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Focusing solely on the effect of the medication without taking a holistic view of the patient does not seem very constructive

We are grateful to Dr. Braillon and Naudet [1] for drawing attention to the off-label use of baclofen given to alcoholdependent patients. The temporary recommendation for use (TRU) of baclofen in such an indication, issued in March 2014 by the French National Safety Agency for Medicines and Health Products, required the online reporting of patients’ follow-up through the TRU portal. The authors of the letter stated that only a small proportion of patients were registered on the portal, indicating poor compliance by prescribers. This claim is not entirely accurate. The general practitioners or specialists in addiction medicine, dealing daily with patients in whom baclofen seemed to be indicated may not have reported these cases but still used the followup protocol, thus fulfilling the primary goal of the TRU [2]. Dr. Braillon and Naudet argued that off-label use of baclofen is not supported by scientific evidence, but they omitted that off-label use of medications under medical supervision may be useful, especially when evidence-based treatments have first failed [3]. This last point is clearly made in the French Alcohol Society guidelines, which state that baclofen should be used as a second-line treatment in alcohol dependence [4]. Finally, the authors make no comment on the risk of self-poisoning, which was the main objective of our study. To date, although the effectiveness of high-dose baclofen in alcohol dependence is limited, it does not seem very constructive to focus only on baclofen’s effects, without taking a holistic view of the patient. Physicians who prescribe baclofen to patients, for whom they believe this medication is indicated, should inform their patients of the risks and benefits of off-label use, as in this case they are outside the prescribing conditions set in the TRU protocol. Moreover, even if a medication has limited benefit, its prescription, under close medical supervision, may enhance the patient’s engagement in treatment, especially when combined with psychotherapy [5]. Multidisciplinary management of addictive illness is of paramount importance. We need to reflect on the indications of treatments to combat addiction, their risks of misuse or poisoning (common to all medications, not only to baclofen) and their use in populations that may be receiving multiple psychotropic treatments and also have comorbid conditions. This reflection needs to involve primary care providers, pharmacologists, pharmacists, psychiatrists, addiction specialists and toxicologists, so that we can advance together in the interest of our patients.