Self-poisoning with baclofen in alcohol-dependent patients: national reports to French Poison Control Centers, 2008-2013.
BACKGROUND
Alcohol use disorders are frequently associated with self-intoxication in attempted suicide. In France since 2008, the off-label use of baclofen for treatment of alcohol dependence has greatly increased, leading to temporary regulation of use of the drug. At the request of the national authorities, the French Poison Control Centers carried out a retrospective survey to give an overview of baclofen exposure in this population.


METHODS
A retrospective study was carried out from January 2008 to December 2013, focusing on baclofen exposures in alcohol-dependent patients managed by the nine national French Poison Control Centers.


RESULTS
294 observations of baclofen exposures in alcohol-dependent patients were identified in our database. Of these, 220 were suicide attempts by self-poisoning and 74 were unintentional. The mean age of patients was 41.7 years, with a sex-ratio of 1.6. Patients attempting suicide with baclofen were younger than those with unintentional exposures, and 43.6% of them were women (vs 22.9%, p < 0.01). The mean supposed ingested dose was higher (480.7 mg) in patients who attempted suicide (vs 192.5 mg, p < 0.0001). 21.8% of intentional exposures involved baclofen alone. Psychiatric comorbidity (50.4%) was more frequent in the group of self-poisoning (p < 0.001). 132 patients were coded as severely exposed (60.0%). Nine victims died, but the causal link between self-poisoning with baclofen and fatal outcome should be interpreted with particular caution.


CONCLUSIONS
Baclofen self-poisoning by alcohol-dependent patients is a serious concern for the French health authorities. Our results are similar to those previously published, suggesting that most patients with baclofen overdose should be admitted to an intermediate or intensive care unit as the clinical course requires close monitoring. Because suicidal ideation and suicide attempts are more prevalent in people with substance use disorders than in the general population, and because of the lack of recommendations governing baclofen prescription in such a situation, its use needs to be better controlled.
a Poison Control Center, Toulouse-Purpan University Hospital , Toulouse , France.
Fanny
F
Pelissier
b Poison Control Center, Clinical Pharmacology Department , Sainte Marguerite Hospital , Marseille , France.|c Groupe de Travail Toxicovigilance des Médicaments, ANSM , Saint Denis , France.|d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.
Luc
L
de Haro
c Groupe de Travail Toxicovigilance des Médicaments, ANSM , Saint Denis , France.|e French National Agency for Medicines and Health Products Safety (ANSM) , Saint Denis , France.
Florence
F
Cardona
c Groupe de Travail Toxicovigilance des Médicaments, ANSM , Saint Denis , France.|d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.|e French National Agency for Medicines and Health Products Safety (ANSM) , Saint Denis , France.
Cyndie
C
Picot
d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.|f Poison Information and Toxicovigilance Center, Nancy University Medical Center , Nancy , France.
Emmanuel
E
Puskarczyk
d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.|g Toxicovigilance and Poison Control Center, Hospices Civils de Lyon , Lyon, France.
Jean-Marc
JM
Sapori
c Groupe de Travail Toxicovigilance des Médicaments, ANSM , Saint Denis , France.|d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.|h Poison Information and Toxicovigilance Center, Hôpital Civil , Strasbourg , France.
Christine
C
Tournoud
a Poison Control Center, Toulouse-Purpan University Hospital , Toulouse , France.|c Groupe de Travail Toxicovigilance des Médicaments, ANSM , Saint Denis , France.|d Comité de Coordination de Toxicovigilance , Institut de Veille Sanitaire (InVS) , Saint Maurice , France.|i Department of Addiction Medicine , Toulouse-Purpan University Hospital , Toulouse , France.
Nicolas
N
Franchitto
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D001418:Baclofen / Q000097:blood / Q000506:poisoning*; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011041:Poisoning / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D013406:Suicide, Attempted; D055815:Young Adult
D001418:Baclofen
Poisoning; alcohol dependence; baclofen; poison control center; suicide attempt