SAFETY AND EFFECTIVENESS OF ETHANOL FOR PREVENTION OR TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME

To oppose the use of oral or intravenous ethanol for the prevention or treatment of alcohol withdrawal syndrome (AWS) because of its poor effectiveness and safety profile; further,

To support hospital and health-system efforts that prohibit the use of oral or intravenous ethanol therapies to prevent or treat AWS; further,

To support the removal of oral or intravenous ethanol from hospital and health systems for the prevention and treatment of AWS; further,

To educate clinicians about evidence-based therapies for AWS.

Rationale

AWS can delay patient recovery and interfere with response to therapy. Based on a review of the available evidence, including treatment guidelines from the American Society of Addiction Medicine (ASAM), ASHP opposes the use of oral or intravenous ethanol to prevent or treat AWS. Limited and conflicting evidence of effectiveness, inability to achieve accurate and consistent dosing and blood levels, and the availability of safer and more effective therapies are among the reasons to oppose use of ethanol to prevent or treat AWS symptoms. Benzodiazepines are the preferred drugs for the treatment of AWS, along with other supportive and adjunctive therapies as clinically appropriate. Guidelines from the American Association of Family Physicians recommend benzodiazepines on a fixed schedule for AWS, outpatient detoxification, and enrollment in an alcohol treatment program. The use of pharmacological agents exclusive of ethanol is also an established part of UK clinical guidelines for alcohol treatment: core elements of alcohol treatment as well as the American Society of Addiction Medicine Clinical Practice Guidelines, both of which recommend that “oral or intravenous alcohol should not be used for the prevention or treatment of alcohol withdrawal.” ASHP supports efforts to prohibit the use of ethanol for AWS and advocates education to a variety of healthcare practitioner audiences to increase awareness of appropriate evidence-based therapies.