Background

The gamma-hydroxybutyric acid (GHB) 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 (BZDs) or tapering with pharmaceutical GHB. In Belgium, standard treatment is tapering with BZDs, while in the Netherlands, pharmaceutical GHB is the preferred treatment method. Though BZDs are cheaper and readily available, case studies suggest GHB tapering results in less severe withdrawal and fewer complications.

Objectives

This study aimed to compare two treatments-as-usual in tapering methods on withdrawal, craving and adverse events during detoxification in GHB-dependent patients.

Methods

In this multicentre non-randomised 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 and adverse events were systematically recorded. Differences in withdrawal and craving were analysed using a linear mixed-model analysis, with ‘days in admission’ and ‘detoxification method’ as fixed factors. Differences in adverse events were analysed using a Chi-square analysis.

Results

Withdrawal decreased over time in both groups. Withdrawal severity was higher in patients receiving BZD tapering (subjective mean = 36.50, standard deviation = 21.08; objective mean = 8.05, standard deviation = 4.68) than in patients receiving pharmaceutical GHB tapering (subjective mean = 15.90; standard deviation = 13.83; objective mean = 3.72; standard deviation = 2.56). No differences in craving were found. Adverse events were more common in the BZD than the 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 fewer complications than BZD tapering.

中文翻译：

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用药物 GHB 或苯二氮卓类药物逐渐减少 GHB 依赖性患者的解毒效果：比利时和荷兰常规治疗的匹配受试者观察性研究。

背景

γ-羟基丁酸 (GHB) 戒断综合征通常具有暴发性病程，发病迅速，严重并发症进展迅速。在临床实践中，通常使用两种药理学方案来抵消 GHB 解毒过程中的戒断症状：苯二氮卓类药物 (BZDs) 逐渐减少或药物 GHB 逐渐减少。在比利时，标准治疗是逐渐减少 BZD，而在荷兰，药物 GHB 是首选治疗方法。虽然 BZD 更便宜且容易获得，但案例研究表明 GHB 逐渐减少导致戒断严重程度降低和并发症更少。

目标

本研究旨在比较两种常规治疗方法在 GHB 依赖患者戒毒期间的戒断、渴望和不良事件方面的逐渐减量方法。

方法

在这项对两种治疗方法的多中心非随机间接比较中，GHB 依赖患者接受了 BZD 减量（比利时样本：n  = 42）或 GHB 减量（荷兰样本：n  = 42，匹配的历史样本）。使用主观和客观戒断量表评估戒断，使用视觉模拟量表评估渴望，并系统地记录不良事件。使用线性混合模型分析分析戒断和渴望的差异，以“入院天数”和“解毒方法”作为固定因素。使用卡方分析来分析不良事件的差异。

结果

两组的戒断时间都随着时间的推移而减少。接受 BZD 逐渐减量的患者（主观平均值 = 36.50，标准偏差 = 21.08；客观平均值 = 8.05，标准偏差 = 4.68）的戒断严重程度高于接受药物 GHB 减量的患者（主观平均值 = 15.90；标准偏差 = 13.83；客观平均值） = 3.72；标准偏差 = 2.56）。没有发现渴望的差异。BZD 组的不良事件比 GHB 组更常见，尤其是谵妄（分别为 20% 和 2.5%）。

结论

这些结果支持早期的工作，即 BZD 逐渐减少可能并不总是足以抑制 GHB 依赖患者的戒断。但是，需要考虑到这两种治疗方法都是在不同的国家进行评估的。根据目前的研究结果，在解毒期间对 GHB 依赖的患者可以考虑使用药物 GHB 逐渐减少，因为与 BZD 逐渐减少相比，它可能具有更轻的戒断和更少的并发症。