title: Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series.
abstract: BACKGROUND
  About 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors.
  
  
  OBJECTIVE
  The objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city.
  
  
  METHODS
  Clinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years) who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients' files using a checklist developed by the authors.
  
  
  RESULTS
  Twenty-four (60%) patients were male, and 16 (40%) were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran) was the most common (75%) drug of use, followed by opium (10%) and opium residue (7.5%). None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5%) mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30) days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to report on the safety and feasibility of inpatient symptomatic pharmacological treatment for assisted withdrawal among opioid-dependent children and adolescents in Iran. More well-designed studies to investigate the long-term outcomes of opioid treatment among children are warranted.
authors.affiliation: Child and Adolescent Psychiatry Department, Zahedan University of Medical Sciences, Zahedan, IR Iran; Research Center for Children and Adolescents Health, Zahedan University of Medical Sciences, Zahedan, IR Iran.
authors.forename: Mahboubeh
authors.initials: M
authors.lastname: Firouzkouhi Moghadam
authors.affiliation: Student research‏ ‏committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Seyed-Sepehr
authors.initials: SS
authors.lastname: Hashemian
authors.affiliation: General Practitioner, Zahedan University of Medical Sciences, Zahedan, IR Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Pishjoo
authors.affiliation: Child and Adolescent Psychiatric Ward, Ali Ebne Abitaleb Hospital, Zahedan, IR Iran.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Ghasemi
authors.affiliation: Addiction and High Risk Behavior Research Center, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences (IUMS), Tehran, IR Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hajebi
authors.affiliation: School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Noroozi
keywords: Assisted Withdrawal; Inpatient; Substance Use; Vulnerable Children