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Is Prometa the prescription for addicts?

May 27, 2009 12:00:00 AM PDT
More than 120,000 Americans die each year from alcohol or drug dependence. Support groups and counseling used to be the only ways get help. But what if there was a drug that could erase the cravings? We take a look at the debate surrounding a prescription for addiction.Matt McLellan's art tells a story -- a story of his addiction and pain.

"It's just an awful, ugly piece. The arm of the devil," said McLellan.

Matt McLellan started with alcohol. Then, it was marijuana and crystal meth. But his worst enemy -- crack cocaine. His wife and three kids moved away. Matt lost his house and spent more than $50,000 on the cocaine.

"I couldn't walk away until all of the money was gone," said McLellan.

For eight years, he tried to quit. Finally a treatment called Prometa helped Matt stay clean and sober for a year.

"I haven't seen anything else like it," said Dr. Steve Ayers.

Dr. Ayers uses Prometa on his patients. The treatment involves three to five infusions of a drug used to treat overdose. Then for a month, patients take daily doses of oral pills -- typically taken for anxiety and seizures.

"It physiologically changes the brain tissue, the brain chemistry," said Dr. Ayers.

The theory: the drugs calm hyper nerve cells. Some believe this lowers cravings.

"I have the conviction that it absolutely does work," said Dr. Raymond Johnson.

Dr. Johnson has used Prometa on more than 200 patients. He says about 70 percent recovered, but not everyone is convinced.

"There are no clinical trials that suggest it is effective," said Dr. John Mendelson, senior scientist, California Pacific Medical.

Dr. Mendelson says the studies were not "double-blind," meaning Prometa has not been tested against a group of patients that receive no treatment. The regimen is not FDA approved and can cost up to $15,000, which is not covered by insurance.

While Prometa has its critics, Matt McLellan says it's the only thing that worked for him.

"I think I'm so blessed to have found a cure for this disease in my lifetime," said McLellan.

The drugs used in the Prometa cocktail are FDA approved for other uses -- but not for addiction. They are part of a program that also includes nutritional supplements and counseling sessions. Three double-blind, placebo-controlled studies at UCLA and Cedars-Sinai are under way to further evaluate Prometa's success.

Web Extra Information: Attacking Addiction: Cure In A Cocktail

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," Dr. Johnson told Ivanhoe.

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.

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