Nalmefene

A story discussed a lot in the media today (e.g. here here) is the proposal to extend the prescription of Nalmefene, an opioid receptor modulator used to reduce alcohol cravings, to up to 600 thousand heavy drinkers (loosely defined as people drinking 3 pints or half a bottle of wine per night) in the UK. It would be offered free on the standard NHS prescription package. The proposal has the initial backing of  the National Institute for Clinical Excellence (NICE ) based on their estimates of the cost of alcohol dependence, the costs of the drug and associated treatments, and the potential effectiveness of the drug in reducing alcohol craving. The proposal raises a lot of fascinating questions about the ethics, effectiveness and desirability of different types of behavioural interventions. In terms of the debate on libertarian paternalism, there is arguably an element of "nudging" in the proposal in that it is being offered to people to take up voluntarily. However, it is not usual to think of nudges as being consumed in the form of pharmaceutical products. Also, those who believe policy should be more directed at creating supportive choice environments might baulk at the potential nihilism inherent in a strategy that seeks to act directly on individual-level neurological mechanisms. Furthermore, those who support strategies to improve individual autonomy may be concerned that policies relying on pharmaceutical interventions further reduce the autonomy of the individual. On the other hand, if the drug is indeed effective beyond the clinical trials it could be argued that it is possible for individuals to take such a product as an autonomous choice and also that it could help them in creating the conditions for future further autonomy through breaking the patterns of habit and addiction. It will be very interesting to track the debate on this policy throughout the next year.

**The NICE Guidance document with details of the proposal is available here