Management of withdrawal from alcohol and other drugs

Lintzeris, Nicholas; Sunjic, Sandra; Demirkol, Apo; Branezac, Mira; Ezard, Nadine; Siefried, Krista J; Acheson, Liam S.; Bascombe, Florence; Tremonti, Chris; Haber, Paul

doi:10.57022/mjjp9930

Cited by 4 publications

References 155 publications

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Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review

et al. 2022

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Rationale Regular consumption of gamma-hydroxybutyrate (GHB) may result in a dependence syndrome that can lead to withdrawal symptoms. There are limited data on medications to manage GHB withdrawal. Objectives To examine characteristics associated with delirium and discharge against medical advice (DAMA), in the context of implementing a GHB withdrawal management protocol at an inner-city hospital in 2020. Methods We retrospectively reviewed records (01 January 2017–31 March 2021), and included admissions that were ≥ 18 years of age, admitted for GHB withdrawal, and with documented recent GHB use. Admissions were assessed for demographics, medications administered, features of delirium, ICU admission, and DAMA. Exploratory analyses were conducted to examine factors associated (p < 0.2) with features of delirium and DAMA. Results We identified 135 admissions amongst 91 patients. Medications administered included diazepam (133 admissions, 98.5%), antipsychotics (olanzapine [70 admissions, 51.9%]), baclofen (114 admissions, 84%), and phenobarbital (8 admissions, 5.9%). Features of delirium were diagnosed in 21 (16%) admissions. Delirium was associated with higher daily GHB consumption prior to admission, while duration of GHB use, time from presentation to first dose of diazepam, and concomitant methamphetamine use were inversely associated with delirium. DAMA occurred amongst 41 (30%) admissions, and was associated with a longer time from presentation to first dose of baclofen, while being female and receiving a loading dose of diazepam were inversely associated. Conclusions This study adds to the literature in support of the safety and feasibility of diazepam and baclofen for the management of GHB withdrawal. Prospective, randomised trials are required.

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Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review

et al. 2022

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Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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Background Stimulant drugs are second only to cannabis as the most widely used class of illicit drug globally, accounting for 68 million past-year consumers. Dependence on amphetamines (AMPH) or methamphetamine (MA) is a growing global concern. Yet, there is no established pharmacotherapy for AMPH/MA dependence. A comprehensive assessment of the research literature on pharmacotherapy for AMPH/MA dependence may inform treatment guidelines and future research directions. Methods We systematically reviewed the peer-reviewed literature via the electronic databases PubMed, EMBASE, CINAHL and SCOPUS for randomised controlled trials reported in the English language examining a pharmacological treatment for AMPH/MA dependence or use disorder. We included all studies published to 19 June 2019. The selected studies were evaluated for design; methodology; inclusion and exclusion criteria; sample size; pharmacological and (if included) psychosocial interventions; length of follow-up and follow-up schedules; outcome variables and measures; results; overall conclusions and risk of bias. Outcome measures were any reported impact of treatment related to AMPH/MA use. Results Our search returned 43 studies that met our criteria, collectively enrolling 4065 participants and reporting on 23 individual pharmacotherapies, alone or in combination. Disparate outcomes and measures (n = 55 for the primary outcomes) across studies did not allow for meta-analyses. Some studies demonstrated mixed or weak positive signals (often in defined populations, e.g. men who have sex with men), with some variation in efficacy signals dependent on baseline frequency of AMPH/MA use. The most consistent positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate. Less consistent benefits have been shown with the antidepressants bupropion and mirtazapine, the glutamatergic agent riluzole and the corticotropin releasing factor (CRF-1) antagonist pexacerfont; whilst in general, antidepressant medications (e.g. selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) have not been effective in reducing AMPH/MA use. Conclusions No pharmacotherapy yielded convincing results for the treatment of AMPH/MA dependence; mostly studies were underpowered and had low treatment completion rates. However, there were positive signals from several agents that warrant further investigation in larger scale studies; agonist therapies show promise. Common outcome measures should include change in use days. Future research must address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

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Emergency care

2024

Oxford Handbook of Addiction Medicine

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There are several different contexts in which emergency care may be needed for people who use substances. The principles and practice of emergency care of people who present with various acute clinical syndromes are described. These include intoxication and overdose, acute withdrawal state, agitation and aggression, confusion and delirium, reduced levels of consciousness, acute psychosis, and suicidality. Key components of risk assessment and resuscitation are provided, including the principles of emergency management to stabilize the patient. The information presented is designed to assist the provision of acute care by the clinician in managing common emergencies related to psychoactive substance use and is not intended to cover acute management of the broad range of other, non-substance use-related physical and mental health conditions.

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Management of withdrawal from alcohol and other drugs

Cited by 4 publications

References 155 publications

Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review

Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review

Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

Emergency care

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