Dosage and Frequency - Take 2 - Binge Drinking

[Cinders]

Dosage and Frequency - Take 2 - Binge Drinking

Boy, have I got lost on this thread.

I am from Amurrica. I think of myself as a southern gal, but I have lived all over this country and in Taiwan and Germany. (I want to go to New Zealand and trout fish, one of my dreams. I DO NOT want to go swim in any Australian reefs, that scares the you-no-what out of me.)

When my husband went to England, he visited Stone Henge and the bypass that sparked The Hitchhikers Guide to the Galaxy. I go nowhere without a towel. :-)

Okay. This is an inane post. Sorry, hungry and tired.

Love,
Cindi

[redhead77]

Dosage and Frequency - Take 2 - Binge Drinking

Originally posted by Otter on page 3:

"This is very much along the lines of what I was saying in the Dosage and Frequency take 2 thread that doctors MUST start looking at the risks and benefits of Baclofen versus leaving someone in an acute alcoholic state. Diazapam is NOT used concurrently with alcohol consumption and not until alcohol is clear from the system. Baclofen IS used while a patient is still inebriated and it has the effect of slowing consumption of alcohol and stopping it if used from the start at a proper level which stops craving. This is, IMHO, a huge issue in public medicine because people are not being treated properly by doctors and hospitals who are not using Baclofen in this way and they are subjecting patients to the risk of withdrawal from alcohol, which Baclofen reduces, simply to give them another medication, Librium, which is addictive and should only be used for short periods in detox and DOES NOT reduce cravings, putting the patient at risk of cross addiction and morbidity."

Sorry, my computer won't let me quote what you said Otter. It keeps kicking me out. :H Diazepam and lorazepam are used while people still have alcohol in their system. At least in this country Otter. We use a measure of alcohol withdrawal to determine when one needs to be medicated. We use something called the CIWA scale. If someone comes in with a BAL of say 400 and their BAL drops to 200, and they show signs of alcohol withdrawal, we start medicating. We don't wait until all alcohol is out of their system. We don't care. We want to avoid withdrawal. Librium is not a first line drug here for withdrawal anymore. Maybe 20-25 years ago, it was. Bac has been shown to be slightly beneficial in studies of alcohol withdrawal. It has not been better than benzos, though. What I could get my hands on, only showed a subject sample of 5 people who took bac for withdrawal. I guess with such a small sample, it's hard to determine what's the better route. As it stands, it's benzodiazepines. I'm not sure where you get your info. Amurrica does not have the same methods as Scotland apparently. I guess gratefully.

[terryk]

Dosage and Frequency - Take 2 - Binge Drinking

redhead77;1192807 wrote:

Sorry, my computer won't let me quote what you said Otter. It keeps kicking me out. :H Diazepam and lorazepam are used while people still have alcohol in their system. At least in this country Otter. We use a measure of alcohol withdrawal to determine when one needs to be medicated. We use something called the CIWA scale. If someone comes in with a BAL of say 400 and their BAL drops to 200, and they show signs of alcohol withdrawal, we start medicating. We don't wait until all alcohol is out of their system. We don't care. We want to avoid withdrawal. Librium is not a first line drug here for withdrawal anymore. Maybe 20-25 years ago, it was. Bac has been shown to be slightly beneficial in studies of alcohol withdrawal. It has not been better than benzos, though. What I could get my hands on, only showed a subject sample of 5 people who took bac for withdrawal. I guess with such a small sample, it's hard to determine what's the better route. As it stands, it's benzodiazepines. I'm not sure where you get your info. Amurrica does not have the same methods as Scotland apparently. I guess gratefully.
I've had this conversation with Otter before, or rather I've brought this up to Otter before:

From https://www.mywayout.org/community/f2...ml#post1152387:

Otter;1152387 wrote:
4. Baclofen can, and should, be used for alcohol withdrawal with only limited use of benzodiazapines, to avoid cross addiction. Studies have shown that Baclofen is as good as benzodiazapines for withdrawal and can be used during drinking whereas Benzodiazapines cannot, thereby allowing for detox to start during drinking.

The studies I've read have mentioned limited doses of baclofen with uncomplicated withdrawal and still have mentioned use of benzos to control serious symptoms Safety and efficacy of baclofen in the treatm... [Curr Pharm Des. 2010] - PubMed - NCBI

The more recent reports I've read suggest that there's not enough evidence to support using baclofen alone for withdrawal:
Baclofen for alcohol withdrawal. [Cochrane Database Syst Rev. 2011] - PubMed - NCBI
Efficacy and safety of pharmacolo... [Cochrane Database Syst Rev. 2011] - PubMed - NCBI

I'm pretty sure I have more articles somewhere...

My only concern here is someone who tries to rely on baclofen alone for a home detox and winds up seizing in serious trouble because they have no access to anti-convulsants. It's a big deal.


-tk

[terryk]

Dosage and Frequency - Take 2 - Binge Drinking

Here's a study that says baclofen reduced or eliminated the need for benzos in all but 1 patient (of 18 in the baclofen group compared to 7 of 13 in the placebo group) who developed symptoms of alcohol withdrawal.

Treating alcohol withdrawal with oral baclofen: A... [J Hosp Med. 2011] - PubMed - NCBI



In this RCT, baclofen looks very good for AWS, but not absolute.

EDIT: Otter has indeed mentioned this study: https://www.mywayout.org/community/f2...ml#post1049630

[terryk]

Dosage and Frequency - Take 2 - Binge Drinking

Just to show that I'm trying to be objective here:

Suppression of alcohol delirium ... [Clin Neuropharmacol. 2003 Sep-Oct] - PubMed - NCBI



This sounds very promising, but I don't think that it *proves* that baclofen can be used exclusively and unequivocally for detox/to prevent withdrawal. And let's not forget that this was *one* patient under a doctor's care, in a hospital, with a viable back-up plan.This is not something to try at home without medical supervision. I just edited out the dosing specifics because I don't want this to become a blueprint for someone's homebrewed detox attempt. The complete, full-text journal article is available for anyone that wants to make the effort to obtain it (i.e. not from me).

-tk

[redhead77]

Dosage and Frequency - Take 2 - Binge Drinking

Thanks for doing all that work tk. And you did it while trying to remain objective. It sounds like bac may be a suitable method for detoxing from alcohol for some patients. But there isn't enough literature to support this entirely (as you've indicated). I know there have been some people here who have successfully detoxed on bac, or who have detoxed their family members with it. I guess it has to be looked at on an individual basis. Absolutely no one should be attempting to detox from a serious alcohol problem alone. With bac or with benzos. If one has the proper support at home, and if family members know how to use bac, and what signs to look for to determine if things are getting out of control, then I guess that's their perrogative. As long as people know when to bring someone to the hospital. Like I said, we do detox people here with benzos, and we don't wait until they are in serious withdrawal. People can die. We get pretty aggressive around a CIWA score of 8, I believe. From what Otter writes, it sounds like his country isn't nearly as aggressive, and it may even seem better to avoid the hospital. This is very sad.

[Otter]

Dosage and Frequency - Take 2 - Binge Drinking

I think this is all missing the point. Benzodiazapines are the medicine of choice around the world for detox so there is little knowledge of the use of Baclofen. Saying that you can start detoxing before the alcohol is out of the system misses the point. With Baclofen you can start when there is a very high level of alcohol in the system because it curbs the craving and starts to stop the drinking. Benzodiazapines have no such similar effect.

Detox on Baclofen is at a fairly high dose. So is Benzodiazapine. They both make you zonk. A starting point for a reducing prescription of librium is 90 mg a day. Both have side effects but Benzos are addictive so you have to taper off.

Baclofen on the other hand, is supposed to be used for alcoholism at high dose, is not addictive so you don't taper off. As we saw with Bluto, LoOp and Paulslice they started at high dose and stayed there leaving them near or at their switch points.

When you have someone in a deeply alcoholic state and want to stop them drinking you cannot use Benzodiazapine. If you look at using Baclofen you have to consider the risks of the medication and controlling any other side effects of withdrawal from alcohol and weigh that against the risks of allowing the patient to continue drinking.

At present, generally, in this country, because benzos would not be used for a person in this sort of situation the result is simply to let the drinking run its course, because this aspect of Baclofen is not widely understood or even known about.

So, a lot of people die in this state. I know someone who did. You just watch it happen.

If Bluto had just gone to a hospital here and asked for Benzos they would have told him to stop drinking first and come back for a detox once he had been referred by his doctor. That is just the way it is here. They don't offer a sobering up procedure. That is what I read from the Minnesota study. If you have someone in ER who has been in a car accident and brought to hospital in a very intoxicated state, they have to be treated for alcohol withdrawal when they are in that state and that is where Baclofen excels beyond anything that Benzo's do.

That is my take on it, for what it is worth.

[Otter]

Dosage and Frequency - Take 2 - Binge Drinking

This is apropos of nothing but I found this thread and wanted to add these valuable comments. In addition to the countries listed on the graph, there are also Jersey, Guernsey, Aldernay, Sark and the Isle of Man. All these places have their own separate governments and are not represented in the UK parliament in London. However, their head of state is Queen Elizabeth, they have the same NHS, BBC and other institutions paid for by the UK, particularly army, navy etc.

That is the problem with the UK, that it has about 9 "countries" within it, some of which are represented in the central parliament at Westminster in London and some which are not. The United Kindom is a reference to the union of the kingdoms of Scotland and England under James I but not to the kingdoms of the Channel Islands, Jersey etc. This is what makes the whole Scottish independence debate so ridiculous because the UK government can't even understand its own structure. It has no written constitution and can't restructure itself because parts of the country are still ruled by the Queen and are outside the jurisdiction of the UK parliament altogether. So, it is a mess.

I only mention all this because here we have a country which claims to be advanced but has leaders who have no idea what to do even about such an important issue as the proper constitution of the country and parade about saying "Scotland, stay with us". Stay with who? Half the constituent parts of the entity known as "Great Britain", governed by the Queen, aren't even represented in a central parliament even though their defense and medical services are provided by that government.

What hope is there that a place like that would get a topic like baclofen right? It is a topsy turvy, evolved quasi federal, feudal monarchistic aristocratic "swamp".

nuff said

[bleep]

Dosage and Frequency - Take 2 - Binge Drinking

SlipperyPete;1192070 wrote: Don't worry, Ginger, I'm slowly getting the word out that Washington means the state, and not the district. When I say I'm from Washington, and they go "D.C.?" I launch into a 20 minute profanity laced tirade about how if I meant D.C. I would've said D.C., and George Washington was left handed so he would've preferred his name to be associated with the West Coast and and Amurrrica wouldn't be shit if it weren't for the REAL WA and WHY ARE YOU LOOKING AT ME LIKE THAT!?!?!

We live next door to someone who works in the US embassy, and obviously the guy is American. From Washington DC, so at least 1 person and his family lives there, even if they aren't there at the moment. Had to go a long way to find him though.