So how did baclofen make the journey from Paris, France to Perth in Western Australia?
Through a search to find new and better treatments for one of the most challenging and common conditions in our health system. Alcoholism.
I work in an inner city emergency department (ED) at the Royal Perth Hospital in Perth, Western Australia. Our emergency department sees around 75,000 patients each year. We’ve looked at our presentations and know that 1 in 8 patients are in our ED because of alcohol: alcohol intoxication, alcohol withdrawal or alcohol related injury or illness.
I’m an Emergency Medicine Specialist with a particular interest in working with the most challenging, difficult and frequently presenting patients who come to our ED, to find better ways to help them. Alcoholic patients are our biggest and hardest group of challenging patients, especially when they also have other issues like homelessness or mental health problems. Many of the alcoholic patients we see in ED had already tried all the treatments I knew about – medications like acamprosate and naltrexone and they had usually been through numerous detoxes and rehabs and had failed them all. That’s why they ended up in the ED, intoxicated, withdrawing, injured or ill. But we didn’t have anything else to offer them for their alcohol addiction, the root cause of their problems.
It was this frustration which led me to search the scientific literature in 2013, looking for new ideas or innovative treatments. I turned up a few treatments for alcoholism I’d not heard of before like topiramate and gabapentin but the results didn’t look promising.
The next step happened by chance. I was looking for the answer to a completely unrelated question which had arisen from a challenging patient seeking an opiate drug called fentanyl from hospitals and GPs around Perth. I’d never heard of fentanyl being used as a drug of addiction so went searching for this information on the Web and turned up the internet forum drugs-forum.com. It had information on drug abuse, drug addiction and treatments from drug users and abusers. I rapidly found the answer to my question – yes, fentanyl is highly sought after as a drug of addiction in the eastern states of Australia.
But I also realised that these internet forums were an abundant source of information from the real world of addiction, the like of which I’d never seen before. So I searched the alcoholism forums to see what treatments were being tried and what the consumer experience of them was. Amongst the many posts regarding the various treatments for alcoholism, I found baclofen coming up again and again.
What struck me was that baclofen seemed to be different from other medications used in alcoholism treatment – these alcoholics talked about indifference to alcohol, a complete lack of cravings, how easy it was to stay off alcohol with baclofen and how it worked where other treatments had failed. They also talked about Dr Olivier Ameisen, how he discovered baclofen in treating his own alcoholism.
My next step was to go back to the scientific literature and find what evidence existed for baclofen’s use in alcoholism. I uncovered a number of scientific papers going back to 2002 with small numbers of patients but striking results: they are discussed in the Science section of this website. The most interesting was the 2012 paper by Renaud de Beaurepaire who described the results of treating 100 treatment resistant alcoholics with baclofen and following them for 2 years at which time 50% were either abstinent or drinking at safe levels. In fact the results had been established at the three month mark and remained very stable over 2 years. This is a remarkable result.
The alcoholic cohort in de Beaurepaire’s paper sounded an awful lot like the alcoholics I struggled with at RPH – long term, heavy daily drinkers who had failed all attempts at treatment. And this treatment regime didn’t involve detox, rehabilitation or any mandated drug and alcohol counselling. Just baclofen, started while the patient was drinking as usual and titrated up until cravings were suppressed.
The paper is discussed in more detail in the previous section and in the Science section.
My reaction to this information about baclofen for alcoholism was like that of Dr de Beaurepaire and many other doctors in France. Baclofen treatment had the potential to help many patients who struggled with alcoholism and had not found help with the available treatments. These patients faced an inexorable decline in their health and social functioning, usually leading to an early death. It was hard to see how treating them with baclofen could be worse or more dangerous than the fate they currently faced. Baclofen didn’t need to treat all alcoholics to be worthy of trying but it had the potential to help many who had failed current treatments.
Armed with information about baclofen, I went to speak with our government funded drug and alcohol agency but was met with polite disinterest and a desire to wait until more studies were published before considering baclofen for their programs. This didn’t really surprise me. I had already read about the struggle of the French pioneers in this area.
I decided to start treating patients with baclofen myself. I turned to my own institution, Royal Perth Hospital (RPH), with it’s long tradition of innovation and of helping the most marginalised people in our population and found willingness there. In order to treat patients with baclofen for alcoholism at RPH, approval was needed from our Drugs and Therapeutic Committee. This required a submitting a detailed application form containing information about baclofen’s risks and benefits, evidence of efficacy, cost and a comparison to the other medications for alcoholism. The committee readily granted approval, seeing baclofen’s potential for a group of patients who occupied a huge number of hospital beds and for whom new treatments were desperately needed, preferably before their health declined to the point of requiring hospital care.
The RPH Executive also supported my work in treating alcoholic patients with baclofen at RPH, again seeing the potential for enormous benefits for the hospital and the wider community.
In 2014 I started offering baclofen treatment to a few of the patients who presented to the ED with long histories of alcoholism and failed treatments and from them I started to learn about baclofen for alcoholism.
During 2014 and 2015, there were increasing amounts of information available from France (in French) from experienced prescribers and treated patients which I could access. These included Dr Renauld de Beaurepaire’s book “Verites et mensonges sur le baclofene”, a baclofen prescribers forum (medecin-baclofene.fr), two baclofen websites (baclofene.com and baclofene.fr), numerous internet posted interviews with baclofen prescribers on Youtube and even a TED talk.
By the end of 2015, I had treated 57 patients and had learnt a lot from them about how to use baclofen. It’s some of the most rewarding work I have ever done. Many patients did amazingly well, some had to struggle hard to pull themselves out of alcoholism and others rapidly stopped seeing me or were unable to shake off the demon of alcohol despite baclofen helping their cravings.
Over the last two years, I have seen baclofen fulfil its promise in my hands but it was time to take the message out of the hospital and into the community where more patients could be helped. It was time to build a website, get some publicity going and start working with GPs and other interested doctors to create a group of baclofen prescribers in Perth.