THINKING of taking a break from the booze? Many of us drink more than we probably should and wish we were better able to control our intake. Several drugs now in development could help us do just that.
In 2012, . Awareness campaigns and prevention services have done little to reduce the amount that people drink overall, and consumption has remained steady or increased around the world. The scale of the problem has led people, including , a psychopharmacologist at Imperial College London, to want to try a different approach.
Last month, a patent application was filed for a drug that is supposed to give people a pleasant intoxication as well as limit the amount they drink.
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In an unlikely marriage, the compound was created by the drug designer behind mephedrone, a now widely banned substance that has caused at least one death and been implicated in 13 others in the UK. The man, who has asked to be referred to by his pseudonym, Dr Z, initially intended his creation to be sold as a legal high. But after having discussions with Nutt and trying it on himself, he now plans to gift the patent to Nuttâs charitable research group , in the hope it will be used as a âbinge mitigation agentâ.
How it might finally be used will depend on the results of detailed testing â including how quickly it is absorbed and how it mixes with alcohol. But it might become something youâd take at the start of a night out, or perhaps even add to each drink.
âIt might be something youâd take at the start of a night out, or perhaps even add to each drinkâ
Nutt and Dr Z have called the new drug âchaperonâ. Its less catchy name is MEAI or 5-methoxy-2-aminoindane. Structurally, it is closely related to two drugs you can buy as a legal high in some places â MDAI and MMAI. Both were invented by from Purdue University in West Lafayette, Indiana, and have some of ecstasyâs euphoric effects.
Unpredictable effects
Nichols says chaperon also looks a bit like another drug, PMA, which is known to be highly toxic. And therein lies the risk: âThere really is no good way to predict biological activity in a completely novel structure,â he says. What it does to the brain is also hard to predict because small tweaks to a molecule can result in big changes to the neurotransmitters and pathways it acts on.
So far no lab tests have been done on the substance, but Dr Z and about 40 other people have tried it. One of those people was me (see âa test of chaperonâ). According to Dr Z, there have been no serious problems, although one person didnât enjoy the experience. Several others said it made them feel euphoric.
The effects varied, but some of the experimenters reportedly lost the desire to drink. The effect didnât kick in immediately. The longest delay was 2 hours, and it took 5 hours before I felt like holding back on the booze â although this may have been because I took a very small dose to start with. This isnât necessarily a problem, says Dr Z, as long as people know that in advance so they donât keep taking it while waiting for it to work. However, he is concerned that the effect is so much like ecstasy: âMaybe the drug is too good?â
Nutt doesnât think chaperonâs ability to induce euphoria is necessarily an obstacle. There are other drugs that help people with alcohol problems to drink less or that act as a less harmful substitute â including some that Nutt is involved with (see âThe alcohol fightersâ). But most cultures around the world use drugs for pleasure, so a drug like chaperon could be a âwin-winâ situation, he says, acting both as a binge mitigator and providing some of its desirable effects.
But âyou need scientific testsâ, says Nutt. âAnecdotal evidence isnât enough.â These would involve finding out what receptors it binds to, how it affects rats and working out a safe dosage profile, before raising funding to conduct clinical trials to see whether it really does reduce alcohol intake.
from the Australian National University College of Medicine says the safety bar for new medicines is high â and even higher for recreational products.
Caldicott is enthusiastic about the potential of a substance like chaperon, that has some of alcoholâs desirable qualities, but he is worried about mixing drugs and alcohol: âFrom a harm minimisation perspective, mixing drugs and alcohol is never a good idea. Itâs one of the basic premises.â
of the Australian Drug Law Reform Foundation says it is hard to predict what a drug will do when widely released. Its success will depend on whether it lowers peopleâs intake of alcohol or simply adds another dimension to a night out.
Of course, thereâs every chance the drug will simply be banned, like so many of Dr Zâs creations. Nutt is philosophical. âLetâs just hope they donât,â he says. âWe have to see this as an opportunity to reduce harms rather than a new drug that has hit the market.â
Leader: âRaise a toast to drugs that could replace alcoholâ
The alcohol fighters
Many drugs already exist that are intended to limit or replace alcohol use.
David Nutt from Imperial College London has been working on alcohol substitutes for years and says he now has five at various stages of development. While chaperon might limit the amount that people want to drink (see main article), the other drugs mimic the neurological effects of alcohol by tinkering with receptors that bind to GABA, the neurotransmitter that alcohol acts on in the brain. Nutt wonât reveal what the drugs are, but he has tried some of them himself and finds them enjoyable. Whatâs more, for some, thereâs an antidote so you can drive home after a night out.
In the 1980s, after seeing the way the mildly intoxicating drug kava was used in Fiji without the kind of violence associated with alcohol, . Whether it reduced overall harm is a matter of debate, but it came with downsides including skin irritation and liver toxicity. .
Drugs like naltrexone and block dopamine receptors in the brain, which alcohol acts on to make you feel good. Alcoholics are prescribed naltrexone and those who drink half a bottle of wine a night were by the UK health advisory body.
A test of chaperon
How do you safely try a brand new drug? The bottom line is, you canât. But I still wanted to put chaperon, the âbinge-drinking mitigation agentâ, to the test. So to reassure myself that I wasnât taking an excessive health risk I asked some scientists working in the field to carry out a few tests.
Their investigation was far from comprehensive, but it found that the drug doesnât seem to be toxic to kidney cells or to a type of neuron. NMR spectroscopy showed that the sample was pure chaperon, scientifically known as 5-methoxy-2-aminoindane or MEAI.
Having decided that the risk is acceptable, I try it on a night out drinking with friends. The first dose brings on a feeling of, well, nothing. After waiting 2 hours, I start to drink, slowly upping my dose of chaperon. Four hours after my first dose, I begin to feel a focused, relaxed high. But this feeling doesnât make me want to moderate my drinking. And more chaperon seems like a fun idea too.
By about midnight, more than 5 hours after the first dose, I feel intense but controlled euphoria. Now the idea of drinking alcohol seems repulsive â as does eating bar food. My friends are still ordering drinks and if I hadnât taken chaperon, Iâm sure I would be too.
My friends later described my behaviour as rational, if a little tense. The drug didnât stop me from sleeping and I had no anxiety or depression in the following days. So it seems like a party drug without some of the side effects.
My experience is not a scientific study. Itâs a sample of one, and not even a carefully monitored and measured one. But for what itâs worth, it took a lot of the drug to make me want to stop drinking and by then I felt both drunk and high. I enjoyed it, and I did not suffer any acute health problems, though the long term risks are unknown. My verdict? Much more research and development needed.
This article appeared in print under the headline âA not-so-bitter pillâ
