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Abstract
Naltrexone was approved by the US Food and Drug Administration (FDA) in December 1994.
Although it is one of only two medications for alcohol rehabilitation approved in
the US, naltrexone is not frequently prescribed. This paper examines the factors limiting
physicians' use of naltrexone. Data were collected through a survey of US physician
members of two addiction medicine professional associations. Logistic regression analysis
was conducted with the dependent variable being any prescription of naltrexone. Independent
variables consisted of physician practice characteristics, physician ratings of naltrexone's
attributes (e.g. efficacy), physicians' patient characteristics, and physicians' exposure
to information about naltrexone. On average, addiction medicine physicians prescribed
naltrexone to 13% of their alcoholism patients. The two main self-reported reasons
why physicians did not prescribe the medication to more patients were that patients
refused to take the medication or comply with prescribing regimes (23%), and that
patients could not afford the medication (21%). Multivariate results indicated that
physician perceptions of naltrexone's effectiveness and safety were significantly
associated with prescribing. Physicians who had more exposure to information about
the product (e.g. by reading more journal articles about naltrexone) were more likely
to prescribe it. In summary, multiple factors are contributing to the relatively low
naltexone prescription rate.