Making Naltrexone Accessible: A Public Health Approach to Alcohol Use Disorder

There is a trademarked phrase: Things We Do for No Reason, copyrighted by a medical publisher to highlight certain practices medical professionals ought to follow but often do not. The article I read, Things We Do for No Reason: Avoiding Naltrexone for Alcohol Use Disorder in Liver Disease, provides a good segue to my post on why access to naltrexone should be as accessible as naloxone.

According to the most recent figures, about 28 million people above the age of 12 have an alcohol use disorder (AUD) (NIAAA, 2024). Out of this number, less than 3% receive medication-assisted treatment with any FDA-approved medication (NIAAA, 2024). Small wonder deaths from excessive alcohol consumption exceeded 178,000 in the U.S. in 2024 and over 3 million worldwide. Binge drinking remains the most common form of excessive drinking.

These figures are staggering, but what is even more staggering is society’s indifference to the problem. The gold standard for the treatment and prevention of AUD is naltrexone (SAMHSA, 2026), yet hardly anyone has heard about it, especially within the medical profession. Physicians receive limited training in treating alcoholism, and few patients receive treatment in a medical setting.

Can things change if alcoholism is treated as a public health issue? The success in reducing smoking rates was primarily through public health initiatives. Nicotine gum and patches were made available over the counter, along with measures like increased taxes on cigarettes and smoking restrictions. Similarly, increasing access to naloxone—first through statewide prescriptions and later as an over-the-counter medication—may have contributed to a decrease in opioid overdose deaths. Increasing access to naloxone also debunked concerns that it might inadvertently exacerbate the opioid crisis.

I advocate for initiating a grassroots movement to educate people about options to mitigate excessive drinking. The first step is increasing access to naltrexone tablets. This can be done by having individual states issue statewide prescriptions, allowing patients to obtain a bridge supply of naltrexone before seeing a provider. A robust educational program must be launched to inform all stakeholders about naltrexone. Many AA groups will likely welcome members taking naltrexone. Once members, especially sponsors, learn about this safe, effective, non-addictive, and non-abusable medication, they can become strong supporters (Menzies, ARCA).

The alcohol problem is so huge and growing that we need to address it head-on. Naltrexone may well be an important part of the solution.

If you would like to connect with Percy Menzies, M. Pharm., regarding this article, you can reach him through his LinkedIn profile.”