The End of My Addiction

craving in human beings. And three is that high-dose baclofen, on the same ratio of 1 to 3 milligrams per kilogram of body weight as in the laboratory animals, has entirely suppressed my craving for alcohol and resolved my anxiety better than any other medicine I have tried. And as you know, I have tried them all. I want to share this with the medical community, but I am afraid I will not be credible as an alcoholic.”
    Boris said, “Ultimately, the facts will decide, and you have powerful facts to report. What you’ve done is fascinating. When are you sending me the paper?”
    “What paper?”
    “The paper you must write on your findings. I am a contributing editor at JAMA [ The Journal of the American Medical Association ] now, and I can pass it on to the right person.”
     
    Over the next weeks, I busied myself with drafting a self-case report on my alcoholism and the change brought about by high-dose baclofen in only five weeks. I was not sure at this point if I should try to publish the case report anonymously or with a pseudonym. I had outed myself as a physician with addiction in my own hospital seven years earlier. To do so in a published paper was an even more radical step, and there would be no going back. From then on, anyone who Googled my name would see that I was an alcoholic, or at the least an ex-alcoholic. Would I ever find a job if the case report included my name? I also worried about embarrassing my family, but fortunately Jean-Claude and Eva had no objection.
    Weighing the personal risks against the potential public benefits, I recalled people I had met in detox and rehab. A number of them had died from alcoholism or other addictions. Others were still fighting for survival. Tentatively I decided that I would name myself in the case report in order to give it maximum impact. Revealing my identity would also make the point that those who suffer from addiction deserve to be treated with the same dignity and respect as sufferers from other diseases.
    One thing missing from the baclofen-related research I had found so far was support for baclofen’s safety at high doses. But then one day, searching for articles on “oral high-dose baclofen,” I hit something promising. In 1991 C. R. Smith et al., of the Medical Rehabilitation Research and Training Center for Multiple Sclerosis at Albert Einstein College of Medicine, had published a paper in Neurology entitled “High-dose oral baclofen: experience in patients with multiple sclerosis.” The abstract referred to MS patients taking more than 80 milligrams of baclofen a day and said that “taking a high dose was not associated with discontinuing treatment.” 1
    I checked around Paris for the article, but could not find a library that carried Neurology . In August I learned that the library at the Necker Hospital had the journal. Students and most of the staff were away, and the library was nearly empty when I went there to read the article.
    The article reported on MS patients taking up to 270 milligrams of oral baclofen, my own high point, for thirty-six months with no reported side effects. Equally important, the authors wrote, “Unfortunately, physicians tend to underutilize baclofen…Pinto et al. identified patients who had taken up to 225 mg daily for up to 30 months and emphasized that many patients need more than 100 mg daily and that side effects are only infrequently a persisting problem.” Now I had ample proof that I was not an anomaly, and that oral baclofen was safe in doses much greater than the 30–60 milligrams addiction researchers were using in their human trials of the drug. But how much higher?
    I searched for “baclofen overdose,” and found the abstract of a 1986 article by R. Gerkin et al. in Annals of Emergency Medicine , which reported that a woman had been unsuccessful in committing suicide by taking “more than 2 g[rams] of baclofen…the largest ingestion of baclofen reported to date.” 2 Not only had 2 grams of baclofen—almost seven and a half times the 270 milligrams that had suppressed my alcohol craving and more than sixteen and a half times my maintenance dose of 120 milligrams—proved nonlethal, but the woman had also made a complete recovery with no lingering side effects.
    John Schaefer’s Australian accent rang in my ears as I recalled his saying, “Olivier, it’s a very safe drug.” Given that the article on MS patients was published in Neurology , the leading journal in John’s own field,