Harmen Beurmanjer

68 Chapter 5 Craving The Visual Analogue Scale (VAS) was used to asses craving on 0-10 scale. Patients ticked the number that applied to their current experienced level of craving. The VAS is widely used in health research, and is commonly used in studies to assess severity of craving in patients with substance use disorders(Dijkstra et al., 2017; Schmitz et al., 2017). Adverse events After detoxification, patients and staff were asked to fill out a discharge questionnaire (Dijkstra et al., 2017) to identify adverse events. In addition, discharge summaries were reviewed for any adverse events or other issues that emerged during detoxification. Adverse events were interpreted as untoward medical occurrences in a participant, such as delirium, other events resulting in severe discomfort for the patients, life-threatening situations, or admittance to intensive care unit. Detoxification treatment Detoxification with BZD Diazepam (or lorazepam when serious liver disease was present) was titrated based on vital parameters. Vitals were measured once per 30 minutes. When blood pressure rose above 140/90 mmHg and/or heart rate rose above 100 beats per minute (bpm) diazepam 10mg (or lorazepam 2.5mg) was administered. In the event of a more than 20 mmHg rise in pressure (systolic or diastolic blood), and/or 20 bpm increase in heart rate the diazepam dose was increased with 20mg (or lorazepam 5mg). The dose of diazepam (or lorazepam) was adjusted every thirty minutes, if needed, until blood pressure and heart rate dropped below 140/90 mmHg and 100 bpm, respectively. The total detoxification and tapering schedule took on average seven days. Detoxification with pharmaceutical GHB Detoxification started with a titration phase, where patients were treated with pharmaceutical GHB on 70% of their street GHB dose. Next, the GHB dose was titrated up in case of withdrawal and titrated down in case of sedation, until the right pharmaceutical GHB dose was found on which patients were stable and experienced neither withdrawal, nor sedation. This usually took between one and two days, after which the tapering phase started. During the tapering phase the GHB dose was lowered by 300mg GHB per given dose per day. The interval between doses was usually two hours, or up to three hours depending on withdrawal severity. For a more detailed description of the protocol see(Dijkstra et al., 2017). The total detoxification and tapering schedule took on average 11 days.