After a years-long struggle with alcohol, all of the answers to Kelly Kahanyshyn’s problems were found at the bottom of a bottle – a pill bottle.
“I tell you what, and I say this all the time: I don’t know what $1 million looks like, but I know what it feels like,” said the 53-year-old hairdresser, who started drinking as a teenager and was helpless to stop alcohol from slowly taking over her life.
Kahanyshyn finally resolved to get help last year after she started getting up in the middle of the night to drink and was indulging at work.
She went to treatment and was prescribed a drug called naltrexone as part of her recovery strategy.
Six months later, she was still drinking.
During that period, however, her counsellor took her to a talk by Dr. Jeff Harries, a retired Penticton family physician, who has now dedicated his life to raising awareness in the medical community of six particular drugs with which he’s had remarkable success treating alcoholics.
Kahanyshyn and her counsellor later did a phone consultation with Dr. Harries, who switched her from naltrexone to topiramate, an anti-seizure drug that is used off label to treat alcohol use disorder.
Three months and two short relapses later, she is sober with a completely new outlook on life.
“I feel like a whole different person,” said Kahanyshyn.
While working as a general practitioner in Penticton in 2003, Dr. Harries happened upon an article in medical journal The Lancet that explained how topiramate had been proven to help many people stop or reduce excessive drinking.
“That’s when I first understood that things weren’t as I’d been told in medical school,” said Dr. Harries.
“I tried (topiramate) on this patient, and I witnessed this miracle over a month. They didn’t need counselling or detox. They just slowly didn’t feel the need to drink.”
Since then, Dr. Harries has prescribed it and the five other drugs to “hundreds” of patients, ranging from teenagers to street people to fellow doctors, all of whom needed help to stop drinking.
So convinced is he of the drugs’ untapped ability to help alcoholics, Dr. Harries has also spent the past three years travelling around B.C. and Alberta talking to an estimated 3,500 doctors and other health professionals about his experiences.
Dr. Harries’ recent audiences have included B.C. Divisions of Family Practice, emergency room doctors at Kelowna General Hospital and family medicine residents at the University of Alberta
Sometimes he receives a speaking fee, but is even happy just to have his expenses reimbursed, because the talks are a labour of love for him.
FINDING WHAT WORKS
In addition to naltrexone and topiramate, the other drugs recommended by Dr. Harries are acamprosate, baclofen, gabapentin and ondansetron. None was created to treat alcoholics specifically: gabapentin is an anti-seizure drug that also helps with nerve pain from shingles, while ondansetron is an anti-nauseant commonly given to chemotherapy patients.
All of the drugs, though, work on brain chemistry, which is out of balance in alcoholics.
“Their brain circuitry is kind of out of whack because of their life experiences, their genetics and the impact of alcoholism. And so these meds work in different ways on different (brain) circuits, depending on what they’re struggling with,” explained Harries.
“But there are things in their history and their past you can sort of discover and give you a good idea which drug will work for them. So if you’ve had PTSD, topiramate is more likely to work for you. If you’ve had a history of migraines, topiramate is more likely to work. If you became an alcoholic when you were 13, ondanestron is more likely to work for you. If you’re Indo-Canadian, naltrexone is more likely to work.”
Also important is Harries’ approach to treating alcoholism as an illness, not weakness of character, and encouraging the use of other tools, such as counselling and joining programs like Smart Recovery and Alcoholics Anonymous.
His experience forms the basis of a paper he helped write that has been submitted for publication to the British Medical Journal.
Dr. Harries said the paper shows how the talks he has delivered to other doctors have changed prescribing patterns and increased the chances of patients being give one of the drugs. He said the paper demonstrates those changes have “dramatically” reduced the number of alcohol-related admissions and emergency visits to Penticton Regional Hospital compared to other cities.
Still, doctors right across Canada have been slow to follow Dr. Harries’ lead.
A study conducted by the University of Manitoba in 2018 found just 493 of 53,625 people in that province with a diagnosis of alcohol use disorder had been prescribed drugs as part of their treatment.
That’s likely because society’s slowly evolving view of alcoholism as a disease is the same as the medical community’s, according to the president-elect of Doctors of BC.
“I hate to say it in the 21st Century, but stigma about addictions and alcohol use disorder is still a thing,” said Dr. Matthew Chow.
“Although it’s less so now, because people realize that substance use and alcohol use disorders are no longer treated like a moral failing or lack of willpower, people understand more and more it’s a medical illness and it deserves medical treatment.
“It takes a long time for that kind of an understanding to really percolate through society, and percolate into physicians’ day-to-day practice.”
Another factor, he continued, is the knowledge gap that Dr. Harries is uniquely positioned to fill.
“The funny thing about docs – and this is why what Dr. Harries is doing is so awesome – is that docs tend to listen to other docs,” said Dr. Chow.
“If a guideline is issued from an ivory tower, a lot of front-line docs will look at that and say, ‘I don’t know if I can practically do this in my clinic.’ But when another doc like Dr. Harries says it, it’s more meaningful.”
Dr. Harries’ dedication has not gone unnoticed: He was recently honoured with the 2020 Everyday Champion award from the BC Patient Safety and Quality Council.
“Jeff’s tireless passion for improving the quality of care for people with alcohol use disorder is inspiring,” council chairman Dr. Devin Harris said in a statement.
“His work educating clinicians, destigmatizing alcohol use disorder and caring for patients is breaking down barriers and helping people access medications. He’s a wonderful example of who we celebrate through our Everyday Champion award – someone who goes above and beyond to lead change in our health-care system.”
Dr. Harries and his wife, Dr. Leona Harries, opened a family practice together in Penticton in 1990.
The two, who have nine children, ran the clinic together until May 2018, when he semi-retired after being diagnosed with ALS.
Also known as Lou Gehrig’s disease, ALS affects nerves in the brain and spinal cord that are used for voluntary muscle control, gradually leaving patients paralyzed and unable to eat or breathe.
Approximately 80% of patients die within two to five years of their diagnosis, according to the ALS Society of Canada. Those grim odds have only added to the importance of Dr. Harries’ mission.
“I feel some urgency because I know I won't be able to continue this forever due to my health,” he said.
“But mostly I feel the urgency because of ongoing unnecessary suffering these people and their families endure.”
Yet his legacy was secured somewhat in December 2019, when the British Columbia Centre on Substance Use released the new “Provincial Guidelines for the Clinical Management of High-Risk Drug and Alcohol Use.”
Running to 190 pages, the document was prepared with the help of a 43-person committee of which Dr. Harries was a member.
The guidelines cover everything from how to diagnose alcohol use disorder and help patients detox to what supports they’ll need in recovery. Also featured prominently are prescribing instructions for the medications championed by Dr. Harries.
Those drugs are described by the guidelines as “critically underutilized.”
“The cumulative result of these missed opportunities is a system where patients and providers alike are often constrained to managing the negative consequences of alcohol use rather than preventing or reducing harm through early intervention and treatment,” the guidelines state.
Above all, said Dr. Harries, the new approach to treating alcohol use disorder is rooted in giving people hope.
“Once you’ve started to give them hope, which is a really important part of treating anyone, then they can join with you in being hopeful.
“It’s just such a contrast with the hopelessness and such broad impact of this untreated or under-treated illness: the sexual assaults that occur, the violence, all the crazy family situations,” said Dr. Harries.
“It’s the most amazing thing I’ve seen in medicine – and I’ve delivered babies.”
6 DRUGS TO TREAT ALCOHOLISM
- Acamprosate (common brand name Campral): “This medication is used along with counselling and support to help people who are alcohol dependent not drink alcohol. Acamprosate works by restoring the natural balance of chemicals in the brain (neurotransmitters).”
- Baclofen (Lioresal): “Baclofen is used to treat muscle spasms caused by certain conditions (such as multiple sclerosis, spinal cord injury/disease). It works by helping to relax the muscles.”
- Gabapentin (Nerontin): “Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles (a painful rash due to herpes zoster infection) in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug.”
- Naltrexone (Revia): “Naltrexone belongs to a class of drugs known as opiate antagonists. It works in the brain to prevent opiate effects (e.g., feelings of well-being, pain relief). It also decreases the desire to take opiates. This medication is also used to treat alcohol abuse. It can help people drink less alcohol or stop drinking altogether. It also decreases the desire to drink alcohol when used with a treatment program that includes counseling, support, and lifestyle changes.”
- Ondansetron (Zofran): “This medication is used alone or with other medications to prevent nausea and vomiting caused by cancer drug treatment (chemotherapy) and radiation therapy. It is also used to prevent and treat nausea and vomiting after surgery. It works by blocking one of the body's natural substances (serotonin) that causes vomiting.”
- Topiramate (Topamax): “Topiramate is used alone or with other medications to prevent and control seizures (epilepsy). This medication is also used to prevent migraine headaches and decrease how often you get them.”
Source: HealthLink BC