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DEVELOPMENT OF A RISK ASSESSMENT TOOL TO DETERMINE WHETHER PATIENTS WITH GHB/GBL DEPENDENCE CAN BE MANAGED IN AN OUT-PATIENT OR IN-PATIENT SETTING. Bowden-Jones O 1 , Dargan PI 2 , Lingford-Hughes A 1 , Reed L 1 , Wood DM 2.

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DEVELOPMENT OF A RISK ASSESSMENT TOOL TO DETERMINE WHETHER PATIENTS WITH GHB/GBL DEPENDENCE CAN BE MANAGED IN AN OUT-PATIENT OR IN-PATIENT SETTING.

Bowden-Jones O1, Dargan PI2, Lingford-Hughes A1, Reed L1, Wood DM2

1Club Drug Clinic, Chelsea and Westminster Hospital, Central North West London NHS Foundation Trust, London, UK

2Clinical Toxicology Service, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK

Introduction

  • Gamma-hydroxybutyrate (GHB) is a naturally occurring short chain fatty acid which produces effects via GABAB and GHB receptors. GHB was first synthesized in the 1960s. Gamma-butyrolactone (GBL) is a pro-drug for GHB
  • There is increasing evidence of individuals developing dependence to GHB and GBL.1,2
  • Cessation of use is associated with a physical withdrawal syndrome with varying degrees of severity.3
  • Those who present in active withdrawal appear to be more likely to develop more severe features and a significant proportion, reportedly as high as 25%, require admission to the intensive care unit (ICU).

Methods

  • We reviewed more than 50 case notes from individuals presenting to;
    • a) an Emergency Department in active GHB/GBL withdrawal (25 case notes)
    • b) an addiction clinic specialising in club drug problems (28 case notes).
  • Factors associated with more severe withdrawal, the need for outpatient cases to be admitted for inpatient care and/or the need for admission to ICU for management were determined from these case notes.

Results

  • Six broad categories were identified:

i) current other recreational/illicit drug use;

ii) previous GHB/GBL withdrawal history;

iii) current level of social support;

iv) previous psychiatric history;

v) past medical history;

vi) intensity of GHB/GBL use.

  • Within these categories, factors felt to be associated with the need for inpatient withdrawal management were:

i) dependent alcohol / benzodiazepine use;

ii) severe previous withdrawal and/or previous ICU admission for withdrawal therapy;

iii) lives alone/poor social support;

iv) psychosis / recent self-harm;

v) previous seizures/epilepsy;

vi) frequent daily dosing over an extended period.

The tool has subsequently been prospectively used in a small number of clinical assessments and has proven valuable in both acute hospital and community settings.

Conclusions

  • We have developed a risk assessment tool based on retrospective case note review. Initial finding suggest this tool may have utility in clinical decision making.
  • The tool now needs to be prospectively assessed in a setting managing large number of individuals with GHB/GBL dependency to determine whether the factors identified as requiring in-patient management are appropriate.
  • References
  • 1. Alejandro G & Nutt D. Gamma hydroxy butyrate abuse and dependency. Journal of Psychopharmacology 2005: 19(2) 195–204
  • 2. Drasbek KR, Christensen J, Jensen K. Gamma-hydroxybutyrate – a drug of abuse. Acta Neurol Scand 2006: 114: 145–156
  • 3 Martijn S et al. Gamma-hydroxybutyrate withdrawal syndrome: dangerous but not well-known General Hospital Psychiatry 31 (2009) 394 – 396
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