Open letter to Science Magazine regarding NIH investigation of George Koob

Dear Jocelyn,

Earlier, I sent you an email with some links to my involvement in baclofen treatment for alcoholism.

What prompted me to write to you was your article about George Koob being investigated in relation to his stopping funding policy studies.

I’ve been following baclofen studies for the past 9 years. Baclofen was first found to be effective as a treatment for alcoholism about 40 years ago when an application for patent was filed in, I believe, Louisiana for the use its use in alcoholism. More recently, Olivier Ameisen rediscovered baclofen and wrote a book called "The End of My Addiction" which was released in 2009. In it he explains how baclofen, as an anxiolitic, calms the underlying anxiety which, for some, causes them to consume alcohol in an almost involuntary way, resulting in their addiction. Since then, the use of baclofen has spread via word of mouth in the USA and other English-speaking countries. There are now many doctors and rehabs who use and prescribe baclofen and a large community of users who buy baclofen over the internet. There are also a number of support forums for users of baclofen.

It has been, for those of us who follow the baclofen "movement", incomprehensible that this drug is not being promoted by anyone. It is now long out of patent and is sold as a generic so there is no reason for it’s manufacturers to expend millions of dollars which would be required to patent it for alcohol use. As it’s use in alcoholism is "off licence" there is, arguably, no need for it to be trialed and rebranded as an alcoholism drug, in any event. It is prescribable already.

Some years ago, a user of baclofen got in touch with me and showed me an email he had received from George Koob in respect of baclofen. He had asked Dr. Koob whether he felt that baclofen was as effective in the treatment of alcoholism as Gabapentin, another gaba-b agonistic anxiolitic with fewer side effects than baclofen. Dr. Koob, while working at the Scripps institute had investigated Gabapentin for use in alcoholism and the NIH is now funding studies into the use of gabapentin encarbil for alcoholism by Xenoport. https://www.nih.gov/news-events/news-releases/nih-begins-clinical-trial-new-medication-alcohol-use-disorderThis could lead to a patentable medication. Similarly, Reckitts Benckiser, and Xenoport, are engaged in trials of Arbaclofen placarbil for treatment of alcoholism and all other uses, primarily to replace Subudone as a frontline treatment for opioide addiction.

If you read Dr. Ameisen’s book, you will see that Dr. Koob has long been aware of the use of baclofen. He is quoted in the book as supporting Ameisen’s theory and, indeed, you will find articles on the internet by Dr. Koob about whether alcoholism is caused by a neurological anxiety disorder.

Those of us who follow this movement have been puzzled for a long time as to why the NIH has not recommended to the medical profession and hospitals that drugs like baclofen be used as a front line treatment for alcoholism. I was unaware until I read your article that Dr. Koob seems to be firmly in the grips of pharmaceutical companies like Xenoport who stand to gain billions of dollars in profit from the development and marketing of these drugs in a patentable form. Of course, we all welcome advances in science, but baclofen is already available cheaply as a generic and Reckitts Benckiser has already found itself prosecuted by the FDA for offences related to the sale of generic versions of subudone. The loss of that drug has caused a massive loss of many billions of dollars to RB.

The lack of interest in generic baclofen is now easy to understand. Plainly, Dr. Koob is not interested in alerting the American public or Congress to the beneficial effects of baclofen or generic gabapentin, a they are cheap and widely available. He seems to prefer to promote the interest of his funders and his old employer, Scripps.

Can I please ask that you respond to this email. Alcoholism results in about three million deaths a year. It’s simply not acceptable that people in Dr. Koob’s position should not take an active role in promoting a safe drug for use in alcoholism when it is now being used around the world successfully. User’s of baclofen have become very discouraged as well by the lack of support in the public sphere for their use of the drug. Recovering alcoholics need support and understanding and that does not come when even the NIH are keeping quiet about the use of the drug while promoting the study of patentable derivatives. The reason put forward by many for not promoting the use of baclofen, for instance, is that it has a high side effect profile, which is not true if the dosage is moderated properly. Many users of baclofen overdose on the drug, not realizing how potent it is. There are also serious issues with discontinuation of the use of baclofen. It needs to be taken regularly through the day and for alcoholics who have difficulty managing their own affairs, this is problematic and withdrawal from the drug can cause delirium and suicidal thoughts. It is therefore of huge importance that this drug, which is being widely used, is studied and supported. It has become a grass-roots, underground movement of alcoholics desperate for help who find that it works wonders, but are left with no support from government or the wider community. Surely it is the responsibility of the NIH to exercise a role in these sorts of developments, instead of ignoring drugs while favouring those who seek to profit from new drugs.

I would like to have your comments.

Yours sincerely,

David Harris

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