Nalmefene (Selincro) availability in England and Wales

You area has categorised it as Amber.

Their official policy statement says that:

Nalmefene is recommended for prescribing by GP's in primary care when recommended by local DAAT according to NICE TA and License criteria.

Since I can't post links here, I will send you a PM with the relevant document link that you might wish to show to your doctor.

In February 2015, Surrey's Area Prescribing Committee advised doctors that they should NOT be prescribing nalmefene until they receiving specific prescribing instructions (called a Pathway) from them.

''The Surrey Heads of Medicines Management met with Public Health colleagues from Surrey County Council on the 2nd of February 2015 to discuss the current alcohol services commissioned by Public Heath in Surrey and to work on the development of a pathway to include the provision of nalmefene as a treatment option (NICE TA235, Nov 2014, Nalmefene for reducing alcohol consumption in people with alcohol dependence). It was noted that nalmefene is considered as a treatment option only in conjunction with continous psychosocial support and in people who remain at a high drinking risk after two weeks of initial intervention. Until this work is completed, with the agreement of a pathway for the safe and effective use of nalmefene within its licensed indication in conjunction with psychosocial support, GPs are advised not to prescribe nalmefene.''

So, GP's must refer you to an alcohol specialist so that they can prescribe and provide the addition support - at least until your health authority have established a specific instruction (which they haven't done yet!).

However, this is only a guideline - it has not yet been given a traffic light category at all in your area.

I will PM you with the link to this so that you can print this out and give it to your doctor during your discussion with him/her.

I will also include a link to nalmefene-specific alcohol counselling that C3 Europe can provide to you free of charge.  As a qualified alcohol counsellor, I have the ability to provide you with the support and guidance that your local alcohol services would provide if your doctor referred you to them. We also meet the standards for nalmefene support, as specified by the manufacturers of the medication, Lundbeck. This would also save your Local Health Authority money as they wouldn't need to provide the counselling, so they will probably like that a lot!

Because the issue in Surrey specifically seems to be around the providing of the support, if your doctor feels that nalmefene is medically suitable for you, then he/she may prescribe for you based on the fact that you have arranged your own counselling support.  It is no different to you arranging your own private alcohol counselling to help you with your problem, except it is free of course.

Hope this helps and please don't hesitate to contact me if you require any other information.

Joanna.

 

Hi Denise,

In the Northants area, your local NHS has opted to have nalmefene prescribed by the specialist physician at your local drug and alcohol recovery service.

Here is what they say:

Nalmefene for reducing alcohol consumption in people with alcohol dependence. NICE has published TA325 “Nalmefene for reducing alcohol consumption in people with alcohol dependence”. It advises that Nalmefene (Selincro) is recommended as a possible treatment for people with alcohol dependence who:

•are still drinking more than 7.5 units per day (for men) and more than 5 units per day (for women) 2 weeks after

an initial assessment and

•do not have physical withdrawal symptoms and

•do not need to either stop drinking straight away or stop drinking completely.

Nalmefene should only be taken if the person is also having ongoing support to change their behaviour and to continue to take their treatment, to help them reduce their alcohol intake.

In Northamptonshire Nalmefene will be available via the specialist drug and alcohol service; GPs are not

recommended to prescribe it and it will therefore be categorised as “red” by NPAG in December.'

Since I do not know the town you are in, I cannot tell you where you nearest alcohol recovery centre is.  If you are unsure, then you can ask your GP surgery to look up who the doctor would refer someone, too.  Once you know that, then you can often ring and self-refer yourself to them.

With regards to talking therapy, if you get a prescription on the NHS, then additional support is a pre-requisite of the prescription.  However, the additional support is really focused on adherence to the prescribing instructions, goal setting and monitoring progress etc - a little like the kind of support that someone would receive if they were receiving nicotine replacement medicines on the NHS that come with a similar pre-requisite.

In Chesire, nalmefene is available but your local guidelines advise that it should only be prescribed in specialist care, by doctors that specialise in alcohol misuse.  Unless your GP has an interest in treating alcohol dependency issues, you can expect him/her to follow the guidelines and refer you onto the relevant specialist doctor.

I've attached a photo and suggest that you look at the two guidelines provided, depending on whether you live in Chesire East or Cheshire West.  If you are not sure, then may need to ring your local GP surgery to ask them which it would be.

Whichever it is, it tells you exactly who the organisation is that has been appointed to assess and prescribe for nalmefene.

Thank you.  Very helpful.