Baclofen: To screen or not to screen in postmortem blood?
File(s)
Accepted version
Author(s)
Nahar, Limon Khatun
Murphy, Kevin G
Paterson, Sue
Type
Journal Article
Abstract
Baclofen (BLF) has been prescribed in the UK since 1972 for the alleviation of spasticity. However, evidence suggests BLF is also recreationally misused. It has been associated with ethanol, gamma-hydroxybutyric acid (GHB), pregabalin (PGL) and gabapentin (GBP) use/abuse and deaths have been reported. With current postmortem (PM) toxicological screening approaches, BLF is not routinely included in the general drugs screen, and is only screened for if specifically mentioned in the case documents. The extent of BLF misuse is thus unclear. This study was carried out to determine the prevalence and concentrations of BLF in Coroners’ toxicology, to investigate whether BLF misuse with ethanol, GHB, PGL and GBP is causing death and to determine the potential extent of the under-reporting of BLF-associated deaths. Between 01/01/2016 to 31/12/2017, 3750 PM femoral vein bloods were screened for BLF; all positive cases were quantified. Only 0.56% of samples screened positive for BLF, with concentration ranging from 0.08 to 102.00 µg/mL (median = 0.28). It was determined that routine analysis without additional screening of BLF had been performed, 43% of BLF positives cases would have been missed. However, given the low incidence of detection, this only represents 0.25% of the cohort. Likely illicit use of BLF with GHB was seen in one case only. Death from the recreational use of BLF with PGL and GBP was not observed. Only two cases positive for BLF had an ethanol concentration of ≥ 50 mg%. Two cases of presumed intentional overdose of BLF were observed. This study highlights that although BLF abuse may be occurring, deaths are rare. It is therefore not cost or time effective to screen for BLF in all PM cases. With BLF currently being investigated for the treatment of alcoholism and withdrawal symptoms of illicit drug use, BLF-related deaths may rise in the future.
Date Issued
2021-07
Date Acceptance
2020-09-17
Citation
Journal of Analytical Toxicology, 2021, 45 (6), pp.612-618
ISSN
0146-4760
Publisher
Oxford University Press (OUP)
Start Page
612
End Page
618
Journal / Book Title
Journal of Analytical Toxicology
Volume
45
Issue
6
Copyright Statement
© The Author(s) 2020. Published by Oxford University Press on behalf of Society of Forensic Toxicologists, Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in [insert journal title] following peer review. The definitive publisher-authenticated version Limon Khatun Nahar, Kevin G Murphy, Sue Paterson, Baclofen: To Screen or Not To Screen in Postmortem Blood?, Journal of Analytical Toxicology is available online at: https://doi.org/10.1093/jat/bkaa132
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in [insert journal title] following peer review. The definitive publisher-authenticated version Limon Khatun Nahar, Kevin G Murphy, Sue Paterson, Baclofen: To Screen or Not To Screen in Postmortem Blood?, Journal of Analytical Toxicology is available online at: https://doi.org/10.1093/jat/bkaa132
Identifier
https://academic.oup.com/jat/advance-article/doi/10.1093/jat/bkaa132/5912484
Subjects
Autopsy
Baclofen
Gabapentin
Humans
Pregabalin
Substance-Related Disorders
0301 Analytical Chemistry
1115 Pharmacology and Pharmaceutical Sciences
Analytical Chemistry
Publication Status
Published
Date Publish Online
2020-09-27