I need a good one-page response to

I need a good one-page response to this The third leading cause of death in the United States for people 18 years and older are alcohol related deaths (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2018). There are many FDA approved pharmacological assisted therapies available to patients with alcohol use disorders, however only 6% of patients utilize these modalities (Umhau, 2019). This highlights the clinical practice issue for the need for appropriate screening and referral to treatment for patients with substance use disorders. Umhau (2019), discusses the use of Naltrexone and its success in alcohol use disorder. Naltrexone is available in an oral form and injectable form, known as Vivitrol. The variety of formulations gives more options to patients and allows for better adherence, compared to taking a pill every day, patients have the option to receive a monthly injection. Naltrexone’s mechanism of action and therapeutic effects are related to its antagonistic effects at the opioid receptors (Umhau, 2019). The mechanism of action is thought to block the release of endorphins or pleasure experienced when consuming alcohol, in turn reducing cravings and consumption of alcohol. Umhau (2019), discusses how Naltrexone is not only great at reducing cravings and consumption of alcohol, but especially in patients with a strong family history or genetic link to their alcohol use disorder. The typical starting dose for Naltrexone is 25 mg PO every day, and can be titrated to the FDA approved dose of 50 mg, oral, daily dose (Umahu, 2019). This research article also addresses the issues of adherence to naltrexone. Sometimes dosing may be 100mg on Monday and Wednesday and 150mg on Friday to increase adherence. However, the once monthly injection of Vivitrol formulation proves to increase adherence most (Umahua, 2019). When comparing Vivitrol to oral naltrexone there was a significant cost discrepancy between the two. Vivitrol was estimated to be $1,100/month versus oral naltrexone at $100/ month (Malone et al., 2019). I find that in my clinical area most insurance covers the oral naltrexone, and does not cover the long acting injection, Vivitrol. Which is unfortunate as Vivitrol could be more cost effective as an increase in adherence could mean less use of detoxification and emergency services (Malone et al., 2019). As far as accessibility of Naltrexone, it is available in many different areas such as inpatient, outpatient, residential and primary care settings (Malone et al., 2019). However, the injection would require a professional to administer it once monthly, requiring patients to travel once monthly to a provider for administration which may not be plausible (Malone et al., 2019). Overall, Naltrexone is a successful, FDA- approved pharmacological modality for patients with alcohol use disorder (Umhua, 2019). It is proven to reduce alcohol consumption and cravings compared to placebo (Umhua, 2019). Naltrexone is widely available in many different settings, and covered by most insurances (Malone et al., 2019). There are different formulations that could help increase adherence, however, the long acting injectables have higher associated costs and less coverage through insurance (Malone et al., 2019). SCIENCE HEALTH SCIENCE NURSING NURSING 283

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