Bad Science: “Miracle” Cures for Addiction

snake oil

 

 

Addiction is hard to treat. Like other chronic illnesses, relapses are common, and frustrating to both the patient and the family. Substance use disorders cause considerable disability and even death. Treatments do help many people, especially medication-assisted treatment for opioid use disorder, but still aren’t as successful as we’d like.

Scoundrels looking to make a quick buck often prey on patients with diseases that are difficult to treat, like cancer, multiple sclerosis, substance use disorders, and the like. Sometimes bogus treatments have no basis in science at all. Sometimes minimally helpful treatments are touted as being more successful than science shows that they are. In all these cases, bad science is used to cover questionable, usually financial, motives.

I hate bad science. For the purposes of this blog post, I’m defining bad science as when people attempt to give their treatment, or method, or viewpoint, a sheen of scientific validity by using or misusing data, or by having no relevant data at all.

Some examples are more outrageous than others, and bad science has been used for decades.

Charles B. Towns, together with Dr. Alexander Lambert, declared the Towns-Lambert cure for alcohol and drug addiction to be 90% effective. The Towns-Lambert cure was a mixture of belladonna, hyoscyamine, and herb called prickly ash, castor oil, and mercury. Patients were also given chloral hydrate, a sedative similar to a barbiturate, along with morphine and paraldehyde. It fact, it was while he was a patient in Towns’ New York hospital that Bill Wilson, co-founder of Alcoholics Anonymous, had his vision that lead to his spiritual awakening, which in turn lead to the formulation of the Twelve Step program of AA.

Eventually, the number of repeat patients undermined claims of the cure rates of the Towns-Lambert method. Despite his lack of evidence, Towns’ claims became ever more extravagant, leading Dr. Lambert eventually to disassociate himself from Townes. Eventually, the Towns cure was discredited and disappeared.

This wasn’t the first treatment with better marketing than science, and it certainly wasn’t the last.

I had the displeasure of seeing a product being promoted at a recent conference I attended. This device, and I’m not going to give the name since I don’t want to give the promoter any free publicity, generates electrical pulses to the head. Three electrodes are placed just under the skin, and the device is worn for five days while the patient receives intermittent electrical stimulation. This supposedly gets rid of opioid withdrawal symptoms.

The person peddling this new invention shot himself in the foot in my view as soon as he said this device worked 100% of the time. When I asked for studies which had been published in peer-reviewed journals, he said they had loads of studies. Sadly, none were yet published that had been done in humans. He did have human data, but it wasn’t published yet, since an IRB (internal review board) hadn’t approved the study design before they undertook the study, so they had to find someone to approve the study after it was done.

Huh? No, that’s not the way review boards work. Review boards review studies before they are done, to assure no patient will be put in danger needlessly. I’ve never heard of a post-study review board.

So anyway, their human data hadn’t yet been published.

I hinted (oh OK, I came right out and said it) that perhaps it was a bit unethical to promote and expensive treatment ($500, not covered by insurance) unless they had human data, approved and reviewed by the research community, showing efficacy. The promoter of the item countered by saying it was unethical NOT to provide this device, given the benefit it provides.

He didn’t understand that my objection was to the lack of scientific process that all new treatments should undergo, to show they are of at least some benefit prior to use in clinical practice. This should be done before the treatment is marketed. But he pointed to all the success stories on their website, testimonials by patients of how effective this treatment was at preventing opioid withdrawal.

These testimonials are called anecdotal data in the scientific community. Anecdotal data isn’t nothing. It is a type of information that can suggest a potential effective treatment. But anecdotal data alone isn’t sufficient to claim efficacy. It’s only a potential starting point.

People tend to give testimonial type of anecdotal information more credence than they deserve. Hearing a story of miraculous healing touches our hearts. If we are also desperate for a similar cure, we risk making emotional decisions rather than rational ones.

I wasn’t trying to tell this salesman his product didn’t work. For all I know it will be the greatest breakthrough in addiction medicine in the last one hundred years. What I’m saying is that we don’t yet know if it works, because it hasn’t yet been properly tested. And therefore, I thought it was unethical to sell it before testing it.

Does anyone remember Prometa? It was all the rage ten years ago. News articles asked if it was the big breakthrough in addiction treatment. Anecdotal stories from former methamphetamine addicts were heart-warming. The company that supplies Prometa, Hythiam, was created by a former junk bond salesman, which could have been a red flag. That salesman heavily promoted Prometa with the anecdotal stories from addicts who had lost everything but were now drug free and happy.

The medications that made up Prometa are hydroxyzine (an antihistamine with sedating properties), gabapentin (an anti-seizure medication also used for neuropathy) and flumazenil ( a benzodiazepine antagonist). All three are FDA approved for uses other than addiction, but the proprietary combination of these made up Prometa, and it was sold as an addiction treatment cure without FDA approval. This is perfectly legal, by the way.

One drug treatment court, in Tacoma, Washington, paid $400,000 to buy Prometa for its participants. When it was discovered that several of the people making decisions for the drug court also owned stock in Hythiam, it left some people believing there was a conflict of interest. And after results from that drug treatment court were available, Prometa performed no better than traditional (and much cheaper!) treatments. [1]

Ten years later, I rarely hear the word Prometa. Hythiam changed its name to Catasys. Dr. Walter Ling, a very respected scientist in the addiction treatment world, completed a double-blind placebo-controlled studies showed Prometa to be no more effective than placebo.

But all this happened after that former junk bond trader made up to $15,000 for every Prometa patient treated. All those patients and their families were disappointed by another treatment that promised much and delivered nothing better than placebo.

I think it’s unethical for a company to bring a product to market before there’s adequate science to prove that it works. This rather rigorous process is what makes a product or procedure or methadone evidence-based.

Until you’ve got something that’s evidence-based, please don’t waste my time by trying to sell it to me.

When the marketing of a medication outpaces the research supporting it, watch out. We are in snake oil territory.

If a salesman blathers about how good his product is, but can’t hand you a good study published in a peer-reviewed journal, beware. With science, you’re supposed to do the studies first, then present at a conference of your peers, or in a peer-reviewed journal. The data should be able to be replicated by other facilities before we can see it is an evidence-based treatment. Barring that, it’s only a possible treatment among many possible treatments.

  1. “Prescription for Addiction,” 60 Minutes, CBS News, December 9, 2007 http://www.cbsnews.com/news/prescription-for-addiction/3/
  2. Ling et. al., “Double-blind placebo-controlled evaluation of the PROMETA program,” Addiction, 2012 Feb;107(2):361-9
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8 responses to this post.

  1. Posted by Andrew angelos on October 2, 2016 at 9:09 pm

    Unrelated to this weeks topic. I’ve followed your blog for about 2 1/2 to 3 years now I believe. Once again thanks for the outlet. I’ve posted a few times and enjoy the topics you present weather or not I agree with you. I’ve had the hardest time getting into a suboxone program. I’ve been taking suboxone for about 3 1/2 years at present. About 1 1/2 years ago my program abruptly ended. I tried to get into other programs but none had room or didn’t accept my ins. I recently got a new job and had to purchase my own ins and after some leg work was able to find a doctor and get into see him. My circumstance is a bit of a problem since I work all around the country for about 4 to 6 weeks at a time. Hopefully that will be ending soon and they will adding me to jobs more locally. My new doctor was a stark contestant from my old program in which I never once met my prescribing doctor. Now I meet directly with the doctor. He , based on my old records was willing to accept me and work around my work schedule. I’m so happy to not have to buy the subs off the street. The last batch I got was 40 dollars a 8 mg strip. I brought up this blog in my appointment and the doctor also reads it. Over he last year and a half this blog has kept me going and helped to continue my resolve to not give up and never go back to using full opioids. I hope to reduce dosage and eventually be off the drug someday but my doctor said he is also willing to treat me forever if that’s what I need. A stark contrast between the last program. Which had a maximum of 3 years. Thanks for your efforts and your time. You do make a difference in people’s life and I hope you know that.

    Reply

  2. Posted by Troy on October 4, 2016 at 7:05 pm

    Greetings, I’ve just discovered your blog and I was hoping you could offer me some advice. I live in Australia where I’ve been under the management of a pain clinic specialist. I’ve been prescribed Oxycodone 20mg capsules Instant Release 3 times a day for the last 7 years due to chronic pain associated with several complex medical conditions. One of them being “Ehlers Danlos Syndrome” a genetic disorder effecting collagen and soft tissue, tendons, cartlige and causing dislocations and  hypermobility. I also have degenerative joint and connective tissue disorder resulting in various surgeries in my knees and hips for worn cartlidge. I regularly get inflamation, stiffness and severe aching pain in all my connective joint areas from neck down to toe. The worst pain originates from chronic neck problems resulting in severe migraines and Cervical Neck Instability mainly in the atlas c1. So anyways I guess I’m trying to establish that my pain medication is warranted. These days as a chronic pain patient I feel as though unless I prove my legitamacy I may be perceived as a potential drug abuser.

    Here in Australia, the damage caused by the behaviour of drug seekers and doctor shopping has been immense in destroying the trust of doctors and caused all sorts of problems and difficulties for legitimate patients with chronic pain. Medical Practioners have naturally become overly cautious and suspicious dealing with anyone presenting with a history with pain medication and there’s this attitude as if everyone on opiates are guilty until proven innocent.

    As a chronic pain patient I’ve been mistreated in hospital ER during a number of unrelated medical emergencies by presumptious doctors who are way too quick to jump to conclusions before they bother to read your medical history. Once you’ve been subjected to these type of mistreatment you begin to develop an apprehension and concern each time about how you might be perceived and these feelings hurt your ability to have an open discussion even with your own prescribing doctor. As a result of this fear I’ve not been able to talk to my doctor about the topic of withdrawals or wanting to taper of my medication. Even though it should be an accaptable fact that long term use of opiates results in dependance, there still seems to be a misunderstanding of the difference between physical dependence and drug addiction. Many patients, the general public, and sadly even some physicians fear that anyone taking opioid medications on a long-term basis will become addicted. As a result, pain patients are often labeled as “drug seekers” and stigmatized for their use of opioid medications. At the fear of being misunderstood I continue to suffer in silence and feeling enslaved to repeat a regular routine of dosing 3 times a day or else face withdrawals. In this current regime I don’t have the flexibility to adjust my dose by lowering or increasing to meet the random onset of pain. What sort of advice would you have for someone in my shoes? Is buprenoprphine also the best option for chronic pain patients who want to break away from their prescription dependance? Thank you for your time and help.

    Reply

    • I’m sorry you are having this problem.
      I don’t treat pain, though many of my patients with opioid use disorder also have chronic pain. In fact, many of them developed addiction as a complication of their treatment for pain.
      Many of my patients say buprenorphine brings their pain to manageable levels, but there is no way I can tell you what will work for you. My best advice is to see a doctor well-trained in pain management. It sounds like you really aren’t happy with your present doctor and it never hurts to get a second opinion.
      Hope this helps.

      Reply

  3. Thanks Jana for sharing this post. Addiction is a complex but treatable disease that affects brain function and behavior.No single treatment is right for everyone. I think A range of care with a tailored treatment program and follow-up options can be crucial to success.

    Reply

  4. Posted by William Taylor, MD on October 5, 2016 at 3:29 pm

    Your postings are always enjoyable and provocative. Thanks. Two comments:

    1. I used to live and work in Tacoma. Stories of political corruption emanating from there do not surprise me in the least.
    2. Fanciful addiction cures past and present, based on pseudoscience, keep emerging but are discredited fairly rapidly. The elephant in the room, however, is the status of scientific evidence for abstinence-based rehabilitation programs, some of which are very prestigious and well supported by the media, the justice system, health insurance, and the medical profession. How well do they work in the long run?

    Reply

  5. Posted by Robin Sherman, APRN on October 7, 2016 at 1:03 pm

    I completely agree with you. Problem is there seems to be a serious lack of funding for legitimate research to be done fore treatments which do not have the potential for financial profit. This is sad and I rarely here health care professionals address this problem.

    Reply

  6. I remember in the 1970s when a psychoactive substance called Ibogaine from west Africa was touted as a cure for addiction. Also a Dr Meg Patterson (deceased) claim electronic frequencies were used to wean rock stars like Pete Townsend, Eric Clapton and others. These were more magic bullets I supposed that claimed to eliminate withdrawal symptoms with little effort.

    Reply

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