islander peoples who drink.

Objective: This article aims to review the relative efficacy and safety of naltrexone. It will also discuss reasons why it may be a preferable first-line pharmacotherapy for Aboriginal and Torre Strait Islander peoples with alcohol dependence who are seeking to change their drinking.

Discussion: The major effect of naltrexone is reducing episodic heavy drinking, a pattern often seen in Aboriginal and Torre Strait Islander peoples with alcohol dependence. Possible genetic and epigenetic factors, and practical considerations including once-daily dosing also make naltrexone an appealing agent in this population.