Poster available online: http://addictologie.hug-ge.ch/

1. WHO collaborating center For research and education in substance use disorders STOPPINGTHE PRESCRIPTION OFDISULFIRAMON AN EVIDENCE BASED MEDICINE DECISIONThe perception of Geneva’s addictology caregivers Gabriel Thorens, Riaz Khan, Yasser Khazaal, Daniele Zullino gabriel.thorens@hcuge.ch Geneva University Hospital Belief in disulfiram’s utility in treating alcohol addiction Introduction Aversive treatment in addictology has failed to demonstrate efficacy. The perception of its utility may, nevertheless, still be strong in caregivers. The only randomized trial1 comparing the efficacy of disulfiram against placebo showed no differences in recovery time of alcohol consumption or total abstinence. Even if the potentially dangerous side effects are rare, their risk overcomes hypothetical benefits2. Methods In December 2007, the Geneva Division of addictology decided to stop the disulfiram prescription. The healthcare team’s related perceptions were monitored during 3 month period using a 31-items auto questionnaire. Results 55 participants (response rate 61.1%), 54.1% women, mean age 43.7. Professions: 54.8% nurses, 30.6% MD, 9.7% social workers, 4.8% psychologists 54.6% didn’t agree with the decision to stop disulfiram prescription 36.4% thought their patients got worse after the decision 72.2% agreed that the decision was based on evidence based medicine 69.1% thought that disulfiram works because of the context of administration 69.1% thought that Disulfiram works through the fear of its potential effects Before After …the disulfiram stop policy 78% 77% Conclusions While most caregivers acknowledged that the decision to stop disulfiram’s prescription was based on evidence, most still believed in its utility for a majority of patients (even after two years of the new policy). Most believed that disulfiram works mainly trough dissuasion. The present study thus confirms the hypothesis of a significant gap between the acknowledgement of evidence-based treatment policies by health care givers and their perception concerning appropriate clinical methods. The results highlight the importance of an comprehensive preparation of such a fundamental policy change, with a particular focus not only on evidence but also on personal beliefs. References 1 Fuller RK and col. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. JAMA 1986 Sep 19;256(11):1449-55 2 Chick J. Safety issues concerning the use of disulfiram in treating alcohol dependence. Drug Saf. 1999 May;20(5):427-35. Poster available online: http://addictologie.hug-ge.ch/