A NEW TREATMENT FOR ADDICTION ?
It has been shown scientifically that drugs with a certain chemical property, called NMDA receptor blockers, can prevent and reverse tolerance to drugs, prevent addiction, and to some extent reverse addiction already present.
Tolerance is the phenomenon of needing higher and higher doses of a drug to achieve the same effect. Anybody taking a narcotic painkiller, for instance will become tolerant of it to some extent. Two things happen as a result of tolerance – higher doses are needed to achieve the same effect that a low dose produced when the drug was first taken. The other effect of tolerance is that if someone who is tolerant to a drug suddenly stops taking it they will usually have some sort of ‘withdrawal’ effect. Withdrawal is the painful and unpleasant but not fatal process that prevents most addicts of opiate drugs from stopping, if not quitting.
Tolerance is a constant and necessary part of the process called addiction, but tolerance by itself does make someone an addict. Anyone taking opiate drugs for more than a couple of weeks will be tolerant to them and will experience withdrawal if they stop suddenly. This does not make them addicts.
However, tolerance is always a part of the process of addiction, which is the process of losing voluntary control over one’s use of a drug (or activity such as gambling). People who become addicted always need more and more of the drug to which they have become addicted. Until recently addiction was thought of as a mysterious psychological process and all kinds of explanation for it were advanced, including character defects, sin, and lack of correct religious observance. Overcoming addiction has been a hit or miss process and one popular method involves supernormal religious or ‘spiritual’ methods involving a ‘higher power’ – AA for example.
However, the idea that addiction might be a simple chemical process based on the functioning of the nervous system is evident from simple observations – rats can become as addicted to alcohol, opiates, or cocaine as humans can. It is hard to involve higher mental function, psychiatric problems, or religion in a process that also affects rats.
Many scientists and scientific doctors now believe that addiction is a genetically caused process happening in certain vulnerable people when they are exposed to a drug or activity to which they are genetically ‘primed’ to become addicted to.
There are two drugs used in medicine that are known to stop addiction in some people. An antidepressant known as Wellbutrin, or Zyban, will remove the urge to smoke in some people – as soon as they start taking this drug they lose the urge to smoke. The addiction disappears without resorting to God or a ‘higher power’. A drug called naltrexone or Revia, will stop addiction to alcohol in some people. Surprisingly, it is an opiate blocker – it prevents opiate drugs from working. How it prevents and removes addiction to alcohol is not known. An alcoholic who can not voluntarily control his or her use of alcohol who takes naltrexone ( if it works for him or her) can drink or not drink subject to rational voluntary control – in other words the ‘alcoholic’ is no longer alcoholic and can ‘drink like a normal person.’
Two drugs known to be generally anti-addictive because of their NMDA blocking properties are already in use - dextromethorphan, a cough medicine, and ketamine, an anesthetic.
Dextromethorphan is not suitable for treating addiction because it is itself subject to abuse by some people who take it to get ‘high’. Ketamine has the same problem, but is already in use medically to reduce tolerance to opiate pain killers.
Memantine is a third drug with NMDA receptor blocking properties that has been shown to prevent the development of addiction (in rats) and to prevent tolerance developing in rats and humans. It has also been shown to reduce tolerance without causing much withdrawal, and by so doing it to some extent reverses addiction already present. It has not been used therapeutically in humans with addictions until now.
Finding that memantine was commercially available as a human drug for treating Alzheimer’s Disease this drug has been tested it in humans with taking opiate pain killers or having addictions or both, and some amazing discoveries have been made.
1. Opiate addicts on methadone maintenance programs sometimes get ‘stuck’ on methadone and find they can not stop the drug without terrible and long-lasting withdrawal. In addition, when they get off methadone they are still addicts and liable to start using opiate drugs again. Giving them memantine allows them to stop methadone in a few weeks without withdrawal, and seems to prevent the craving and compulsive use that would lead them back into addiction. Because memantine is not a controlled drug, it is far preferable to take it than to be on a methadone program with all its rules and controls and interference with normal life.
2. It is not yet known how long ex-addicts have to take memantine to prevent re-addiction, or whether or not they are ‘permanently cured’. Because addiction is known to be a learned process, and preventing learning prevents addiction, and because memantine interferes with the learning processes called tolerance and addiction, there is reason to suspect that becoming un-addicted with memantine may also be a learning experience and hence a permanent cure. However it may be that people will have to take memantine continuously or at regular intervals to prevent re-addiction.
3. Opiate addicts taking memantine can still get high, but not the way that addicts get high – it is not a life-altering never-to-be-forgotten experience that must be compulsively repeated over and over. Addicts wishing to stop being addicts seem to do so when they take memantine.
4. Only a few alcoholics and cocaine addicts have been tested on memantine so far, but with promising results. They seem to slow down and stop their use of the drug they are addicted to.
5. People with severe chronic pain taking opiate pain killers sometimes have to keep increasing their dose because of tolerance. This does not make them addicts, although some become addicted. Because of their need for very high doses their doctors may suspect them of being addicts or of selling their prescription drugs, and it may be very expensive because of the high doses they need. If they take memantine in addition to their opiate drugs, they can get by with lower doses and yet have better pain control. Some patients taking memantine have lowered their opiate doses by up to 75% and still had better pain control than they did without this new drug.
6. It is not known what effect memantine will have on addicts not wishing to stop being addicts. It would certainly make it cheaper for them to get high, because it prevents the tolerance which makes them need astronomical doses. However, it would also stop them ‘liking’ the drug so much. Contrary to popular belief addicts do not ‘enjoy’ taking drugs. They may seek a ‘high’ which is a special psychological and emotional state of long term value only to addicts, but a ‘high’ is not enjoyable to an advanced addict, and most addicts have long since stopped enjoying their addiction at all. There is no such thing as a happy addict, or for that matter one who is not filled with self-loathing and disgust. Addiction is a state with all the bad points of slavery, and none of the good ones, and people tend not to enjoy being slaves. Addicts don’t use drugs to feel good – they use drugs compulsively, and because they feel even worse if they don’t use the drug to which they are addicted.
7. Memantine appears to be the first generalized treatment for both tolerance and addiction. It seems to prevent the development of addiction, to turn off addiction that is already present, and it also lets people use lower doses of pain killers with greater benefit. It definitely works for opiates, probably for alcohol and cocaine, and only occasionally for nicotine, but this needs to be scientifically tested and these results need to be confirmed by multiple scientific investigators before it is turned lose on doctors and the public.
Memantine (Trade name Ebixa in Canada, where the drug is sold for treatment of Alzheimer’s Disease) has had startling and wonderful effects on a few patients in St. Catharines. If these effects are scientifically confirmed with controlled and ‘double blind’ experiments then the first step in the elimination of that scourge of human beings known as addiction will have been taken. Even if turns out to be effective for only a few patients it will be invaluable as a tool to scientifically investigate addiction by allowing us for the first time to ‘turn off’ addiction in animals and humans.
There is much that needs to be worked out with this new drug. For one thing the correct dose is not known. So far, successful anti-addiction has been achieved with doses from two to three times as high as those used for treating Alzheimer’s Disease, but instead of being taken daily the drug is taken every second day.