Carisoprodol: an underrecognized drug of abuse in north India ☆ , ☆☆ Naresh Nebhinani, M.D., D.N.B. a, ⁎, Munish Aggarwal, M.D. b , Surendra Kumar Mattoo, M.D. b , Debasish Basu, M.D., D.N.B., M.A.M.S. b a Department of Psychiatry, Postgraduate Institute Medical Science, Rohtak, Haryana, 124001, India b Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India abstract article info Article history: Received 7 June 2012 Accepted 29 July 2012 Keywords: Carisoprodol Meprobamate Abuse Dependence Background: There is limited literature on clinical profile of subjects abusing carisoprodol. Methods: Our series of 34 subjects shows that a typical subject was an unmarried, unemployed, urban resident from a nuclear family set up; was a substance abuser before being introduced to carisoprodol by another substance abuser; initiated the use to get a better “kick” and after regular use reported craving and withdrawal symptoms. Results: The effect of carisoprodol was dose dependent: a majority reported a feeling of general wellbeing on consuming up to three tablets; a hypomanic state with 4–10 tablets and confusion, disorientation and drowsiness with N 10 tablets at a time. Conclusion: Thus being an underrecognized drug of abuse, carisoprodol is in need of wider awareness and regulatory measures to prevent its emergence as a greater menace in the future. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Carisoprodol or N-isopropylmeprobamate (brand names Carisoma and Soma) is a centrally acting muscle relaxant indicated in acute painful musculoskeletal conditions [1]. It was developed and promoted as a congener of meprobamate emphasizing better muscle relaxing properties, lower risk of overdose, and less potential for abuse [2]. Initially it was thought to be devoid of abuse potential [2]. However, later experience has established that it is associated with both abuse and impairment (i.e., increased risk of automobile accidents) [3]. It is usually prescribed for administration three times daily and at night in dosage formulations of 250 and 350 mg [4]. The onset of action is rapid (about 30 minutes) and the effects last about 2–6 hours. Metabolized in the liver via the cytochrome P450 oxidase isozyme CYP2C19, and excreted by the kidneys, it has a half-life of about 8 hours. The abuse potential can be attributed to a considerable proportion being metabolized to meprobamate, a known drug of abuse and dependence [5]. Tachycardia, involuntary movements, hand tremor, and horizontal gaze nystagmus may be specific carisoprodol intoxication effects [6]. Serotonergic and GABAergic systems are implicated for some of the symptoms and signs of carisoprodol intoxications [7]. This may have implications for the clinical evaluation and treatment of such intoxications [8]. Recreational users of carisoprodol seek its muscle relaxing, anxiolytic, and sedating effects. Also, because of its potentiating effects on narcotics, it is often abused in conjunction with opioid drugs. Additionally, it is used as sexual performance enhancer and to prevent withdrawal among opioid addicted users [9–11]. It is believed that carisoprodol has gained reputation among drug abusers as an agent whose use begins as benign substitute for “harder” drugs and then escalates gradually for its own psychic effects. The “carry-over” phenomenon of dissemination of information from one addict to another makes the abuse of carisoprodol self-sustained. This is said to explain the spreading popularity of carisoprodol and it getting established as an addictive substance by itself [12]. In India carisoprodol was not considered a problem drug till recently. In 1999, the Ministry of Social Justice and Empowerment, Government of India (MSJE, GOI) and the United Nations International Drug Control Program, Regional Office for South Asia (UNIDCP, ROSA) started a large scale national survey for the extent, pattern and magnitude of substance abuse in India. The National Household Survey (NHS), a major component of this survey reported the following nationwide current prevalence profile: Alcohol was the commonest substance (21.4%), followed by cannabis (3%) and opioids (0.7%). Drug Abuse Monitoring Survey (DAMS) component of this survey, obtained from consecutive new patients/treatment seekers contacting various treatment facilities, again revealed alcohol as the commonest substance (43.9%), followed by opioids (26%) and cannabis (11.6%). Possibly because it was not listed in any of the General Hospital Psychiatry 35 (2013) 89–92 ☆ Funding: None. ☆☆ Conflict of interest: None to declare. ⁎ Corresponding author. Tel.: +91 8059434515; fax: +91 01262 211162. E-mail address: drnaresh_pgi@yahoo.com (N. Nebhinani). 0163-8343/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.genhosppsych.2012.07.011 Contents lists available at SciVerse ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com