Nalmefene - has it ben superceeded by another drug????

thank you for the quick reply.   We come under West Sussex.  I do think the doctors have "given up" on him and we end up with the yoyo effect of hospital, home, fall, hospital.  On the info I've found re Nalmefene it does say that it's not suitable for people who have withdrawal effects and he is getting DT's although we are trying to get him to not drink at home, only when he goes to the pub.  It's just very frustrating!!!!  Any help you can suggest would be wonderful.

I will look things up for you and come back to you very shortly.  I do know that nalmefene IS available in the Mid-Sussex area for sure because I looked it up for someone else last week.  So, now I will look up West Sussex for you.

However, I can tell you that it is highly unlikely that he would meet the criteria at this stage.  The criteria for a man is approx 9 units of alcohol a day, and not at risk of withdrawal symptoms.

However, he would be eligible if he could get his drinking down to that point.   There is NO excuse for them saying they don't prescribe it, period.

Will PM you very shortly with the info.  Is there any chance of private care to get detoxed and then assessed for this privately rather than on the NHS?

I have Private Messaged you the NHS Trust link for West Sussex that clearly shows that (as long as the criteria is met and it is medically suitable for the patient) the West Sussex area ARE authorised to prescribe nalmefene.

It is categorised a RED medication, meaning that GPs are advised to refer potential patients to the local alcohol specialist recovery centres for them to assess, prescribe and monitor, if suitable.

It is incorrect for them to be telling you that the NHS Trust do not prescribe it.

Also, please note I made an error in my repy to you.  The criteria for nalmefene for males is 7.5 units of alcohol a day, not the 9 that I originally quoted you.  Sorry about that!

thank you so much your information has been very helpful indeed.  He did try a brief period of detox but self discharged due to them being "religous" based and he won't attend AA for the same reason.  He also says that he finds it very upsetting listening to other people's stories (which makes him want to have a drink!) and would prefer going to a group where people have given up and have lots of benefits to tell!!!  Not too sure how many units he's one at the moment but will check.  

He recently had an extended period in hospital and it would have been an ideal time for them to prescribe Naltrexone, but they didn't!!!

Unfortunately, most GPs aren't interested in people with a drink problem. Most hospitals aren't interested in people with a drink problem unless they arrive via an ambulance and need to be hospitalised. Most of the alcohol recovery centres are fairly useless, run by staff who are really not qualified to offer any advice or counsel people. And as you say, AA is fairly religous based.

Believe me, I've been through all the above scenarios, except the AA, because I also don't do god.

I've read some of the NICE Guidance and there is a lot of information regarding costings i.e. how much it costs to keep hospitalising people with alcohol issues.   Have you managed to find any help at all ?

Oh yes, but not before I'd been through the whole process, including a long hospital stay.

I wouldn't say I found help, more I did my research and then bullied people into helping. I wouldn't want to even start to think what my almost two months hospital stay cost (had to be transferred to a second hospital for specialist care), along with all the ourpatient visit costs of two different hospitals (different conditions) over the last two years.

And still my GP is quite indifferent to it. It seems the NHS is happy to treat the symptoms by hospitalising people which is expensive, but will not put money in at the cheaper early stage of causal problems. They always say, prevention is better than cure, but they are not practising that themselves.

so sorry to hear you had all that trouble!!!! At least you hung on in there and had the ability to cope with it all but the fact you had to bully them into helping you is horrendous, most people would not be able to deal with that so good on you!!!  Surely there must be some sort of drug that can be given to people who need to cut down on their drinking (they must do this for people in hospital??) so that they are then in a position to take the Nalmefene and have the councelling, otherwise there doesn't seem to be a way out of it. 

I would imagine those that end up in the hospital are simply detoxed. Aside from those areas that adhere to NICE guidelines, the only options I've heard of are private treatment or taking matters into one's own hands by ordering from overseas. Naltrexone is used in other EU countries and is available OTC in France, from what I hear. Perhaps a prescription from a French physician could also be filled in the UK? I don't know. I understand France has adopted Baclofen as a drug to reduce/eliminate drinking as well, so they seem more open to the idea of Medication Assisted Treatment for Alcohol Use Disorder. Unfortunately, AA doctrine is most pervasive, despite it's miserable success rate.  

As far as drugs for treating for alcohol dependency, there are a few ways. One of the immediate ways is to detox the person, so that they can come of alcohol without the cold turkey symptoms. This is usually done with a benzo and here is where the whole system is crazy.

I went into hospital and they pumped me full of Librium (benzo) without even telling me. About a year later, after being alcohol free, I had a wobble. I went to see my GP and asked for diazepam (benzo, Valium) so I could detox. She wasn't really happy about giving it to me, even though she knew all my history and the stint in hospital.

I ended up saying to her fine, what do you expect me to do, because if you don't give me any, I shall go down the pub at lunch time, because my body needs alcohol or diazepam to function and it will be one or the other. So, the next day, after the doctors had their Friday morning GP surgery meeting, they decided to give me a prescription, rather than me continue to poison myself (their words).

The supidity of it is, one week's prescription is all you need, of valium. And the lunacy is that you can die from alcohol cold turkey, but you can't die from heroin cold turkey. Heorin users get better treatment than alcohol dependent people. But you can see where I was coming from in my earlier message, that you have to basically say, if you don't help, I will carry on drinking and be back in hospital, is that what you want, because that is what will happen, before something actually clicks and common sense starts to takeover.

The trouble is, if someone is a long term alcohol user, it isn't just the physical side you need to deal with, it is the psychological side that also needs to be dealt with, otherwise, you will be back to square one.

There is medication like nalmefene/naltrexone that helps to quench the want of alcohol, by taking away some of the high you get from it and therby reducing the psychological want. There is also Campral, which resets the neural pathways and stops the patient thinking about alcohol, it is hard to describe it, but when you come off alcohol, your whole being is usually fidgetting to have a drink. Campral calms this constant urge and allows you to get on with life, without constantly thinking about having a drink.

The medication is out there, it has been approved by NICE/NHS and it works. Sadly the medical services still see alcohol dependency as lacking in moral fibre and not a medical issue, until you arrive in the back of an ambulance. And what's even worse, is that the alcohol recovery centres that you are directed to, have staff that are untrained and incompetent and I am being kind with that summary of their abilities.

Blimey - that is telling it like it is.  Scary.

G.

so would you say it's better to try to deal (or bully!) with the GP rather than the alcohol recovery people?   I understand what you're saying about their apparent lack of training/empathy etc!!

I would suggest you would be best to insist/demand an appointment with the prescribing physician at the alcohol recovery centre.  Before that appointment, do your research on what you both believe would be the most desirable option for him but have an open, calm and informed discussion with the prescribing physician.

At a lot of the alcohol recovery centres, the difficulty and lack of training etc is at the key worker level, and the prescribing physician is often very good.

At the point this is at, it is currently beyond the experience of what your GP has.  From his/her point of view, this is a case for an alcohol specialist/consultant in the same way that someone who was suspected of having cancer would be referred to a cancer specialist.

So, get through to the physician at the alcohol centre, who is authorised by you local health authority to prescribe medication that can help.

I should first calirfy my use of the word bully. I mean by that that you have to be very assertive and refuse to accept the word no, even to the extent of perhaps, sometimes, making yourself unpopular.

Back to your question, you probably won't have a choice in the matter. Most doctors would direct you to one of these alcohol recovery charities, which aren't really charities, they are government funded. Alcohol issues come under mental health, and part of the budget is dirverted to these ARCs. Because GPs are not funded for it, they don't see it as part of their remit to help.

So people get bounced from their GP to these ARCs. I read Joanna's reply to you and I normally agree with everything she writes, but in this case, it is my personal experience, that you will not get to see the prescribing doctor immediately and I have been to two of them. Generally you will see a key worker, who takes details and your case history.

Then a second meeting will happen, for a small ARC this will be the same person but in a larger ARC the first person just does the legwork and hands it over to someone else. At that stage they may make an appointment to see the nurse for a health check and after that, with the LFT results back you may get to see the doctor.

They prefer counselling rather than medication, which I think is mainly down to the fact they are not trained about them and have no knowldge how they work. You may then get your medication, but as Joanna has said, you need to do all your research first, so you know exactly what you want, so that you have that informed discussion. Again as Joanna has said, the doctor you get to see is usually quite good.

Unfortunately you are then handed back to the key worker, who is usually untrained. My last one knew nothing about the medication I was taking or how it worked, I had to explain it all to her. There prime interest seemed to be in class A (usually heroin) taking and the daily dishing out of methadone, plus the weekly Friday visits to the courts for probation. There seems to be funding for the class A stuff, because it is usually funded by street crime, so there is an incentive to try and keep a lid on it.

So, in summary, probably no help from your GP and if you want medication you will have to go to an ARC, but you need to do your work beforehand and know exactly what you want.

Just so it doesn't sound like I'm contradicting myself, I believe I only got the diazepam from my GP, because it was my GP that had sent me to hospital and was aware of the situation and the way in which I answered the part refusal to help me. The diazepam was for the detox, for the next stage medication in dealling with alcohol going forward, I had to go to an ARC and the only reason I did, was to get my prescription, because it was costing me £120 a month to import it myself. Other than getting my prescription, it was a waste of six months of my time, visiting it each month.