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 underreporting of BLF-associated deaths. Between 1 January 2016 and 31 December 2017, 3,750 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 if 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.

中文翻译：

---

巴氯芬：在死后血液中筛查还是不筛查？

巴氯芬 (BLF) 自 1972 年起在英国被用于缓解痉挛状态。然而，有证据表明 BLF 也被娱乐性地滥用。它与乙醇、γ-羟基丁酸 (GHB)、普瑞巴林 (PGL) 和加巴喷丁 (GBP) 的使用/滥用有关，并且已有死亡报告。使用目前的尸检 (PM) 毒理学筛查方法，BLF 并不常规包括在一般药物筛查中，只有在案例文件中特别提及时才会进行筛查。因此，BLF 滥用的程度尚不清楚。本研究旨在确定验尸官毒理学中 BLF 的流行率和浓度，调查 BLF 与乙醇、GHB、PGL 和 GBP 的滥用是否会导致死亡，并确定 BLF 相关死亡的漏报程度。2016 年 1 月 1 日至 2017 年 12 月 31 日期间，对 3,750 PM 的股静脉血液进行了 BLF 筛查；所有阳性病例都被量化。只有 0.56% 的样本筛选出 BLF 阳性，浓度范围为 0.08 至 102.00 µg/mL（中位数 = 0.28）。已经确定，如果在没有额外 BLF 筛查的情况下进行常规分析，43% 的 BLF 阳性病例将被遗漏。然而，鉴于检出率低，这仅占队列的 0.25%。仅在一个案例中发现了可能非法使用 BLF 和 GHB。没有观察到 BLF 与 PGL 和 GBP 的娱乐使用导致的死亡。只有两例 BLF 阳性的乙醇浓度≥50 mg%。观察到两起疑似故意过量服用 BLF 的病例。这项研究强调，尽管可能会发生 BLF 滥用，但死亡人数很少。因此，在所有 PM 病例中筛查 BLF 既不经济也不划算。由于目前正在研究 BLF 治疗酒精中毒和非法药物使用的戒断症状，​​未来与 BLF 相关的死亡人数可能会增加。