A pill that helps people cut down on alcohol will be available to people who drink at least half a bottle of wine or three pints a night from today. Experts say the drug reduces the urge to drink and can be prescribed alongside counselling support. 
 
 The National Institute for Health and Care Excellence (Nice) has published formal guidance recommending nalmefene, following draft guidance released in October, which means that patients have the right to request the drug if they meet certain requirements. 
 
 Nalmefene, also called Selincro, is suitable for anyone who regularly drinks high amounts of alcohol, which is defined by the World Health Organisation as 7.5 units a day for men and five units a day for women. It helps patients gradually cut back on their alcohol intake and is therefore not suitable for anyone with a severe alcohol problem who needs to stop immediately. The pill costs £3, can be taken up to once a day, and is designed to be used whenever the patient wants to stave off the desire to drink. 
 
 Lyndsey Dudley, a spokeswoman for Nice, said the drug would be suitable for people who “probably don’t even recognise themselves as an alcoholic”. 
 
 She said: “It is much like a patch that you might wear to give up smoking, to support you to cut down on your alcohol intake. Some days you might feel stronger than others.” 
 
 More than two million Britons are believed to be mildly dependent on alcohol. Thirty-five thousand people are expected to be given nalmefene as part of treatment for alcohol dependency in the first year. However, the actual figure might prove to be lower. Data released yesterday for Scotland, where nalmefene was approved for use in October last year, show that only 53 people were prescribed the drug in 2013/14. The 35,000 figure is based on the prediction that 58,000 people are expected to receive psychosocial intervention for mild alcohol dependency, of whom 60% will be given nalmefene. 
 
 Dudley said the figure may change as “people might not want to go down the medication route straight away”. 
 
 Information given by the drug’s manufacturer Lundbeck identifies fictional examples of the sort of people eligible for nalmefene, including Sue, 39, who “looks forward to a glass of wine after work when the kids go to bed but always finishes the bottle while cooking and eating with her husband, and opens a second bottle a few days each week”. 
 
 Professor Carole Longson, Nice’s health technology evaluation centre director, said: “Many people have a difficult relationship with alcohol even though they have a very stable lifestyle, maintain jobs and a social life and would not automatically assume they have a problem. But regularly drinking over the recommended daily amount of alcohol can seriously damage your health. 
 
 “Those who could be prescribed nalmefene have already taken the first big steps by visiting their doctor, engaging with support services and taking part in therapy programmes. We are pleased to be able to recommend the use of namelfene to support people further in their efforts to fight alcohol dependence. 
 
 “When used alongside psychosocial support nalmefene is clinically and cost effective for the NHS compared with psychosocial support alone.” 
 
 Professor Jonathan Chick, a medical adviser for Drinkaware, said: “Two glasses of wine per day is not by any definition ‘mild alcoholism’. Nalmefene is for people who are concerned about their drinking, have tried to cut down, have been given brief advice/counselling by their doctor and are still regularly drinking more than low-risk levels. 
 
 “The risks start at 14 units per week for women and 21 for men, but patients who will be prescribed nalmefene will be drinking higher amounts than that, and will have provoked changes in their brain patterns which have led to difficulty controlling their drinking.” ||||| Middle-class drinkers in Britain who enjoy having more than three glasses of wine a night, will be given a pill to reduce their dependency on alcohol. 
 
 The National Institute for Health and Clinical Excellence has approved the use of Nalmefene, also called Selincro, to curb men and women drinking more than the required 7.5 units and 5 units a day limit. 
 
 The institute said the drug has been approved for use alongside counselling support for people, who want to reduce their alcohol intake by up to 1.8 units a day. 
 
 Nalmefene is available from today and costs £42.42 for a 14-tablet pack, or about £3 a day. Around 35,000 people are expected to be given Nalmefene in the first year. 
 
 Professor Carole Longson, director from NICE Health Technology Evaluation Centre, said: "Many people have a difficult relationship with alcohol even though they have a very stable lifestyle, maintain jobs and a social life and would not automatically assume they have a problem. But regularly drinking over the recommend daily amount of alcohol can seriously damage your health. 
 
 "Those who could be prescribed nalmefene have already taken the first big steps by visiting their doctor, engaging with support services and taking part in therapy programmes. We are pleased to be able to recommend the use of namelfene to support people further in their efforts to fight alcohol dependence," she said. ||||| UNNATURAL CAUSES | SICK AND DYING IN SMALL-TOWN AMERICA: Since the turn of this century, death rates have risen for whites in midlife, particularly women. In this series, The Washington Post is exploring this trend and the forces driving it. 
 
 Respondents who took part in The Washington Post-Kaiser survey on long-term, opioid painkiller use share their experiences of living with pain. (Monica Akhtar,Erin Patrick O'Connor/The Washington Post) 
 
 One-third of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the powerful painkillers, according to a new Washington Post-Kaiser Family Foundation survey. 
 
 Virtually all long-term users surveyed said that they were introduced to the drugs by a doctor’s prescription, not by friends or through illicit means. But more than 6 in 10 said doctors offered no advice on how or when to stop taking the drugs. And 1 in 5 said doctors provided insufficient information about the risk of side effects, including addiction. 
 
 The survey raises sharp questions about the responsibility of doctors for an epidemic of addiction and overdose that has claimed nearly 180,000 lives since 2000. Opioid deaths surged to more than 30,000 last year, according to new data from the U.S. Centers for Disease Control and Prevention, with deaths from heroin alone surpassing the toll from gun homicides. 
 
 Doctors have been widely blamed for sparking the crisis by overprescribing highly addictive opioids to treat everyday pain. The survey suggests that they are still doing too little to stop it. 
 
 “Why isn’t it 100 percent?” demanded Gary Mendell, founder of Shatterproof, a grass-roots group dedicated to reducing addiction in the United States, referring to the share who say doctors have counseled them on stopping the medication. “It’s unbelievable that it’s not 100 percent.” 
 
 
 
 
 
 Patrice A. Harris, chairwoman of the American Medical Association’s Board of Trustees and chair of its task force to reduce opioid abuse, acknowledged that doctors could do more to counsel patients on avoiding addiction. 
 
 “The doctors that I have talked to are discussing this with their patients,” Harris said. But, citing the survey, she added: “We could certainly do a better job.” 
 
 Despite the high rate of dependence, the poll finds that a majority of long-term opioid users say the drugs have dramatically improved their lives. Opioids relieve pain that is otherwise in­trac­table, they said in follow-up interviews, allowing them to walk, work and pursue other activities. Fully two-thirds of users surveyed said relief is well worth the risk of addiction. 
 
 People living with opioid users tend to have a darker view of the drugs’ effects. While one-third of users say they are hooked, more than half of people living with them suspect addiction, the survey found. Family members are also far more likely to say the drugs have damaged the users’ physical and mental health, finances and personal relationships. 
 
 Still, the survey’s findings highlight a fundamental conflict: While the drugs are a scourge for many, they are a godsend to others, especially the estimated 100 million Americans who live in chronic pain. Efforts by policymakers to restrict use have been met with outrage. 
 
 “We’re not saying that no one should ever be on these pills,” but most people would be “healthier and more functional if they were off them,” said CDC Director Tom Frieden, who this spring urged doctors to sharply limit the number of pills they prescribe. 
 
 “The bottom line here is that prescription opiates are as addictive as heroin. They’re dangerous drugs,” Frieden said. “You take a few pills, you can be addicted for life. You take a few too many and you can die.” 
 
 Opioid abuse — both prescription painkillers and their chemical cousins, heroin and fentanyl — is the main cause of rising death rates among middle-aged white Americans, particularly women in rural areas. It also has contributed to the first overall decline in U.S. life expectancy at birth in more than two decades, the government reported Thursday. 
 
 [CDC issues guidelines for prescribing opioids] 
 
 In 2014, U.S. doctors wrote 240 million prescriptions for opiates, enough for every adult to have their own bottle of pills. The CDC estimated that about 2.1 million Americans are addicted to legal narcotics. 
 
 In the first-ever guidelines on opioids for physicians, the CDC in March urged doctors to try nonnarcotic methods before offering patients pills containing oxycodone, hydrocodone and other opioids. The guidelines noted that there is little evidence that opioids are effective beyond 12 weeks. 
 
 “Three days or less will often be sufficient; more than seven days will rarely be needed,” the guidelines say. 
 
 But many people take the drugs much longer. In the past two years, about 5 percent of American adults have used prescription opioids for at least two months, the poll found; about half of those report taking the drugs for two years or more. 
 
 
 
 
 
 For the survey, one of the most comprehensive polls of long-term opioid users to date, The Post and Kaiser interviewed 622 people who said that they had taken narcotic painkillers for at least two months over the past two years. The survey also included 187 people who said they share a household with an opioid user, usually a spouse or a parent. 
 
 The survey did not include people who were treated for cancer or a terminal illness. At the time of the interview, 45 percent of long-term users were no longer taking the drugs, while 55 percent were still taking them. Users were slightly more likely than the general public to be white and far more apt to be middle-aged. 
 
 Nearly all long-term users (95 percent) said that they began taking the drugs to relieve pain from surgery, an injury or a chronic condition. Just 3 percent said that they started as recreational users. 
 
 More than 8 in 10 said that they tried to manage their pain with nonnarcotic medication; about 7 in 10 said that they tried alternative treatments, such as physical therapy and acupuncture. More than half (57 percent) found those methods ineffective. 
 
 
 
 
 
 Charles Stonesifer, 74, a former bricklayer who lives in Baltimore, has taken Tylenol with codeine and then Tramadol over the past two years. “Both my knees are shot,” he said, adding that he would be unable to walk without narcotics. 
 
 Stonesifer said that he had no trouble giving up the drugs when he tried, but his pain returned and he was forced to resume taking them. 
 
 “If they actually stopped you from getting the [drugs], it would be very difficult for me,” Stonesifer said. “It would put me in a wheelchair instead of being able to get around. And once you’re in a wheelchair, you never get up.” 
 
 Nancy Horton, 62, of Martinsburg, W.Va., admits that she is addicted to the 190 milligrams of oxycodone she takes daily to dull the pain of rheumatoid arthritis. Without the drugs, “I get the shakes. I am very anxious,” she said. “I just pace constantly. I can’t get comfortable.” 
 
 After 15 years on opioids, she said, “I look back now and think, ‘What could I have done differently?’ ” 
 
 [A new divide in American death] 
 
 Sizable minorities of respondents report using the drugs for purposes other than managing pain. Such behavior is much more common among people who say they are addicted or physically dependent on opioids. Among this group, 47 percent say they sometimes take the drugs for “fun or to get high”; 38 percent use them to “deal with day-to-day stress”; and 30 percent use them to “relax or relieve tension.” 
 
 Side effects are widespread. Over half of long-term users said that they have experienced constipation; almost as many felt indigestion, dry mouth or nausea; and 15 percent said that they have had breathing problems. One in 5 (21 percent) have taken additional medications to treat those symptoms. 
 
 More than half (52 percent) of long-term users said that they have taken other prescription medications for anxiety, depression and sleeplessness while on opioids, and 1 in 6 said that they have consumed the drugs along with alcohol — risky combinations that could have dire consequences. Overall, nearly 6 in 10 said that they take at least four prescription drugs, and about one-third said that they take seven or more medications. 
 
 
 
 
 
 The survey revealed a largely positive relationship between opioid consumers and their doctors. Large majorities said doctors have warned them to avoid alcohol, cautioned them about possible side effects and explained the risk of addiction. 
 
 But 61 percent said that their doctors did not suggest a plan for getting off the drugs when they were first prescribed, and more than half said doctors have not altered their dose or frequency. Among long-term users who stopped taking opioids, 34 percent said the termination of their prescription was a reason. 
 
 Just 4 percent said that they have a prescription for naloxone, the drug that can be administered by someone else in an emergency to reverse the effect of an overdose. 
 
 
 
 
 
 While about a quarter of long-term users said a friend or family member has suggested they stop taking the drug, two-thirds said that they are “not too” or “not at all” concerned about becoming addicted. And about 6 in 10 of those who report being addicted have not sought treatment or other help. 
 
 Yngvild Olsen, chair of the American Society of Addiction Medicine’s public policy committee, said doctors “have a vital role to play in addressing the epidemic, not only by changing their prescribing patterns and learning a lot more about chronic pain management and addiction, but also by stepping up to the plate in learning how to treat addiction.” 
 
 Emily Guskin, Monica Akhtar and Erin Patrick O’Connor contributed to this report.
– Those Brits who want to cut down on their alcohol intake—and can spare about $5 a day—now have access to a pill to reduce their craving. UK officials have approved the drug nalmefene for use along with counseling to help reduce alcohol dependency, the International Business Times reports. The official approval means people who fit the right profile can request the prescription drug. "Those who could be prescribed nalmefene have already taken the first big steps by visiting their doctor, engaging with support services, and taking part in therapy programs," says a researcher. Nalmefene, which can be taken once a day, helps people feel less of an urge to drink, experts say. It's considered appropriate for many people drinking the equivalent of at least half a bottle of wine daily, the Guardian reports. Plenty of potential candidates to take the drug "probably don’t even recognize themselves as an alcoholic," says a health official, who compares it to a nicotine patch. But since nalmefene is intended to be used to gradually reduce alcohol intake, it's not a good solution for people who need to quit right away, the Guardian notes.