title: Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: The Dutch GHB monitor project.
abstract: Gamma-hydroxybutyrate (GHB) detoxification procedures have been insufficiently studied for effectiveness and safety. Based on case reports, benzodiazepines are generally regarded as first-choice agents in GHB detoxification. Detoxification by titration and tapering (DeTiTap) with pharmaceutical GHB in an open-label consecutive case series of 23 GHB-dependent patients showed to be feasible, effective and safe. This study further explored the feasibility, effectiveness and safety of this detoxification procedure in a large group of patients.
  
  
  
  A large observational multicenter study was carried out in six addiction treatment centers in the Netherlands. GHB-dependent inpatients (229 unique patients, 274 admissions) were titrated on and tapered off with pharmaceutical GHB.
  
  
  
  Successful detoxification was achieved in 85% of cases. Detoxification was carried out in 12.5days in most patients. The DeTiTap procedure proved to be feasible and significantly reduced the experienced withdrawal symptoms and craving (p≤0.001). Several symptoms were found to influence the course of subjective withdrawal symptoms. During detoxification, psychological symptoms such as depression, anxiety, and stress decreased (p≤0.05). The main complications were hypertension and anxiety. Six patients were sent to the general hospital for observation, but all six were able to continue detoxification in the addiction treatment centers. Most patients (69%) relapsed within three months after detoxification.
  
  
  
  The DeTiTap procedure using pharmaceutical GHB seems a safe alternative to benzodiazepines as a GHB detoxification procedure. However, the high relapse rates warrant further investigation.
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Novadic-Kentron, Network for Addiction Treatment Services, PO Box 243, 5260 AE Vught, the Netherlands. Electronic address: boukje.dijkstra@gmail.com.
authors.forename: Boukje A G
authors.initials: BA
authors.lastname: Dijkstra
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Novadic-Kentron, Network for Addiction Treatment Services, PO Box 243, 5260 AE Vught, the Netherlands.
authors.forename: Rama
authors.initials: R
authors.lastname: Kamal
authors.affiliation: Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Martijn S
authors.initials: MS
authors.lastname: van Noorden
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Tactus Addiction Treatment, PO Box 154, 7400 AD Deventer, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: de Haan
authors.affiliation: Pharmacotherapy of Psychiatric Patients, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: Loonen
authors.affiliation: Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Department of Clinical Psychology, Radboud University Nijmegen, 6525 HR Nijmegen, the Netherlands.
authors.forename: Cor A J
authors.initials: CA
authors.lastname: De Jong
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use; D066249:Craving / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011613:Psychotherapy; D012008:Recurrence; D012978:Sodium Oxybate / Q000008:administration & dosage / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001569:Benzodiazepines; D012978:Sodium Oxybate
keywords: Abstinence; Dependence; Detoxification; GHB; Gamma-Hydroxybutyrate; Treatment; Withdrawal