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Paper text:
a 24-year - old male  x ,  smoking 24 cigarettes per day ( cpd ) attended our outpatient department for smoking cessation .
he was referred to us by the physician who treated his lower respiratory tract infection .
he expressed craving , anxiety , insomnia , difficulty in defecation , and mild tremor on reducing the number of smoked cpd .
he was put on nicotine chewing gum 2 mg 3 times a day and baclofen ( liofen xl ) 20 mg at night .
he acknowledged the lack of craving for nicotine when he came for review a week later .
his hostel mate disclosed that he was taking more than the prescribed dose of baclofen .
after initial denial ,  x  accepted the increased intake to be three tablets instead of one .
he was advised to adhere to the prescription and return for review after 2 weeks . before his next appointment , his hostel mate came to us and complained about the daily abuse of drugs .
x  revealed abusive intake of 20 tablets of 30 mg making a total dose of 600 mg baclofen every day .
he described the sense of wellbeing and pleasure without apparent reason after baclofen ingestion and also craving for the drug . under supervision ,
that day night , he complained of insomnia , irritability , anger outburst , and tremor of upper extremities .
he is under motivational therapy and put on bupropion 150 mg in view of the history of nicotine dependence and anxiety symptoms .
a selective gamma - amino butyric acidb(gabab ) agonist , it is used widely used in the treatment of spastic disorders .
baclofen quietens the dopaminergic afferents and indirectly tackles the dopamine surge occurring in the ventral striatal regions due to drug abuse .
evidence - based reports state that chronic administration of baclofen reduces the drug - motivated behaviors in opiate , amphetamine , and cocaine abuse .
the commendable decrease in the reinforcing properties of nicotine at a low dose of 20 mg 4 times daily makes it a promising drug in the pipeline for smoking cessation . despite being in clinical use for several years , reports on baclofen abuse are less . the paradoxical euphoria produced by baclofen maps to the abuse potential of this drug .
the role of gamma - hydroxybutyrate ( ghb ) receptor in producing euphoria has to be evaluated .
winter opined that of all the gabaergic ligands studied , baclofen tended to occasion the greatest ghb - appropriate responding ( 70% ) .
kamal et al . described a ghb - dependent patient , who co - ingested baclofen with ghb and developed a rapid coma , bradypnea , and hypotonia .
this patient  x  exhibited dependence on a high dose of baclofen ( 600 mg / day ) owing to its euphoric effect .
psychological and physical dependence characterized by craving and withdrawal effects temporally correlate with baclofen withdrawal .
de beaurepaire discusses a patient with baclofen use 630 mg / day ( against medical advice ) for a month and a half until he developed acute delirium , agitation , and facial hematoma .
he also discusses a patient who had stimulant effect with 310 mg / day making him placid and less aggressive .
doses higher than 300 mg / day are useful clinically in alcoholics with mostly benign side effects
it includes sedation , dizziness , weakness , nausea , headache , skin rash , itching , shortness of breath , problems in micturition , bowel changes , irregular heartbeat , and chest pain .
massive overdosage is characterized by central depression , hypothermia , hypoventilation , flaccidity , bradycardia , and hypotension .
abrupt cessation can result in mild muscle spasms to life - threatening seizures and multi - system organ failure .
tapering is necessary to avoid baclofen withdrawal . the patient  x  developed insomnia , irritability , anger outburst , and tremor of hand even when the dose was slowly tapered and stopped .
evaluated the separate and combined effects of baclofen 25/50 mg and -tetrahydrocannabinol ( thc ) and opined that large dose baclofen alone occasioned -thc - appropriate responding .
the patient might have substituted his cigarette with baclofen resulting in massive overdose of the drug .
although its ready availability and good tolerance can make it an effective smoking cessation aid , the same can increase its chances of being used as a drug of abuse .
baclofen was initially used for the treatment of spastic conditions . 
 last decade has seen its emergence as a treatment of profound interest in alcohol dependence , opiates and cocaine abuse , and tobacco addiction . 
 however , the published literature on baclofen abuse is sparse . here , 
 we report a patient with baclofen abuse .