Harmen Beurmanjer

64 Chapter 5 Abstract Background: The Gamma-HydroxyButyric (GHB) acid 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 (BZD) or tapering with pharmaceutical GHB. In Belgium standard treatment is tapering with BZD, while in the Netherlands pharmaceutical GHB is the preferred treatment method. Though BZD are cheaper and readily available, case studies suggest GHB tapering results in less severe withdrawal and less complications. Aims: This study aimed to compare two treatments-as-usual in tapering methods on withdrawal, craving and adverse events during detoxification in GHB-dependent patients. Method: In this multicentre non-randomized 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, adverse events were systematically recorded. Differences in withdrawal and craving were analysed using linear mixed model analysis, with ‘’days in admission’’ and ‘’detoxification method’’ as fixed factors. Differences in adverse events were analysed using Chi-square analysis. Results: Withdrawal decreased over time in both groups. Withdrawal severity was higher in patients receiving BZD tapering (subjective mean=36.50, SD=21.08; objective mean= 8.05, SD=4.68) than in patients receiving pharmaceutical GHB tapering (subjective mean=15.90; SD=13.83; objective mean=3.72; SD=2.56). No differences in craving were found. Adverse events weremore common in the BZD than 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 GHB-dependent 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 less complications than benzodiazepine tapering.