Controversial Treatment Fights Drug Addiction

[Tchort]

Connect MidMissouri.com

Monday, May 25, 2009 at 7:16 p.m.

BACKGROUND: According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health in 2006, 23.6 million people aged 12 or older needed treatment for an illicit drug or alcohol abuse problem. In that year, there were nearly 1.8 million admissions for treatment of alcohol and drug abuse to facilities that report to state administrative data systems. About 40 percent of the admissions were for alcohol treatment. Heroin and other opiates accounted for 18 percent of drug-related admissions, and marijuana accounted for 16 percent.

FINANCIAL TOLL OF ADDICTION: A study prepared by the Lewin Group for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism estimated the total economic cost of alcohol and drug abuse to be $245.7 billion in 1992. This estimate included substance abuse treatment and prevention costs as well as other health care costs, costs associated with reduced job productivity, and costs to society such as crime and social welfare.

A MEDICAL TREATMENT FOR ADDICTION? Prometa is a treatment program used on people with alcohol, cocaine and meth addictions. It involves three to five infusions of the medication Flumazenil, which is used to treat benzodiazepine overdose. Patients also take daily doses of hydroxyzine (typically used to treat anxiety) and gabapentin (typically used to treat seizures) for about a month. The idea is the drugs target areas of the brain called gaba receptors that are in charge of calming hyper nerve cells. Doctors believe this is what reduces cravings both in frequency and in strength. The program also involves nutritional guidance and counseling sessions. Many addicts report success with this program. Raymond Johnson, M.D., a psychiatrist in Ft. Myers, Fla., has used the therapy on more than 200 patients. He says about 70 percent have recovered completely. "One thing it [Prometa] does really well is that it decreases the severity of compulsion and craving, and in a lot of cases, it's eliminated it for patients," says Dr. Johnson.

The Prometa treatment program is not appropriate for certain patients including those dependent on benzodiazepines; patients being treated with benzodiazepines for seizure and/or psychiatric disorder; alcoholic patients in severe withdrawal or at risk for severe withdrawal; pregnant women; women who are breastfeeding; and patients with allergies to any of the medications used in the Prometa treatment.

SOME AREN'T CONVINCED: Some doctors like John Mendelson, M.D., a senior scientist from California Pacific Medical Center Research Institute in San Francisco, Calif., say the Prometa program has not been studied effectively. Dr. Mendelson says there are no double-blind, placebo-controlled studies showing Prometa's success, meaning Prometa has not been tested against a group of patients that receives no treatment. He also points out that the therapy is not FDA-approved for addiction. "The real ethical hinge is not that they're promoting the treatment, but that they're charging money for it, and they're selling it as if it was an approved, completely validated treatment," says Dr. Mendelson.

For More Information, Contact:
The Prometa Treatment Program
http://www.prometainfo.com/
(800) 700-5500

http://www.connectmidmissouri.com/news/news_story.aspx?id=304226

It seems Prometa is starting to gain some traction in the media. This is excellent news. A relative of mine (who is a firm supporter of MMT/BMT since my experiences with them) saw an infomercial / talkshow type program about Prometa a year or two ago, and asked me about it. I had no idea, looked it up and honestly I am very optimistic about it. It is specifically for treatment of Alcoholism, Cocaine and Methamphetamine abuse, but honestly I don't see why, especially if combined with other pharmacotherapies, it can't be also used in opioid addiction treatment among other substance abuse and compulsive behavioral problems (gambling/sex compulsions).

Here is a breakdown of the treatment and meds involved:

Hythiam has hypothesized that the treatment works to decrease anxiety and craving by "normalizing" GABA receptors (molecules in the brain that respond to neurotransmitters).

For alcohol dependence, the treatment consists of flumazenil (administered intravenously), hydroxyzine, and gabapentin. The treatment is similar for stimulant dependence, with additional flumazenil administrations. The dosing regimen of the drug combination is discussed in Urschel’s recently published study. The initial intravenous administrations are followed up by orally prescribed medications and behavioral treatment.

http://en.wikipedia.org/wiki/Prometa

 

[Holy_cow]

Sounds like Snake Oil to me.

 

[Tchort]

Sounds like Snake Oil to me.

Why do you say that?

I think the science has a leg to stand on at the very least. For awhile now SSRI's and DRI's have been pretty lackluster in their treatment of compulsive behavior and addiction (even though it is well accepted that these systems play a vital role in addictive/compulsive behavior). Relaxing the stimulation and anxiety of a compromised Dopamine/Seratonin system by targeting GABA receptors seems like a good idea. I wonder what a drug like Gabatril (Tiagabine) could offer.

Currently, SSRI's/DRI's + Benzo's and sleeping pills is the only 'treatment' offered to stimulant abusers, compulsive gamblers, etc. It isn't working. Stimulant or depressant replacement therapy (with D-Amphetamine or Modafinil for speed/coke abusers, Chlomethiazole for alcoholics) has been a failure overall as well.

I think its great that some media outlet is giving a balanced report on Prometa. New ideas in treatment should find much more enthusiasm than they do.

 

[Hammilton]

which is used to treat benzodiazepine overdose. Patients also take daily doses of hydroxyzine (typically used to treat anxiety) and gabapentin (typically used to treat seizures) for about a month. The idea is the drugs target areas of the brain called gaba receptors that are in charge of calming hyper nerve cells.

Neither drug targets GABA receptors.

I agree, this is nothing but snake oil. Look at the amazing reports that concoction from china or korea or thailand (I forget which) gets for it's ability to break opioid addiction. And that African concoction for treating AIDS. People will believe anything, and placebo will carry them for so far.

Lets see how well they stand on their own legs after treatment is finished. I doubt their relapse rate is any better than suboxone or MMT, or hell, AA/NA.

 

[Holy_cow]

There's a reason why it's called a "Controversial Treatment". Are there any proper clinical trials proving the efficiacy of the Prometa treatment? Is the Prometa treatment FDA approved?

 

[Tchort]

Look at the amazing reports that concoction from china or korea or thailand (I forget which) gets for it's ability to break opioid addiction.

Heantos.

Are there any proper clinical trials proving the efficiacy of the Prometa treatment?

Ongoing Studies
Evaluation of the PROMETA Treatment Program for treatment of alcohol dependence at Cedars-Sinai Medical Center, Los Angeles, CA

• Jeffrey Wilkins, MD; Vice Chairman, Department of Psychiatry and Mental Health
• 80-subject, randomized, double-blind, placebo-controlled study of the Prometa Treatment Program on neurocognitive function and cravings in alcohol dependence.

• First subject in: April 2007


Clinical study of the PROMETA Treatment Program for alcohol dependence at Institute of Addiction Medicine in Philadelphia, PA

• Jenny Starosta, PhD and Joseph Volpicelli, MD
• 120-subject, randomized, double-blind, placebo-controlled study; changes in neurocognitive functioning, reduced cravings, subject retention, self-report and biomarkers of alcohol use, safety and efficacy
as endpoints

• First subject in: March 2007


Clinical study for testing efficacy for treatment of methamphetamine dependence at UCLA’s Integrated Substance Abuse Program (ISAP), Los Angeles, CA

• Walter Ling, MD; board-certified neurologist and psychiatrist
• 120-subject, multi-site, randomized, double-blind, placebo-controlled study; abstinence and preventing relapse as endpoints

I'm much more optimistic about the positive results related from studying Prometa and the theory behind it vs the farce of trying to clone Methadone maintenance for non-opioid substance abuse disorders (Keith Moon with a belly full of Chlomethiazole on his deathbed is a good mental image).

 

[qwe]

For awhile now SSRI's and DRI's have been pretty lackluster in their treatment of compulsive behavior and addiction (even though it is well accepted that these systems play a vital role in addictive/compulsive behavior). Relaxing the stimulation and anxiety of a compromised Dopamine/Seratonin system by targeting GABA receptors seems like a good idea

indeed, weaning people off of downregulated GABA receptors (or upregulated acetylcholine or whatever depressants tend to do, i forget ) is what's required. cold turkey causes health problems, possible death, and probable relapse. if people are getting off drugs under medical supervision on weaning doses of things, drugs that will ameliorate withdrawal symptoms like restlessness and dysphoria, drugs that will calm them down from the stimulation of withdrawal, that's a great thing for them! and they'll be able to sleep. there will be less interference from things like depression etc

these are drugs that influence symptoms of depressant withdrawal, and i believe they have some effect at gaba if not mistaken. if the snake oil comment was intended as "it's not science" that's quite wrong...

vs the farce of trying to clone Methadone maintenance for non-opioid substance abuse disorders (Keith Moon with a belly full of Chlomethiazole on his deathbed is a good mental image).

um. if someone is quite addicted to a depressant like alcohol or a benzodiazepine, the only way they may be able to be happy is to continue having a GABAergic depressant. GABAergics are more addictive, physically, than opioids. why wouldn't maintenance be an option? or, besides "methadone treatment" type, why not a clone of "methadone detox", a slow gradual decrease in the amount of the drug?

 

[Hammilton]

these are drugs that influence symptoms of depressant withdrawal, and i believe they have some effect at gaba if not mistaken. if the snake oil comment was intended as "it's not science" that's quite wrong...

Not really. It's not science. Or perhaps more properly, it wasn't science. The science behind it is not great. No research was done at all before these Prometa people started making their millions. Now they're trying to find evidence that it works. That's not how science is supposed to work, you should know.

What does Keith Moon have to do with anything? He wasn't taking clomethiazole as a depressant maintenance, he was abusing the hell out of it. Combining it with alcohol is even stupider.

I don't see anything wrong with a depressant maintenance. Something like alpidem ought to work quite well.

 

[graffitiscraps]

I was treated with Prometa, i know this is an old thread but thought id resurface the topic for discussion if anyone is interested.

 

[Jabberwocky]

How did it go for you, graffiti? Have you managed to stay clean from drugs since? How long has it been since you've been there? I'd be really interested to know.

 

[Venrak]

Me too. Kinda tired of this shit.

 

[23536]

Flumazenil? Is this a joke? Flumazenil is practically poison.