Acomplia, or rimonabant, is a new French medication that has been shown in two studies to help with patients with obesity and smoking cessation.  A pill that helps you lose weight and quit smoking?  Yes, but there's more.  Scientists say the experimental drug could also help people stop abusing drugs and alcohol, too.

      Produced by the French pharmaceutical firm Sanofi-Aventis plans to seek federal approval for rimonabant next year.  Studies suggest rimonabant can block the effects of marijuana and fight relapse in alcohol and cocaine abusers and it helps patients lose weight and keep it off at least two years.  Overweight people lose four times as much weight on Acomplia as on a placebo; however, trial results do suggest that long-term use of Acomplia will be required to maintain the significant weight loss that occurs mainly in the first year. Participants in the trial who were switched after a year from Acomplia to a placebo tended in the second year to regain the weight they had lost.

      This is not surprising.  Obesity is a chronic disease and the best that we can hope for with today's technology is to control it not cure it.  Long term side effects are unknown but the short term side effects seem to be limited to neuropsychiatric effects such as depression and irritability; two patients reported amnesia.  Fortunately, all side effects seem to be temporary and subside when the patients stop taking the medication.

      Rimonabant's effects seem to be tied into its negative effects on the brain's reward system circuitry.  Basically, it appears to help break the connection between an activity like eating or smoking and the rewarding feeling it causes in the brain.

      The body has its own drug-like substances called endocannabinoids; they activate certain brain cells that in turn can lead to stimulation of the brain's reward system. Pleasurable things like eating, smoking, and drinking alcohol are thought to activate a feeling of reward by acting through the endocannabinoid system.

      Rimonabant blocks the effect of the natural endocannabinoids by keeping them from attaching onto the brain cells they normally stimulate. In overeaters, for example, that seems to restore the natural balance of the brain reward circuitry so they don’t overeat for pleasure even after they are not hungry any more.

      This is very important to overweight and obese patients.  If everyone only ate when they were hungry, very few people would have a weight problem.  The truth is many people eat, or rather overeat, because of depression, stress, anxiety, boredom, cravings, or just pure compulsion (built in genetic drive).