Dear Dr. Roach: My sister has a real problem with alcohol. I have tried to get her into a rehab program, but she is resistant. I have read that medications like Ozempic might have some benefit in getting people to stop drinking alcohol. Is there an answer?
W.A.
Alcohol use disorder is a huge problem worldwide, and basic and clinical scientists are constantly searching for new treatments. I found several trials showing initial promise with GLP-1 inhibitors helping to curb cravings, not only for alcohol but for nicotine and opioids as well. Most of these trials use the older drugs: liraglutide, dulaglutide and exenatide. But I found potential benefit for semaglutide (Ozempic) and tirzepatide as well.
However, these are preliminary studies. I can’t recommend these as initial treatment, based on the limited data. Furthermore, they are extremely expensive and subject to drug shortages. There are other medications that are much less expensive, more available, and better tested when it comes to alcohol use disorder. Natrexone and acamprosate both have strong evidence of benefit, and neither are used as often as they should be. There are second-line treatments available as well. By themselves, though, medicines are not the answer.
As it sounds like it might be the case with your sister, a major barrier is when a person isn’t ready to change. A skilled clinician, such as an expert in addiction medicine, sees this frequently and helps get a person motivated to change. Without motivation, treatment is unlikely to succeed.
Dear Dr. Roach: My wife and I contracted COVID recently. All those expired COVID tests worked fine. I called my doctor to get a script for Paxlovid and uploaded all of the positive test results. Last year, we both had COVID, and Paxlovid worked extremely well for us. Still, our doctor said he did not believe in Paxlovid and sent scripts to my pharmacy for azithromycin and dexamethasone instead.
I called back and said I did not want an antibiotic for a viral infection. He reluctantly agreed, but said that because of a new law in Florida, we would have to drive to his office and wait in the parking lot for the nurse to have us sign release forms of some sort.
Do you know why it’s so hard to get Paxlovid now? You don’t even need to sign release forms for narcotics, as far as I know.
K.C.
The data are abundantly clear that Paxlovid reduces the risk of hospitalization and death in people with risk factors. In young, healthy people with no risk factors, Paxlovid really doesn’t have much benefit. However, the data are pretty strong that azithromycin is of no help, and dexamethasone is only appropriate for those who have severe COVID with low oxygen levels.
I couldn’t find any requirement in Florida (or anywhere else) to have patients sign a release form. I am very uncomfortable with your doctor’s behaviour.
According to new guidance from the Food and Drug Administration, state-licensed pharmacists can prescribe Paxlovid as long as they have the necessary information, including recent health records, which are often available on smartphones now.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
