Baclofen, the muscle relaxer used in the treatment of multiple sclerosis and spinal cord disorders, has been known to cause psychological dependence and withdrawal symptoms in some users. Even as baclofen has enjoyed some effectiveness in the treatment of alcohol addiction, research has suggested that improper use can be its own source of addiction.
Baclofen, sold under the brand names Lioresal and Kemstro, is a muscle relaxant and antispastic agent. It is used to treat certain muscle symptoms, such as pain, tremors, and stiffness as the result of multiple sclerosis (MS). It is occasionally given to patients who have injuries or diseases of the spinal cord, which cause symptoms that are similar to those of MS.
Muscle spasticity is a typical condition in people who develop multiple sclerosis, cerebral palsy, or other ailments of the spinal cord. Baclofen, as a muscle relaxer and designed as an antispastic medication, specifically treats these problems.
It has side effects that have led to its comparison to opioid medications, but its mechanism of action — its chemical structure is similar to the GABA neurotransmitter — has more in common with benzodiazepines. For this reason, baclofen has a calming effect, which patients find desirable, and this effect leads to concerns about risky use.
When a patient takes baclofen, they feel their muscles relax, which reduces the level of cramping and tension in their back and other areas of the body. Baclofen does not cure multiple sclerosis, but it is very beneficial in providing a path for patients to move into other forms of treatment, such as physical therapy, which might be prohibitively painful if not for baclofen’s effects.
Baclofen’s side effects include:
Baclofen has had some popularity as a possible treatment for drug and alcohol addiction because of how it changes the chemical processes that fuel substance abuse. Because of how baclofen mimics the chemical structure of the GABA neurotransmitter, which is critical in mood regulation, some researchers have theorized that the calming effects of baclofen can increase the levels of the dopamine neurotransmitter. This can then reduce cravings for a more harmful substance.
This has led to some off-label use of baclofen in addiction recovery, but there have not been enough clinical trials to adequately assess whether baclofen is an effective medication for addiction. Researchers wrote in the Industrial Psychiatry Journal that further controlled trials for baclofen in the treatment of alcohol addiction are “required.”
The call was taken up by researchers who published their results in BMC Psychiatry, wherein they wrote that patient subjects who were given baclofen for their opioid dependence did better in treatment and experienced preferable withdrawal and depressive syndromes. They concluded that “further study of baclofen in the maintenance treatment of opioid dependence” was supported by the results of their work.
Baclofen is not an opioid, and its addictive potential is relatively low unlike controversial forms of opioid maintenance therapy. There is still the risk of a patient developing a physical dependence on it, to the point of inducing withdrawal symptoms if the medication is abruptly stopped.
Withdrawal symptoms of baclofen are similar to those of benzodiazepines and alcohol. The severity depends on a number of factors, including how much baclofen was being consumed, if any other drugs were present, and the patient’s unique biochemistry and mental health.
In general, however, if the baclofen were taken on an addictive level and then stopped, people would experience some of the following withdrawal symptoms:
The Neurohospitalist journal adds that it is possible for sudden baclofen discontinuation to cause psychological symptoms. Researchers note the case study of a 62-year-old woman who experienced “altered mental status” in addition to respiratory problems as the result of her baclofen consumption being inadvertently stopped.
Similarly, Functional Neurology writes of “several cases of hallucinations” following the abrupt withdrawal of baclofen. In that journal, researchers theorized that withdrawal symptoms from chronic use of baclofen are the result of biochemical and molecular changes to neurotransmitter responses, which fits the mechanical definition of addiction to most chemical substances.
One reason that baclofen is confused for an opioid or a benzodiazepine is due to some reports that people feel a euphoric high when they take the medication. This is likely only if the baclofen is taken at very high doses, which might be the case if a patient is desperate for relief for their muscle pain and spasms (or alcohol addiction, as reported on in Frontiers in Psychiatry). However, it is also possible for a person to experience strong pleasurable feelings if they take baclofen recreationally.
There is a danger to this kind of use of baclofen. Taking too much of the medication can depress the central nervous system to the point where the heart rate is dangerously slowed, and blood pressure is dangerously high. This sets the scene for a baclofen overdose, which could render a patient comatose or at risk of death.
This is compounded if a person takes high levels of baclofen with other drugs, to amplify either the pleasurable or medicinal effects (or even both). It is incredibly dangerous to mix baclofen with other drugs that work by slowing down the central nervous system, such as opioids, benzodiazepines, alcohol, muscle relaxers, or sleep aids. Doing so can produce powerfully tranquilizing sensations, so much so that a person can easily develop a psychological dependence on the mixture.
On the topic of the addictiveness of baclofen, the Indian Journal of Psychological Medicine writes of “An Unusual Case of Baclofen Abuse,” wherein researchers noted that “published literature on baclofen abuse is sparse.” The article examines the case of a young man with a smoking addiction who was diagnosed with nicotine dependence. Doctors gave him nicotine chewing gum and baclofen. Despite initial success, the patient was also taking three baclofen tablets a night instead of the prescribed single tablet. Eventually, his intake spiraled to 20 tablets a day (a total dose of 600 mg of baclofen on a daily basis).
The patient told doctors of the increased sense of pleasure and well-being as well as a craving for more baclofen. When his dose was tapered, he experienced insomnia, mood swings, anxiety, and tremors. He was eventually given another tapering drug and enrolled in a motivational therapy course.
The researchers concluded their article in the journal by writing that the patient “might have substituted his cigarette [addiction] with baclofen,” which led to a “massive overdose.”
Baclofen is widely available and offers good tolerance, which presents the possibility of using it as an effective substance abuse cessation aid; however, the researchers pointed out that these same qualities can increase the chances of baclofen being taken up as a drug of abuse.
The Frontiers in Psychiatry article mentioned above noted that the drug “has many potentially dangerous side effects,” and researchers caution that even though the medication is useful in treating alcohol dependence, large amounts of baclofen are required for this effect. If doses were limited to the amounts set out by health regulations, patients “would not have fully benefited from the craving-suppressing effects of baclofen.”
The researchers in Frontiers in Psychiatry argue that if baclofen is to be used properly, it needs to be used in the context of a healthy and open therapeutic alliance between patient and physician.
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