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What is Apomorphine?

  • The exact mechanism is unclear, but apomorphine acts on parts of the brain known to be implicated in addiction. The main effect was reported to be a reduction in the craving experienced by the addict, accompanied by a feeling of calmness and a reduction in anxiety.

  • It was historically taken by injection or tablet under the tongue. However, it is now possible for it to be taken as a nasal spray or a patch.

  • It was found to be very helpful for helping alcoholics to calm down by doctors in the very early 20th century. From there, some doctors noticed it had helpful effects on alcoholic craving in patients.

  • It disappeared partly because the treatment of addicts moved from being a concern of doctors to that of psychiatrists, and the proponents of apomorphine treatment were mostly medical doctors. When they died, their methods and treatment were mostly forgotten

  • Yes. The drug is known to be safe and is available now for other conditions. With enough public interest a trial could easily happen.

  • No. It is not morphine and does not have the additive or euphoric effects of morphine; there are almost no cases in the literature of anybody abusing apomorphine, not least because it causes nausea in high doses.

  • In low doses: sleep, relaxation.
    In high doses: nausea, vomiting, nightmares, cardiac events.

  • Like most drugs, it can be dangerous when taken in exceptionally high doses. However, it is one of the oldest and most well-studied drugs known to medical science – it has few side effects, and they are well known.

  • Yes, it is currently available as a treatment for Parkinson’s disease (apokyn), erectile dysfunction (uprima) and as an emetic for pets.

  • In the UK’s National Health Service treating a Parkinson’s disease patient for one year costs about £10,000. The cost of apomorphine for a week’s treatment to stop the physical craving for alcohol should be about £200. Apomorphine is not expensive to make and it’s out of patent. 
  • There is a shortage of effective drugs for alcoholism; of the newer treatments the NHS uses, a recent review concluded that none show more than “low to medium efficacy”*, and the number of alcoholics needing help is on the rise. Testing whether a safe drug might be repurposed to be helpful for alcoholism carries little risk with an enormous possible benefit.
     
    *Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. 28.07.17.