Case Report: Delirium and complications resulting from the abuse of compound liquorice tablets

Compound liquorice tablets is a cough-suppressing compound formulation containing opium powder and liquorice. With the strict regulation of traditional opioids, this medication has emerged as a novel alternative for substance abuse due to its easy accessibility and low cost; however, its addiction potential and severe adverse complications remain underrecognized and insufficiently addressed in clinical practice.

The patient is a 29-year-old male who began self-medicating with compound liquorice tablets for a dry cough after COVID-19 infection. His daily dosage gradually escalated to 200-600 tablets within two years, resulting in established drug dependence. Two days after discontinuing the medication, he developed delirium manifested as confusion, disorientation, visual hallucinations and psychomotor agitation, accompanied by palpitations, hypertension, tremors, rhinorrhea, vomiting, severe hypokalemia, and bilateral lower limb edema. Organic brain diseases were excluded by systematic examinations. According to the ICD-10 diagnostic criteria, he was diagnosed with opioid-induced mental and behavioral disorders, hypokalemia and hypertension. We implemented a benzodiazepine tapering regimen to control delirium and sympathetic excitation associated with withdrawal symptoms, combined with antidepressants and antipsychotics to improve mood, anxiety, and psychotic symptoms, Under the guidance of a cardiologist, we actively managing hypertension and correcting internal environmental disturbances. Following comprehensive management, the patient's withdrawal symptoms and delirium resolved, with stable emotional state and blood pressure, resulting in successful withdrawal.

This is the first reported case of delirium caused by withdrawal from compound liquorice tablets. It provides preliminary insights for clinical identification, diagnosis, and multidisciplinary management of dependence on compound liquorice tablets, as well as related withdrawal symptoms and complications. This case also alerts to the emerging risk of abuse associated with new substances such as compound liquorice tablets and underscores the need for stricter prescription controls and patient education regarding the risks of abuse.