title: Gamma-hydroxybutyrate detoxification by titration and tapering.
abstract: OBJECTIVE
  To determine the effectiveness and safety of a new detoxification procedure in γ-hydroxybutyrate (GHB)-dependent patients. GHB is an endogenous inhibitory neurotransmitter and anesthetic agent that is being abused as a club drug. In many GHB-dependent patients a severe withdrawal syndrome develops that does not respond to treatment with high dosages of benzodiazepines and often requires an admission to an intensive care unit.
  
  
  METHODS
  Based on the knowledge of detoxification procedures in opioid and benzodiazepine dependence, we developed a titration and tapering procedure. A consecutive series of 23 GHB-dependent inpatients were transferred from illegal GHB (mostly self-produced) in various concentrations to pharmaceutical GHB. They were given initial doses that resulted in a balance between sedation and withdrawal symptoms. After this titration period, patients were placed on a 1-week taper.
  
  
  RESULTS
  We have found that after titration the patients experienced a low level of withdrawal symptoms. During tapering these symptoms decreased significantly and no patient developed a delirium or a psychosis. None of the patients had to be transferred to a medium or intensive care unit.
  
  
  CONCLUSIONS
  This detoxification procedure proved to be safe and convenient in patients with moderate to severe GHB dependence.
authors.affiliation: Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands. nispa.dejong@gmail.com
authors.forename: Cor A J
authors.initials: CA
authors.lastname: de Jong
authors.forename: Rama
authors.initials: R
authors.lastname: Kamal
authors.forename: Boukje A G
authors.initials: BA
authors.lastname: Dijkstra
authors.forename: Hein A
authors.initials: HA
authors.lastname: de Haan
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D018377:Neurotransmitter Agents / Q000008:administration & dosage*; D010865:Pilot Projects; D012978:Sodium Oxybate / Q000008:administration & dosage*; D016320:Substance Abuse Treatment Centers; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018377:Neurotransmitter Agents; D012978:Sodium Oxybate