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Baclofen Addiction, Abuse, and Treatment

Baclofen Addiction, Abuse, and Treatment

Table of Contents

Introduction

Baclofen is a pain medication that many people aren’t familiar with. You might be aware of the addictive nature of opioids. Every day, opioid-related drug overdoses kill over 130 people in the US.1 Addiction treatment in a rehab facility can help with recovery from substance use disorders.

Notably, some experts compare the rise in baclofen use to the increase in opioid use in the past. Baclofen exposures increased in 43 states from 2014-2017. Wisconsin, Virginia, and Missouri had the highest increase in the rates of nonsuicidal use.2

In 2014, doctors wrote 4.76 million baclofen prescriptions. The number increased to 5.70 million in 2016 and slightly decreased to 4.58 million in 2017.3 With the current trends in use, global sales will exceed $400 million in 2024.4

Abusing this drug isn’t as dangerous as opioid abuse. Nonetheless, there is a substantial risk of many negative health consequences, including coma and death.

What is Baclofen?

This medication is a muscle relaxant or muscle relaxer. It is used to relax stiff and tight muscles caused by multiple sclerosis and spinal cord injuries. A doctor may also use the drug to treat nerve pain and other conditions, such as:5

  • Alcohol abuse and dependence: Excessive alcohol use
  • Alcoholic liver disease: Liver damage due to long-term heavy drinking
  • Trigeminal neuralgia: Severe burning pain on the face due to nerve damage
  • Hiccups: Involuntary contractions of the muscles involved in breathing
  • Gastroesophageal reflux disease: Long-term digestive disorder that causes heartburn

Baclofen is only available on a doctor’s prescription.

How Does It Work?

No one knows the precise mechanism of action in baclofen. Animal studies suggest the drug decreases electrical activity in the brain and spinal cord. It may work by:

Increasing the release of brain chemicals (neurotransmitters) that block electrical activity in the brain and spinal cord.

Reducing the release of neurotransmitters that increase electrical activity in the brain and spinal cord.

The overall effect is the depression of activity in the brain and spinal cord, which may be responsible for relieving muscle stiffness and tightness. As a depressant, it causes euphoric effects, reduces stress, and can reduce pain sensations.

The drug comes in the form of oral tablets and liquid. An injectable form is also available, which is injected into the spinal cord by a medical professional. Brands in the US include Lioresal, Kemstro, Ozobax, and Gablofen. The first two brands are no longer available. However, generics drugs may be available.

Street Names of Baclofen

Currently, no street names of the drug are known. Nonetheless, the emergence of the street price (street value) suggests the drug has already reached the illegal drug market. Prices on the illegal market will continue to vary. 

Is Baclofen Addictive?

Baclofen can lead to addiction if it causes:

Abuse

Abuse refers to the inappropriate use of a drug to experience its effects. Drug abuse includes using a substance in higher doses, more frequently, or for longer than recommended. There are only a few reports on baclofen abuse. The first case of abuse came to light in 1998. According to the report, 14 young people abused 60 to 600 mg of the drug at a party.6

Nonetheless, more reports of abuse/misuse have appeared over the years. Out of 15,397 baclofen exposures from 2014 to 2017, 40% involved no other substances. Among baclofen-only exposures, researchers found 250 cases of abuse and 558 cases of misuse.2

Dependence

Dependence occurs when a person cannot function normally without using a drug. An addictive substance can cause physical or psychological dependence, or both. Scientific studies show that baclofen can cause both psychological and physical dependence.

Withdrawal

Abrupt discontinuation of an addictive drug causes many undesirable effects. They are called withdrawal symptoms. Withdrawal from this drug can cause hallucinations, seizures, and even death.

Baclofen has been shown to cause abuse, dependence, and withdrawal. Therefore, it is considered to be addictive. Nonetheless, it is important to remember that many other factors also contribute to addiction. These include a drug’s inherent ability to cause addiction, a person’s genetics, and environmental factors.

Class and Schedule

Class

Baclofen belongs to a class of medications known as skeletal muscle relaxants. There are two broad classes of muscle relaxants. They are:

Centrally Acting Muscle Relaxants

Drugs in this class relax stiff muscles by reducing nerve stimulation in the brain and spinal cord. Examples include methocarbamol and tizanidine.

Peripherally Acting Muscle Relaxants

Drugs in this class work by blocking signals from nerves to muscle fibers. Examples include dantrolene, vecuronium, and rocuronium.

Is Baclofen a Narcotic?

Baclofen is not a narcotic. It does not act on the opioid receptors in the brain. However, like opioids, it may be used to treat severe pain. It’s not a controlled substance.

Is Baclofen on the Schedule?

The DEA categorizes substances based on their abuse potential and approved medical use. As per the Controlled Substance Act (CSA), there are Five drug schedules.

Drugs with the highest abuse potential are included in Schedule I. Examples of Schedule I controlled substances include heroin, LSD, and ecstasy. Drugs in Schedule V have the lowest abuse potential compared to those in other schedules. Examples include Lomotil, Motofen, and Lyrica.

The use of two drugs – gabapentin and baclofen – has soared in recent years. Experts worry that people may have started to take these drugs as an alternative to opioids. Amidst rising concerns of abuse, Kentucky, Tennessee, and Michigan categorized gabapentin as a Schedule V controlled substance.

Many other states are expected to control gabapentin soon. Unlike gabapentin, baclofen is not controlled throughout the US.

Is Baclofen Safe?

Yes. It’s been used since 1977. Any drug that has received an FDA-approval is typically safe. This is because the FDA requires the drug to pass several tests before it reaches the market. These include tests in both humans and animals. The journey from invention to market typically takes more than a decade.

The FDA continues to monitor a drug’s safety years after the drug has reached the market. This is known as post-marketing surveillance (PMS). There were 27 cases of withdrawal and 6 deaths during the first 9 years after the FDA approved baclofen for marketing.7 However, details on the exact causes and other contributing factors are not known.

Most notably, the injectable form comes with a boxed warning on the label. Boxed warnings (or black box warnings) inform prescribers about the potentially fatal risks of a prescription drug.

Thus, it is evident that baclofen is likely to cause fatal complications in some users. However, it does not mean that the drug is not safe. Instead, a boxed warning aims to promote the safe use of powerful drugs.

How is It Used?

Misusing or abusing the drug can be very dangerous and may cause death. Thus, it is critically important to use the drug as prescribed. Below are the things to remember while using the drug.

Use the drug only as recommended. Never take it in higher doses than prescribed or in frequency or duration longer than recommended.

You may take it with or without food.

Read the instructions on the prescription carefully. If you have any queries, talk to your doctor or pharmacist.

If you are using the oral solution (Ozobax), measure your dose using a device. The measuring device is usually supplied with the medication. Ask your pharmacist for the device if you do not get one with the medication.

Do not stop taking the drug even if you feel better.

Use in Pregnancy

Limited data exists on the effects of its use in pregnant women. A doctor may prescribe the drug only if the benefits outweigh the potential risks to the fetus.

Use During Breastfeeding

Baclofen taken by mouth can pass into a mother’s milk. However, the amount present in milk is not known. If you are nursing an infant, talk to your doctor before taking this drug. Your doctor may ask you to stop the drug or stop breastfeeding.

Is Baclofen a Drug of Abuse?

Baclofen is not considered a drug of abuse. Thus, the DEA has not yet categorized it in the list of controlled substances. Nonetheless, it has been more than two decades since the first case of abuse was reported.

How is It Abused?

Baclofen is used to reduce cravings in alcohol abuse and heavy smoking. Some people may abuse it, as it causes euphoria and calming effects. Some people also abuse other prescription drugs such as sleeping pills and antidepressants to enhance the effects. Most importantly, its use in suicide attempts has soared in recent years.

Between 2014 and 2017, US poison centers recorded 15,397 cases of baclofen exposures. Among them, 8185 cases were suicide attempts, 624 involved abuse, and 1022 involved misuse.2

During 2014 to 2017

%

Number of Exposures Increased

%

Increase in Suicide Attempts Involving Baclofen

The number of exposures increased by 36.2% from 2014 to 2017. During the same period, suicide attempts involving baclofen increased by 40.2%.2

Sedative-hypnotics, opioids, antiepileptics, and antidepressants were among the five most commonly used substances with baclofen.2

The exact doses of abuse vary among people misusing baclofen. Nonetheless, doses over 600 mg per day have been reported.

What are the Health Effects of Abuse?

Combining the drug with alcohol, sleeping pills, and other sedatives can cause:

Fatigue

Dizziness

Drowsiness

Loss of balance

Sleep problems

Moreover, abusing more than one drug significantly increases the risk of overdose. Long-term abuse can lead to dependence and addiction.

What are the Signs and Symptoms of Baclofen Abuse?

Identifying baclofen abuse can be tricky. This is because it’s commonly used to treat an existing addiction to alcohol or other substances. Many people who have a co-occurring mental illness also take prescription medications. This makes it hard to tell whether the signs of abuse are due to those medications or baclofen.

That said, certain behavioral changes might help identify abuse.

Mixing it with alcohol, sleeping pills, or marijuana

Visiting more than one doctor to get multiple prescriptions

Using the drug in large amounts or more frequently than prescribed

Having problems at work or school

Developing visible signs of withdrawal when stopping use

Health Risks of Baclofen

Short-term Effects

The drug starts working within a few hours after entering the body as a pill or solution, and blood levels of the drug peak within 2 to 3 hours following use.

The side effects of short-term use can include:

Headache

Lightheadedness

Low blood pressure

Drowsiness

Nausea

Constipation

Serious Side Effects

Mild side effects do not require medical treatment. They usually go away on their own. However, some side effects can cause serious complications. Talk to your doctor immediately if you have:

Chest pain

Blood in urine

Severe mood changes

Hallucinations (feeling things that do not exist)

Seizures

Muscle cramping

An inability to pass urine

Ringing in the ears

Blurred or double vision

Long-term Effects

People with multiple sclerosis may need to use the medication for years. Long-term use can increase the quality of life, but may also cause some unwanted effects. These include:

Impaired memory

Learning problems

Increased fatigue

Muscle weakness

Can You Overdose on Baclofen?

A dose as low as 100 mg may produce toxic effects. Doses more than 200 mg cause severe symptoms. Taking too much baclofen in a short period can cause:

Vomiting

Dizziness

Blurred vision

Slowed breathing

Hypothermia (dangerously low body temperature)

Brain damage

Slow heart rate

Fainting

Weak muscle

Drowsiness

Coma

Seizures

Excessive sleepiness

Irregular heartbeats

Kidney failure

Coma

Where Should an Overdose be Treated?

People who have overdosed on baclofen need treatment at an intensive care unit. Long-term treatment, even after the blood levels have normalized, is necessary. It is critical because baclofen is slowly removed from the brain. The stored drug in the brain can cause sedation long after the blood levels of the drug are within the normal range.

No antidote for baclofen poisoning is currently available. The use of flumazenil (Romazicon) is not recommended. Flumazenil is an antidote for benzodiazepine poisoning.

Supportive Treatments

Supportive treatments can include the following:

Benzodiazepines to control seizures. If seizures persist, a doctor may prescribe other medications such as propofol and barbiturates.

Artificial kidney (hemodialysis) to remove the drug from the blood.

Atropine (AtroPen) to restore heart rate.

Fluid replacement to prevent renal failure. This is done by passing fluids through a tube injected into a vein.

How to Stop Using Baclofen

Never stop taking baclofen without talking with your doctor, especially if you have used high doses for over a month. Suddenly stopping use can cause seizures, coma, or death.

Doctors recommend reducing the dose gradually. This is called dose tapering. Doctors usually ask you to lower your dose over 1 to 2 weeks. However, if you have a long history of use, tapering may last several weeks.

What is Withdrawal from Baclofen Like?

Withdrawal symptoms usually appear hours or a few days after stopping use. Early withdrawal symptoms can include:

  • Muscle stiffness
  • Low blood pressure
  • Itchy skin
  • Numbness

Abrupt discontinuation can cause:

Seizures (may last longer than 5 minutes)

Fever

Confusion

Anxiety

Muscle stiffness

Hallucinations

High body temperature

Excessive bleeding

Rarely, rapid muscle breakdown that can cause kidney damage (rhabdomyolysis), multiple organ failure, and death

The risk of severe withdrawal is high if you have used the injectable form. Treatment is supportive and can include medications to control seizures and muscle stiffness. In severe withdrawal, your doctor may give a low dose of baclofen.

Treatment for Baclofen Abuse

You might think treatment may not be necessary because baclofen abuse is not as dangerous as opioid addiction. However, treatment is essential to not only live a drug-free life but also to reduce the risk of overdose and death.

You should always seek help from experienced professionals only because detox without medical supervision can be fatal.

Several types of treatment are available. The choice depends on the severity of abuse and your doctor’s recommendations.

Detox

Addiction treatment almost always starts with detox, also called detoxification. During detox, baclofen or other drugs are gradually removed from the body. Withdrawal is common, and you may need to take other prescription drugs to stabilize your condition.

Inpatient Program

Once the body has been stabilized, you are ready to move to the next phase of treatment. An inpatient program is an intensive treatment that aims to achieve long-lasting sobriety. It includes individual or group therapy and medications. During treatment at an inpatient facility, addiction specialists will also check if you have other co-occurring mental illness. Inpatient programs are ideal for those who have used high doses of a drug for long periods.

Long-Term Residential Treatment

Long-term residential treatment provides structured care in the therapeutic community or a sober living home. The treatment aims to resocialize addicted individuals and helps them reintegrate into society with minimal problems. Depending on the severity of the addiction, you might need long-term residential treatment for 6 months to 12 months.

Outpatient Program

Outpatient programs are ideal for those who have attained substantial sobriety. These programs do not require you to stay at a facility. Instead, you will have to visit the facility 3 to 4 times and spend a few hours during each visit.