The story of Dr Renauld de Beaurepaire, the champion of Baclofen.
The information is taken from Dr de Beaurepaire’s book “Verités et mensonges sur le baclofène”.
France has a major public health problem with alcohol- out of a population of 55 million, there are an estimated 2 million alcoholics and alcohol is responsible for around 50,000 deaths per year – around 134 people per day.
Dr Renaud de Beaurepaire is a psychiatrist working in the public sector in the hospital group Paul-Guiraud in Villejuif, on the outskirts of Paris. He met Olivier Ameisen in 2006, after Ameisen published a small article (link) in the scientific press describing his experience treating himself with baclofen. Dr de Beaurepaire was impressed by the Ameisen story and decided to try treating with baclofen if suitable cases presented in his practice. He found these in two patients with both severe depression and alcoholism who he treated in 2006-7. Both patients rapidly became indifferent to alcohol, just as Ameisen had described.
Ameisen was frustrated by the lack of interest in baclofen from the medical profession so in 2008 he published a book about his experience with baclofen, “The End of my Addiction” (link). It caused intense public interest in France and was the subject of many press articles, interviews and public discussions about baclofen and alcoholism. Dr de Beaurepaire was cited in the book as the sole known prescriber of baclofen in France and his psychiatric clinic was rapidly swamped with pleas from alcoholic patients to prescribe them baclofen. He saw the immense need and the enormous distress of patients and their families and decided to start a weekly clinic to see patients for baclofen treatment even though it fell outside his normal scope of psychiatric practice.
Dr de Beaurepaire hoped that many other doctors in France would follow his example and join him in treating alcoholic patients with baclofen. This has indeed been the case but it was a lonely battle for many years. Most doctors refused to prescribe baclofen for patients who requested it. The reasons were multiple and complex but one of the most difficult was that baclofen was not officially approved in France for use in alcoholism, only for treatment of muscle spasms. Many doctors were cautious, not wanting to prescribe it until it received official approval for this new use. Most doctors were not familiar with using baclofen in patients and many did not believe that baclofen would be as effective as the popular press had reported. It all seemed anecdotal and experimental and they preferred not to try it.
Dr de Beaurepaire was not deterred by these problems. In psychiatry there was a long history of prescribing medications outside of authorised indications – over 40% of psychiatric prescriptions were “off label” already and this had not stopped psychiatrists prescribing when patients needed it. He saw even less of a problem with baclofen being prescribed off label – here was a medication which had already been prescribed for 40 years without problems and which could treat a common and deadly problem, alcoholism. For de Beaurepaire, the risk:benefit ratio for alcoholic patients was clearly in favour of treating with baclofen.
As a consequence of the lack of baclofen prescribers, most alcoholic patients in France could not find a doctor prepared to prescribe baclofen and many resorted to other means of getting baclofen treatment. This included consulting “baclofen friendly” doctors in neighbouring European countries and buying baclofen from pharmacies in Spain where it could be purchased without a prescription or ordering baclofen off the internet and following Ameisen’s treatment regime described in his book. More stories emerged of patient success stories via the popular press and social media.
From 2011 the number of baclofen prescribers in France rose, particularly amongst GPs and the number of patients treated increased rapidly. By 2012, there were estimated to be around 30-50,000 patients taking baclofen for alcohol addiction with the numbers rising rapidly year on year.
In 2012, de Beaurepaire published a paper (link)on a large series of alcoholic patients: 100 patients treated with baclofen in his clinic for at least 3 months and followed for 2 years. It was the first paper to describe the results of treating a large patient cohort with the “Ameisen” regime: baclofen dose titrated up until a state of indifference to alcohol was reached. This contrasted with previous papers from Addolorato and Garbutt which used low fixed doses of baclofen, 30-60mg.
The first consecutive 132 patients of de Beaureapaire’s clinic were culled down to the first 100 patients who stayed on baclofen for at least 3 months. This was so that he could study the effectiveness of the baclofen treatment itself. The patients were treated simply with titrated doses of baclofen, without detoxification, residential rehabilitation or any specific psychological support program.
In brief, the result was that of the 100 previously treatment resistant alcoholics, 50 of them were at low risk drinking by 3 months of treatment and this stayed stable over the 2 year follow up period.
Dr de Beaurepaire has continued to fight for the wider use of baclofen for alcoholism in France and has been rewarded with an increasing acceptance and use of baclofen. In 2012, de Beaurepaire and other baclofen prescribing french doctors published a practical prescribing guide for baclofen in alcoholism to assist doctors wanting to treat their patients (link). He also published a book “Verites et mensonges sur le baclofene” (Truths and Lies about Baclofen) in 2013 (link), which details his experience of treating over 400 patients and discusses the ongoing controversies in France over the use of baclofen. At present it is only available in French.
Renaud de Beaurepaire’s battle is largely won. In France there are currently an estimated 100,000 patients on baclofen treatment for alcoholism and over 10,000 baclofen prescribing doctors, most of whom are GPs.
In 2015, a small german trial,BACLAD, was published and answered some of the criticism about the lack of placebo controlled trials on baclofen. It was the first double blind, randomised controlled trial (RCT) using Ameisen’s titrated baclofen regime. BACLAD showed 68% abstinence at 3 months for baclofen vs 24% for placebo, an impressive 44% difference.
In early 2016, publication of the results of the Bacloville trial is expected, a large (>300 patients), publically funded, double blind, RCT of patients treated in a general practice setting without detox or rehab. This should finally lay to rest the criticism that there have been no large scale RCTs supporting baclofen’s use in alcoholism.