The central nervous system depressant baclofen is sold under the brand names Gablofen and Lioresal.
The medication is similar in its chemical structure to the brain chemical or neurotransmitter gamma-Aminobutyric acid (GABA). GABA release results in a modulating or slowing down of the activity of the neurons in the brain and spinal cord. The use of baclofen results in similar effects.
The primary medical uses of baclofen include:
It is not useful for treating pain or muscle rigidity associated with having a stroke or Parkinson’s disease.
The drug has various off-label uses, such as treating withdrawal from alcohol and other substances of abuse.
Baclofen is available in pill form or as an injectable solution.
One of the off-label uses for baclofen is as a medically assisted treatment for alcohol withdrawal.
Research studies using animals have suggested that baclofen might be useful in addressing withdrawal symptoms. Recent studies in humans have demonstrated some effectiveness in the use of baclofen to reduce cravings and the use of alcohol in individuals in recovery from alcohol use disorders.
However, the overall research findings are mixed. A large recent research study suggested that its use in the treatment of alcohol withdrawal is not justified by the overall body of research studies.
Baclofen may also be used to treat withdrawal from stimulants, particularly from cocaine. However, research studies have indicated that the use of baclofen may be no more effective than a placebo in addressing withdrawal from stimulants.
Baclofen has also been suggested as a potential treatment for withdrawal from opioid drugs. Again, there are only a few scattered case studies documenting its potential effectiveness. More research needs to be conducted.
Medications and other substances that increase the effectiveness of GABA in the brain are often abused. Because of the calming effects that baclofen may produce in some people as a result of its effect on GABA, the drug may have a potential for abuse.
Very often, substances of abuse that primarily work on the neurotransmitter GABA are not used in isolation. Instead, they are abused with other drugs, such as alcohol or benzodiazepines.
Clinical studies documenting baclofen abuse appear to be rather rare, scattered, and primarily consist of case studies. These case studies have raised the question of whether or not baclofen is abused more often than is documented in the research.
The suspected effects of baclofen abuse would be similar to the abuse of other central nervous system (CNS) depressants that primarily affect the functioning of GABA.
Based on some case studies, it would be safe to assume that those who abuse baclofen would get effects similar to alcohol or benzodiazepines, such as feelings of well-being, relaxation, a loss of inhibitions, problems with motor coordination, and similar issues.
Many of these drugs are abused with other similar-acting drugs, and other effects will occur when an individual uses more than one central nervous system depressant. These could include:
As with the studies addressing potential abuse of baclofen, a few case studies discuss withdrawal symptoms in individuals who abuse the drug. Withdrawal from baclofen appears to include the following symptoms
Some individuals may develop delirium, confusion, hyperactivity or hypoactivity, and psychosis.
Because there is a potential to develop seizures, as recorded in the literature, individuals who withdraw from baclofen use may be at serious risk to have brain damage or die. Treatment for withdrawal from baclofen would most likely include benzodiazepines administered on tapering schedule under medical supervision.
SIGNS OF BACLOFEN ABUSE
Baclofen is not a controlled substance, but a prescription is required to legally obtain and use the drug. Anyone who frequently uses baclofen and does not have a prescription for the drug should be suspected of abusing it.
Research has documented the effects of an overdose on baclofen. The effects of the overdose were:
If someone has been suspected of overdosing on baclofen, immediately contact emergency medical services by calling 911.
Attempt to keep the person calm and reduce stimulation in the environment. Check if the person is breathing and then place them on their side or sit them up so that they do not choke.
Do not administer any medications, fluids, or food unless trained to do so.
If the person is not breathing, perform CPR. If the person appears to be having seizures, attempt to remove all objects from them and lay them down in a safe place.
TREATMENT FOR BACLOFEN ABUSE
There is no formal protocol for treating baclofen abuse.
As mentioned above, medical detox is recommended to manage the withdrawal symptoms associated with discontinuing baclofen. During withdrawal, the person should also become involved in other standard forms of substance use disorder treatment, including therapy, support groups, treatment for co-occurring disorders, and other interventions, as appropriate in the individual case.
Abuse of baclofen is suspected of being similar to the abuse of benzodiazepines or alcohol, and the treatment protocol is similar. Treatment should be long term. It requires abstinence from baclofen and other drugs, except those that are prescribed and used under the supervision of a physician.
The treatment for baclofen abuse can be very complicated when the person has a co-occurring psychological disorder or has been using baclofen to address a neurodegenerative disorder. Specialized treatment by a team experienced in those co-occurring issues is required.
(January 2016). Baclofen, RxList. from https://www.rxlist.com/baclofen-drug.htm
(June 2017). Baclofen. MedlinePlus. from https://medlineplus.gov/druginfo/meds/a682530.html
(August 2018). Baclofen: Its effectiveness in reducing harmful drinking, craving, and negative mood. A meta‐analysis. Addiction. from https://www.ncbi.nlm.nih.gov/pubmed/29479827
(July 2009). Multi-center trial of baclofen for abstinence initiation in severe cocaine-dependent individuals. Drug and Alcohol Dependence. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774896/
(September 2016). An unusual case of baclofen abuse. Indian Journal of Psychological Medicine. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052965/
(January 2017). Oral baclofen withdrawal resulting in progressive weakness and sedation requiring intensive care admission. The Neurohospitalist. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167087/