DEAR DR. ROACH: My sister has a real drinking problem. I’ve tried to get her into a rehab program, but she’s resisting. I’ve read that medications like Ozempic can help you stop drinking. Is there an answer? – WA
ANSWER: Alcohol abuse is a major problem worldwide, and basic and clinical scientists are constantly looking for new treatment options. I have found several studies showing early promising results with GLP-1 inhibitors that help curb cravings not only for alcohol, but also for nicotine and opioids. Most of these studies use the older drugs: liraglutide, dulaglutide, and exenatide. But I have also found potential benefit for semaglutide (Ozempic) and tirzepatide.
However, these are preliminary studies and due to the limited data, I cannot recommend them as first-line treatments. In addition, they are extremely expensive and subject to drug shortages. There are other drugs that are much cheaper, more readily available, and better tested in alcohol abuse. Natrexone and acamprosate both have strong evidence of benefit and both are not used as widely as they should. There are also second-line treatments. However, drugs alone are not the solution.
As seems to be the case with your sister, a major obstacle is when a person is unwilling to change. A skilled clinician, such as an addiction medicine expert, will often see this and help motivate a person to change. Without motivation, treatment is unlikely.
DEAR DR. ROACH: My wife and I recently contracted COVID. All expired COVID tests worked fine. I called my doctor to get a prescription for Paxlovid and uploaded all the positive test results. Last year we both had COVID and Paxlovid worked very well for us. Still, our doctor said he didn’t believe in Paxlovid and sent prescriptions for Azithromycin and Dexamethasone to my pharmacy instead.
I called back and said I didn’t want an antibiotic for a viral infection. He reluctantly agreed, but said that due to 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 some sort of release form.
Do you know why it’s so hard to get Paxlovid now? As far as I know, you don’t even have to sign release forms for narcotics. – KC
ANSWER: The data clearly shows that paxlovid reduces the risk of hospitalization and death in people with risk factors. In young, healthy people without risk factors, paxlovid does not have much benefit. However, the data is pretty clear that azithromycin does not help and dexamethasone is only appropriate for people with severe COVID and low oxygen levels.
I could not find a requirement in Florida (or anywhere else) to require patients to sign a release. I am very uncomfortable with your doctor’s behavior.
Under new guidelines from the Food and Drug Administration, state-licensed pharmacists can prescribe paxlovid as long as they have the necessary information, including current health records, which are now often available on smartphones.
Dr. Roach regrets that he cannot respond to individual letters, but will include them in the column if possible. Readers can email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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