A curious case of the World Health Organization's (WHO) approach on alcohol use disorders—inferences from the WHO list of essential drugs


The 18th World Health Organization (WHO) Model List of Essential Medicines has been published recently. However, the list fails to include any medicines for management of alcohol use disorders [1].

Alcohol use disorder (AUD) is a major cause of morbidity and mortality [2]. It has been estimated that 4.4% of disability adjusted life years (DALYs) lost are attributable to alcohol. Alcohol ranks among the top 10 risk factor causes of DALYs lost, both globally and in all three income-categories of countries [3].

Harmful use of alcohol clearly remains a low priority in public policy. The WHO Global Status Report on Alcohol and Health 2011 indicates that lesser health risks have a higher priority than alcohol use [4]. Nevertheless, the WHO has identified ‘providing accessible and affordable treatment for people with alcohol-use disorders’ as an effective as well as cost-effective strategy to reduce the harmful use of alcohol [5].

The WHO Model List of Essential Medicines is prepared by the WHO Expert Committee. The recommendations of the committee are based on scientific evidence on the comparative effectiveness, safety and cost-effectiveness of medicines [6]. However, over the years, the WHO Model List of Essential Medicines has failed to include any medicines for treatment of alcohol use disorders [7-10]. This remains unchanged in the most recently published 18th such list [1].

Interestingly, the list includes medicines for management of all other major contributors to morbidity and mortality including antibiotics, antidiarrhoeals, antihypertensives, insulin and cytotoxic drugs. This omission of medicines for management of one of the biggest contributor to global burden of disease defies logic.

Benzodiazepines have been well established as effective first-line medicines for management of alcohol withdrawal [11]. Naltrexone and acamprosate have been found to be effective and safe in reducing alcohol consumption in patients with alcohol dependence [12-15]. Clearly, the issue of inclusion of medicines for AUDs in the WHO Model List of Essential Medicines needs to be debated.

Declaration of interests