Sir, despite case reports carrying little weight and often being overlooked or ignored, they not infrequently herald new findings. For example, a report a decade ago flagged up a potential issue with benzydamine abuse.1 Benzydamine (commonly termed Difflam or Tantum Verde) is a topical locally acting non-steroidal anti-inflammatory agent with local anaesthetic and analgesic properties. Found in small doses in over-the-counter (OTC) products and used legally to manage sore mouths and throats from various causes as a mouthwash, spray or gel, it is familiar to most dental professionals. It is also found in some vaginal douches.

However, it has become increasingly evident over the past few years that benzydamine can be misused as a psychoactive agent for recreational purposes (https://psychonautwiki.org/wiki/Benzydamine). In high doses, such abuse has been reported especially in Eastern Europeans (particularly in some Polish, Romanian and Turkish peoples),2 and in Latin Americans (mainly some Brazilians).3,4

There are as yet, few data on any other (such as physical) adverse effects.