Would you prescribe Baclofen?

[_EndOfTheLine_]

Would you prescribe Baclofen?

This is not a Baclofen bashing thread, if such a thing exists. I am trying to give another point of view because people seem to be frustrated that they cannot get a prescription.

At present, if I were a a Dr I wouldn't prescribe Baclofen in the high doses mentioned here, the evidence isn't of high enough quality to support it and even then, would I?. Suppose it depends what level of expertise the doctor has...if you're a consultant in this area, you can basically do what you want and very few can question it but as a GP, I think it would be plain wrong to prescribe it above say (for example) 30 mg/day (I seen a short, small double blind trial at this dosage). Its great that people do well on this, but anecdotal reports aren't worth much. Even expert opinion, as in the case of Dr OA are the bottom of the barrel.

It's all evidence-based medicine these days. This ensures that things like Seethepony posted doesn't happen, or happens as little as possible. There are more recent examples than that, but they are less dramatic. For example Clofibrate, a lipid lowering drug (high lipid is major risk factor for a variety of heart conditions) was studied in a lenthgy double blind trial and it was shown that it was associated with a slightly higher mortality than doing nothing at all and was discontinued. INtervention should be associated with lower morbidity and mortality than doing nothing at all. IS that the case with Baclofen? I don't think we really know.

[bleep]

Would you prescribe Baclofen?

There were disappointingly few responses to what I thought was a very interesting question.

What would you do End, if your patient reported good results on 30mg's. Would you go higher? What if the results continued to improve? What if your patient was definitely going to die from alcohol consumption in the next couple of years anyway, and was unable to stop?

[_EndOfTheLine_]

Would you prescribe Baclofen?

bleep;1080619 wrote: There were disappointingly few responses to what I thought was a very interesting question.

What would you do End, if your patient reported good results on 30mg's. Would you go higher? What if the results continued to improve? What if your patient was definitely going to die from alcohol consumption in the next couple of years anyway, and was unable to stop?

Medical ethics are tricky because there are no clearcut answers, and I suppose that makes it interesting. I'm not sure I would, and I'm not sure I wouldn't. As a testm I always think, if it were my mum would I risk it? (my mum's not an alco or anything but I would never risk her life, or avoid anything that would save her). I would really have to do the research. I suppose if she was in extremis you can really not do any harm so I would tend to roll the dice.

[redhead77]

Would you prescribe Baclofen?

As soon as I kick this alcohol thing in the butt, I'm going on with my education, to a prescriber role. By then, hopefully baclofen will have gotten a little more mainstream. I am certain it will. Even if not a complete "cure", it will certainly prove to be extremely helpful in the battle of this disease. Very little has. I would without a doubt prescribe it. Dr I (L), did have great doubts and many concerns when he started prescribing to a few people. They were cured. He couldn't believe it. He then went on to prescribe to others, who were also cured. He became a believer. He now prescribes to many. Hundreds of people, who even with side effects, have not suffered long term disability. I will ask him in my next conversation when he first started treating and how many years the longest has been. Unless, anyone else knows.

With that being said, it is a matter of time until something happens, whether bac induced or not. Hopefully, the axe will not fall on him. As for now, he is enough of a philanthropist, that he knows that this will help us (cure) in his words, and he is willing to prescribe it. He has already helped to save countless human lives. How could you not prescribe knowing that information? Could you really watch your patients dying before your eyes, and let it happen? When you knew you had a med to help them? Especially when you knew it was safe? I for one couldn't do it, no matter what the repercussions.

[Otter]

Would you prescribe Baclofen?

More Doctors drink Johnnie Walker than any other Whiskey!

Abstract
Alcohol abuse within the medical profession has long been an issue of concern. Recently, the General Medical Council reported that half of the doctors reported for health difficulties liable to affect professional competence were found to have an alcohol problem. This paper examines how rates of alcoholism among male doctors in Scotland have changed over the last three decades. Admission and discharge rates for doctors to psychiatric inpatienl beds with diagnoses of alcoholism are compared with non-medical professions, for the years 1963–87. The results, assessed in the light of changing Standardized Mortality Rates for liver cirrhosis for the medical profession, suggest that doctors as a group remain at a higher risk of alcoholism compared to other professionals, but that this increased risk appears to be largely accounted for by a cohort of heavy-drinking doctors over the age of 45 years.

Maybe part of the problem with getting doctors to prescribe is just that they are mainly drinkers, just like the rest of the population but they have to hide it, or else.

Up til now alcoholism has been treated as not being a medical issue so in a way it is understandable in this day and age of litigation that all doctors should, by rights, refuse to treat for alcoholism because it is not something within their speciality.

It is a rare doctor who knows anything about Baclofen and even if they had heard of it, it is not so easy to find out how much to prescribe and how to manage the side effects over what could be months of unsupervised home treatment.

What I don't understand about OA is why he is so guarded about how to take Baclofen. You have to go through his book with a magnifying glass to find where he describes his titration schedule. I think he has done himself a disservice because a lot of the problem with side effects is down to the way it is taken rather than the medication itself. I still see a lot of people here saying they take large individual doses three or four times a day. This is a brain medicine which is used to mimic some chemical that the brain should produce but does not. So what brain chemical is produced in 3 or 4 big bursts a day?

It has to be taken in regular small even doses throughout the day and night, avoiding craving and side effects. Ameisen's dosing was nothing like this. I think he was taking 60 mg at a time. Maybe he did not have the patience to take it in smaller, regular doses but I don't think he has encouraged the right approach to looking at how to deliver this medication to the brain.

I also think that part of the problem with failure of Baclofen is the "alcoholic mind". In other words, the alcoholic brain is looking for a high so there is a tendency to think that having some heavy side effects from a big dose is the right way to take it, just as an alcoholic would want to have a big drink, not just a sip now and then that had no effect.

[redhead77]

Would you prescribe Baclofen?

Yes, Otter. I believe that medical professionals have some of the highest rates of alcohol abuse (and other substances). And yes doctors REALLY have to hide it. If they want to try bac, their going to do it secretly, probably writing their own scripts. They don't have to worry because it's not a controlled substance. But even the one's who do try bac and stop drinking may be worried to prescribe. How does one explain to their colleagues why they believe in this, or how they even know? Unless, of course you're a philanthropist like Dr L or I would be. Very complicated matter indeed!

[Otter]

Would you prescribe Baclofen?

Also, I think a lot of young doctors and other professionals are hard working, hard living types who feel that drinking is a rite of passage. Remember Hawkeye and Trapper Johnn in MASH. So, if they can drink heavily but work in a highly demanding profession then why bother with alkies who can neither hold their drink nor perform heart surgery? All part of the Ubermench attitude of professionals bred by MCATS and GPAs which results in them looking down on the rest of the populace.

Maybe that is a bit too nihilistic.

[redhead77]

Would you prescribe Baclofen?

Yup. It's called functional alcoholics and most are highly functional. It is hard for many to understand what creates the homeless wino. I don't think it's nihilistic at all.

Edit: Judge Not Lest Ye Be Judged.

[redhead77]

Would you prescribe Baclofen?

Otter, do you mean Hawkeye the comic figure?

[Longshot]

Would you prescribe Baclofen?

redhead77;1080887 wrote: Otter, do you mean Hawkeye the comic figure?

I think in this instance he's referring to Captain Hawkeye Pierce the M*A*S*H* surgeon in the film M*A*S*H* and the subsequent TV series. Hawkeye was constantly boozing, and had a working still in his tent.

If you're looking for a functional alcoholic superhero who's also a member of the Avengers look no further than Tony Stark.

Oh and Iron Man is in the AA.

[redhead77]

Would you prescribe Baclofen?

Thanks Longshot. Got it. I guess my "judge not lest ye be judged" quote still holds true there.