Zahra Emma, Darke Shane, Lappin Julia, Duflou Johan, Farrell Michael
National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia.
National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia.
Forensic Sci Int. 2024 Dec;365:112281. doi: 10.1016/j.forsciint.2024.112281. Epub 2024 Oct 30.
In Australia, the therapeutic indication of baclofen (oral tablets) is for the treatment of muscle spasm. Deaths related to baclofen have been reported, as well as misuse, dependence and self-poisoning. This national retrospective study aimed to investigate the number, characteristics, circumstances, and toxicology of baclofen-related deaths in Australia, 2000-2022. We identified 102 baclofen-related deaths, with a mean age of 45.6 years and 51 % being male. Circumstances of death were: intentional toxicity (54.9 %), unintentional toxicity (30.4 %), unintentional toxicity/disease (9.8 %), and accidental injury (4.9 %). Multiple sclerosis or spinal injury was documented in 15.7 % of cases, substance use problems in 43.1 % and specifically alcohol use problems in 38.2 %. Mental health problems were documented in 73.5 %, a previous self-harm or suicide attempt in 30.4 %, and chronic pain in 37.3 %. The median baclofen blood concentration for all cases was 3.10 mg/L (25th 0.70, 75th 8.10, range 0.04-110.00), unintentional toxicity 1.95 mg/L (25th 0.70, 75th 4.35, range 0.04-24.0), intentional toxicity 6.00 mg/L (25th 1.10, 75th 13.0, range 0.05-110.0). Concomitant substance use was seen in 93.8 %, with antidepressants (69.8 %) and benzodiazepines (64.6 %) most frequently detected. In conclusion, the 'typical' case was middle-aged, most dying due to intentional toxicity, and likely to have a history of mental health and substance use problems. We suggest caution is needed in prescribing baclofen given its potential to be used in intentional and non-intentional overdose.
在澳大利亚，巴氯芬（口服片剂）的治疗适应症是治疗肌肉痉挛。已有与巴氯芬相关的死亡报告，以及滥用、依赖和自我中毒的情况。这项全国性回顾性研究旨在调查2000年至2022年澳大利亚与巴氯芬相关死亡的数量、特征、情况和毒理学。我们确定了102例与巴氯芬相关的死亡病例，平均年龄为45.6岁，男性占51%。死亡情况如下：故意中毒（54.9%）、非故意中毒（30.4%）、非故意中毒/疾病（9.8%）和意外伤害（4.9%）。15.7%的病例记录有多发性硬化症或脊髓损伤，43.1%有物质使用问题，其中38.2%具体有酒精使用问题。73.5%的病例记录有心理健康问题，30.4%有既往自残或自杀未遂史，37.3%有慢性疼痛。所有病例中巴氯芬的血药浓度中位数为3.10mg/L（第25百分位数0.70，第75百分位数8.10，范围0.04 - 110.00），非故意中毒为1.95mg/L（第25百分位数0.70，第75百分位数4.35，范围0.04 - 24.0），故意中毒为6.00mg/L（第25百分位数1.10，第75百分位数13.0，范围0.05 - 110.0）。93.8%的病例存在合并物质使用情况，最常检测到的是抗抑郁药（69.8%）和苯二氮䓬类药物（64.6%）。总之，“典型”病例为中年，多数死于故意中毒，且可能有心理健康和物质使用问题史。鉴于巴氯芬有被用于故意和非故意过量用药的可能性，我们建议在开具巴氯芬处方时需谨慎。
