Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series

Abstract

BackgroundAbout 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.ObjectivesThe 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.MethodsClinical 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.ResultsTwenty-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.ConclusionsTo 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.

A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research

“…The main difference between retention and length of stay was that there were no predetermined expectations about the required length of treatment (e.g., at least 7 days). Seven studies included outcomes relating to total length of stay in the facility [ 4 , 6 , 22 , 24 , 29 , 40 , 80 ]. Eight studies included outcomes relating to length of withdrawal treatment only [ 40 , 41 , 53 , 54 , 71 , 72 , 76 ].…”

“…Males comprised the majority of the sample in 78 (88.6%) of the 88 studies. Mean ages ranged from 11.14 [ 22 ] to 54.1 years [ 23 ] in the 82 studies that reported mean age. Sample sizes ranged from 11 to 72,205.…”

“…The self‐report Cannabis Withdrawal Scale [ 55 , 56 ], the Adjective Rating Scale for Withdrawal [ 12 , 57 ], Visual Analog Scale [ 12 , 39 ] and Marijuana Withdrawal Scale [ 53 , 54 ] were all used in two different studies. Single studies reported using a self‐report of subjective withdrawal symptoms (unspecified scale) [ 58 ], psychiatrist reports based on physical examinations [ 22 ], self‐report via the Alcohol Withdrawal Symptoms Score [ 39 ] and self‐report via Severity of Withdrawal Scale [ 59 ].…”

Inpatient Buprenorphine-Assisted Withdrawal for Treatment of Vulnerable Adolescents with Opioids Use Disorder in Zahedan, Iran: An Observational Study

“…In this study, we integrated buprenorphine-assisted opioid withdrawal management within the child and adolescent psychiatric sub-specialty services for adolescents with opioid use disorder. Before that, available services for opioids treatment were limited to the symptomatic management of opioid withdrawal with clonidine, NSAIDs (nonsteroidal anti-inflammatory drugs), and antihistamines, as well as treatment of psychiatric comorbidities (23). We used a flexible dose reduction schedule of buprenorphine-assisted withdrawal regimen (buprenorphine mono-product, 2 mg sublingual tablets manufactured by Faran Shimi Pharmaceutical Co.) from previous studies (16,24) and trained psychiatric residents for its implementation.…”