Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: The Dutch GHB monitor project

Dijkstra, B.A.G.; Kamal, R.M.; Noorden, Martijn S. van; Haan, H.; Loonen, Anton J. M.; Jong, C.A.J. de

doi:10.1016/j.drugalcdep.2016.11.014

Cited by 50 publications

(65 citation statements)

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“…pression and increase anxiety in humans [13,33]. Furthermore self-reported levels of depression, anxiety, and stress are considerably higher in GHB-addicted patients who regularly take large concentrations of GHB [11,12]. Also, despite these levels being reduced after detoxification, they might persist for extended periods of time after cessation of the drug [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore self-reported levels of depression, anxiety, and stress are considerably higher in GHB-addicted patients who regularly take large concentrations of GHB [11,12]. Also, despite these levels being reduced after detoxification, they might persist for extended periods of time after cessation of the drug [11,12]. Here, the GHB-Coma group (regular users of higher concentrations of GHB when compared with the GHB-NoComa group) reported more negative feelings when compared with the other 2 groups.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Gamma-Hydroxybutyric Acid-Use and Gamma-Hydroxybutyric Acid-Induced Coma on Affect and the Affective Network

et al. 2019

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Background: Gamma-hydroxybutyric acid (GHB) is a drug of abuse associated with increased emergency room attendances, due to GHB-induced comas. Withdrawal from GHB often increases social anxiety and is linked to alterations in emotion processing. However, little is known about the effects of GHB-use and GHB-induced comas on affect regulation in humans. Objectives: We aimed to assess the effect of GHB-use and GHB-induced comas on the affective network. Method: We recruited 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without a GHB-induced coma (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). Participants completed self-report questionnaires assessing negative affect (depression, anxiety and stress) and performed an emotional face matching task during functional magnetic resonance imaging to probe activity of the amygdala and the hippocampus. Results: The GHB-Coma group reported higher levels of depression, anxiety, and stress; showed decreased activity of the hippocampus; and increased functional connectivity of the left hippocampus with the left fusiform gyrus and a cluster on the left temporal-parietal-occipital junction, when compared with the 2 other groups. The GHB-NoComa group showed decreased functional connectivity of the left hippocampus with the amygdala in comparison with the No-GHB group. Conclusions: GHB-use but in particular GHB-induced comas, are associated with altered emotion identification and hippocampal functioning. Awareness campaigns are required to raise consciousness about the adverse effects of GHB-induced comas on affect regulation, despite the absence of subjective side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Gamma-Hydroxybutyric Acid-Use and Gamma-Hydroxybutyric Acid-Induced Coma on Affect and the Affective Network

et al. 2019

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“…Pharmaceutical GHB has the same pharmacological properties as 'street GHB'. GHB-assisted tapering requires up to 12 doses (every 2 h) a day [17]. GHB tapering has been shown to be associated with a high success rate of 85% and limited adverse events in several large non-randomised trials (n = 450).…”

Section: Introductionmentioning

confidence: 99%

“…GHB tapering has been shown to be associated with a high success rate of 85% and limited adverse events in several large non-randomised trials (n = 450). Reported adverse events during detoxification were mainly hypertension (7%) and delirium (2%) [17,18]. It is suggested that tapering with pharmaceutical GHB might be preferable over BZD treatment, owing to its pharmacological similarity with street GHB.…”

Section: Introductionmentioning

confidence: 99%

Tapering with Pharmaceutical GHB or Benzodiazepines for Detoxification in GHB-Dependent Patients: A Matched-Subject Observational Study of Treatment-as-Usual in Belgium and The Netherlands

et al. 2020

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Background The gamma-hydroxybutyric acid (GHB) withdrawal syndrome often has a fulminant course, with a rapid onset and swift progression of severe complications. In clinical practice, two pharmacological regimens are commonly used to counteract withdrawal symptoms during GHB detoxification: tapering with benzodiazepines (BZDs) or tapering with pharmaceutical GHB. In Belgium, standard treatment is tapering with BZDs, while in the Netherlands, pharmaceutical GHB is the preferred treatment method. Though BZDs are cheaper and readily available, case studies suggest GHB tapering results in less severe withdrawal and fewer complications. Objectives This study aimed to compare two treatments-as-usual in tapering methods on withdrawal, craving and adverse events during detoxification in GHB-dependent patients. Methods In this multicentre non-randomised indirect comparison of two treatments-as-usual, patients with GHB dependence received BZD tapering (Belgian sample: n = 42) or GHB tapering (Dutch sample: n = 42, matched historical sample). Withdrawal was assessed using the Subjective and Objective Withdrawal Scales, craving was assessed with a Visual Analogue Scale and adverse events were systematically recorded. Differences in withdrawal and craving were analysed using a linear mixed-model analysis, with 'days in admission' and 'detoxification method' as fixed factors. Differences in adverse events were analysed using a Chi-square analysis. Results Withdrawal decreased over time in both groups. Withdrawal severity was higher in patients receiving BZD tapering (subjective mean = 36.50, standard deviation = 21.08; objective mean = 8.05, standard deviation = 4.68) than in patients receiving pharmaceutical GHB tapering (subjective mean = 15.90; standard deviation = 13.83; objective mean = 3.72; standard deviation = 2.56). No differences in craving were found. Adverse events were more common in the BZD than the GHB group, especially delirium (20 vs 2.5%, respectively). Conclusions These results support earlier work that BZD tapering might not always sufficiently dampen withdrawal in GHBdependent patients. However, it needs to be taken into account that both treatments were assessed in separate countries. Based on the current findings, tapering with pharmaceutical GHB could be considered for patients with GHB dependence during detoxification, as it has potentially less severe withdrawal and fewer complications than BZD tapering.

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“…Over the past decade, recreational drug gammahydroxybutyrate (GHB) drew the attention of clinicians worldwide due to its puzzling effects and a variety of clinical presentations connected with GHB-intoxication (Kamal et al 2017). Despite the substantial increase in published case reports (Drasbek et al 2006, Gonzalez & Nutt 2005, Zvosec et al 2011, when compared to other club drugs, the prevalence of its use is still relatively low, while the complications of intoxication, withdrawal syndrome and dependence are disproportionately high, usually requiring prolonged and intensive treatment (Dijkstra et al 2017) and potentially leading to a fatal outcome (Corkery et al 2016). Several risk factors, including a history of polydrug dependence (Caputo et al 2009), sleep disorders (Stein et al 2011) and psychiatric disorders, especially anxiety, depression and borderline personality disorder (Corkery et al 2016, Bornovalova et al 2005 have been identified for developing GHB dependence .…”

Section: Introductionmentioning

confidence: 99%

GHB Roller-Coaster: Serotonin Syndrome and Withdrawal

et al. 2019

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Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: The Dutch GHB monitor project

Cited by 50 publications

References 32 publications

Influence of Gamma-Hydroxybutyric Acid-Use and Gamma-Hydroxybutyric Acid-Induced Coma on Affect and the Affective Network

Influence of Gamma-Hydroxybutyric Acid-Use and Gamma-Hydroxybutyric Acid-Induced Coma on Affect and the Affective Network

Tapering with Pharmaceutical GHB or Benzodiazepines for Detoxification in GHB-Dependent Patients: A Matched-Subject Observational Study of Treatment-as-Usual in Belgium and The Netherlands

GHB Roller-Coaster: Serotonin Syndrome and Withdrawal

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