The End of My Addiction

increases in dopamine (DA) efflux in the nucleus accumbens (NAc).
    Results
    Pretreatment with baclofen produced dose-dependent reductions in responding for dAMPH under both the FR and PR schedules, and attenuated dAMPH-induced increases in DA levels in the NAc.
    Conclusion
    These results add to previous findings showing that baclofen attenuates the reinforcing effects of psychostimulant drugs, and suggest that further investigation into the effects of GABA B receptor agonists on drug self-administration is warranted.

Baclofen For Comfort Care in Neurology
    Full Article
    Neurology 41 (1991), 1829–1831
    High-dose oral baclofen: experience in patients with multiple sclerosis
    Charles R. Smith, MD; Nicholas G. LaRocca, PhD; Barbara S. Giesser, MD; and Labe C. Scheinberg, MD.
    Abstract
    We reviewed a 10% random sample of charts from an outpatient clinic for multiple sclerosis to determine the frequency with which baclofen was prescribed for spasticity in high doses (> 80 mg/d). About 20% of patients had taken high-dose baclofen, and 15% were still receiving a high dose. Taking a high dose was not associated with discontinuing treatment.
    Spasticity, a frequent problem in multiple sclerosis (MS), can limit daytime function and interfere with sleep. Severe spasticity can result in fibrous contractures predisposing to pressure sores. 1 Baclofen is the treatment of choice for spasticity of spinal origin, 2 but not all patients respond to baclofen in the manufacturer’s recommended dosage range of 40 to 80 mg/d. Some patients experience adverse effects while others derive insufficient benefit. Some clinicians will prescribe beyond the recommended maximum when a satisfactory effect does not occur within the usual dosage range. 1 However, there are no published data on how frequently high doses of baclofen are given, what the range of dosage is, or whether patients on high doses are more likely to discontinue treatment because of adverse effects.
    To gather some data concerning baclofen use in the management of spasticity in MS, we completed a chart review for a 10% random sample of all patients actively followed at a large MS outpatient center. Our purpose was to generate estimates of the frequency of baclofen usage at various dosage levels. Of particular interest were those patients at or above the recommended maximum dosage of 80 mg/d. Since it was a simple chart review, we did not design this study to address directly safety and efficacy issues.
    Methods
    A chart review was completed for a 10% random sample of all patients with MS (n = 1,120) actively followed at the Medical Rehabilitation Research and Training Center for MS of the Albert Einstein College of Medicine. Demographics and history of baclofen use, if any, were recorded. Specifically, the highest dose, current dose, duration of therapy (both overall and at the highest dose), and the reason for stepdown or discontinuation were recorded.
    Results
    Demographics . A total of 112 charts were analyzed. The mean age was 45.2 years (SD, 13.5; range, 18 to 75). The mean duration of MS was 12.9 years (SD, 9.6; range, 5 months to 50.5 years). Women comprised 66% of the sample. As a predominately female, middle-aged sample with a severalyear history of MS, this sample closely parallels the patient population at the Center.
    Analysis of baclofen use. The average duration of therapy with any dose of baclofen was 43.7 months (SD, 37.6 months; range, 1 to 132 months). The average duration at the highest recorded dose was 15.8 months (SD, 16.4 months; range, 1 to 63 months).
    Table 1 presents data on baclofen prescription in terms of the history of baclofen use. While 59% (n = 66/112) were currently taking baclofen, 66% (n = 74/112) had taken it at some time while a patient at the Center. Thus, the majority of patients treated at this Center receive baclofen on an ongoing basis. Of those still taking baclofen, the majority (n = 45/66 or 68%) were receiving baclofen at the highest dose they had ever gotten.

    TABLE 1. History of baclofen use
    As expected, use of high-dose baclofen was frequent, with 15% of patients currently on baclofen receiving more than 80 mg (≤180 mg, 85%; >80 mg, 15%; mean, 59.7 mg; SD, 44.5 mg; range, 5 to 270 mg). When the maximum dosage recorded was considered and patients who had discontinued were included, the percentage of patients who had received more than 80 mg rose to 20% (≤180 mg, 80%; >80 mg, 20%; mean, 65.6 mg; SD, 49.2 mg; range, 15 to