Targeted naltrexone eases binge drinking among sexual/gender minority men

Targeted oral naltrexone results in a significant reduction in drinking outcomes among sexual and gender minority men (SGM) with mild to moderate alcohol use disorder (AUD) during treatment, reports a study. This beneficial effect persists up to 6 months post-treatment.

“Naltrexone may be an important pharmacotherapy to address binge drinking in populations with mild to moderate AUD,” the researchers said.

This double-blind, placebo-controlled trial included 120 SGM who binge drink and have mild to moderate AUD. They were randomly assigned 1:1 to receive targeted oral naltrexone 50 mg or placebo with weekly counselling for 12 weeks.

The researchers assessed binge-drinking intensity, defined as number of drinks in the past 30 days, any binge drinking in the past week, number of binge-drinking days in the past week, and number of drinking days in the past week. They also measured changes in alcohol use with two alcohol biomarkers: ethyl glucuronide in urine samples and phosphatidylethanol (PEth) in dried blood spot samples.

Of the participants, 93 percent finished the trial, with 85 percent completing the weekly follow-up visits. [Am J Psychiatry 2022; 179:915-926]

Intention-to-treat analyses revealed the association of naltrexone with a significant reduction in reported number of binge-drinking days (incidence rate ratio [IRR], 0.74, 95 percent confidence interval [CI], 0.56‒0.9; number needed to treat [NNT]=2), weeks with any binge drinking (IRR, 0.83, 95 percent CI, 0.72‒0.96; NNT=7.4), number of drinks per month (IRR, 0.69, 95 percent CI, 0.52‒0.91; NNT=5.7 for 10 drinks), and alcohol craving scores (coefficient, −9.25, 95 percent CI, −17.20 to −1.31).

As-treated analyses among SGM who took their medication at least 2.5 days per week on average also showed benefits with naltrexone in decreasing any binge drinking (IRR, 0.84, 95 percent CI, 0.71‒0.99), number of binge-drinking days (IRR, 0.67, 95 percent CI, 0.47‒0.95), and PEth concentrations (coefficient, ‒55.47, 95 percent CI, ‒110.75 to ‒0.20).

The beneficial effects of naltrexone in number of drinks per month (IRR, 0.69, 95 percent CI, 0.50‒0.97), number of binge-drinking days (IRR, 0.67, 95 percent CI, 0.47‒0.95), and any binge drinking in the past week (RR, 0.79, 95 percent CI, 0.63‒0.99) were sustained at 6 months post-treatment.

“In summary, we found that targeted use of oral naltrexone was efficacious in reducing alcohol use and craving among SGM who binge drink and have mild to moderate AUD, with sustained effects 6 months after treatment,” the researchers said. “Retention and treatment engagement were also high.”

These findings supported those of previous studies in adult populations with AUD, reporting a significant association between naltrexone treatment and reductions in heavy alcohol use and craving. [CNS Neurol Disord Drug Targets 2010;9:13-22; Addiction 2013;108:275-293]

“Taken together, these data support the use of targeted dosing of oral naltrexone to address binge drinking in SGM with mild to moderate AUD,” the researchers said. “Efforts to expand access to this treatment approach can enhance public health efforts to address binge drinking and associated harms.”