Why is disulfiram not on the PBS?

Abstract

Alcohol dependence is a common, disabling and costly medical condition that affects 4% of Australian adults. Several pharmacological therapies are now available in Australia to treat alcohol dependence, including disulfiram, acamprosate and naltrexone. While all three medicines are registered in Australia by the Therapeutic Goods Administration (TGA), only acamprosate and naltrexone are listed on the Pharmaceutical Benefits Scheme (PBS). Recent reviews show that supervised administration of disulfiram is both effective and safe. Accordingly, disulfiram should be made more available and accessible through PBS listing. Disulfiram helps to achieve abstinence by inhibiting aldehyde dehydrogenase. This leads to the temporary accumulation of acetaldehyde, which causes a potentially severe aversive reaction with nausea, flushing, agitation and dizziness, thereby usually deterring future drinking. Although the treatment has a logical basis, early studies found only mixed evidence for its efficacy. Consequently, disulfiram fell into disfavour.