Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA) (RMK, BAGD, CAJDJ); Novadic-Kentron Addiction Care Network (RMK, BAGD), Vught; Department of Pharmacy (AJL), University of Groningen, Groningen; and Behavioral Science Institute (CAJDJ), Radboud University, Nijmegen, the Netherlands.
J Addict Med. 2016 Jul-Aug;10(4):229-35. doi: 10.1097/ADM.0000000000000214.
Gamma-hydroxybutyric acid (GHB) withdrawal is a complex syndrome which can be potentially life-threatening. Additionally, GHB-dependent patients frequently report co-occurring substance use of other psychoactive drugs. We assessed the add-on effect of co-use on GHB withdrawal symptoms.
We conducted an open-label, pretest-posttest design study with 95 patients selected from 229 inpatients admitted for detoxification, who were divided into GHB only (GO, n = 40), GHB plus sedatives (GSE, n = 38), and GHB plus stimulants (GST, n = 17) groups. GHB withdrawal was evaluated by means of the Subjective Withdrawal Scale. Co-use add-on effects on the severity of withdrawal symptoms were evaluated 2.5 hours after the last illicit GHB self-administration (T1) when withdrawal was expected and 2.5 hours later, after administration of a very low dose of pharmaceutical GHB (T2).
The GO group reported high scores of psychomotor retardation symptoms at both T1 and T2, and also high cravings, agitation, and restlessness at T1, and anxiety at T2. The GSE group reported the highest score in psycho-autonomic distress symptoms at both T1 and T2, whereas the GST group reported the highest score in psycho-motor stress factor at T2. There was no significant difference in withdrawal intensity in all symptom clusters between T1 and T2 for both GSE and GO groups. However, after 5 hours, the GST group reported significant decreases in intensity for all symptoms except for psycho-motor stress. At T1, GST and GSE groups reported more muscle twitches than the GO group as a significant add-on effect to the GHB withdrawal. At T2, the GST group experienced more agitation (P = 0.009), restlessness (P = 0.001), and rapid pulse (P = 0.034) than the GO group.
Co-use, especially of stimulants, caused an add-on effect on the GHB withdrawal symptoms within the first 5 hours.
γ-羟基丁酸（GHB）戒断是一种复杂的综合征，可能有生命危险。此外，GHB 依赖患者经常报告同时使用其他精神活性药物。我们评估了共同使用对 GHB 戒断症状的附加影响。
我们进行了一项开放性、前测后测设计的研究，共纳入 229 名住院接受戒毒治疗的患者中的 95 名患者，他们被分为仅 GHB 组（GO 组，n=40）、GHB 加镇静剂组（GSE 组，n=38）和 GHB 加兴奋剂组（GST 组，n=17）。使用主观戒断量表评估 GHB 戒断情况。在预计戒断时（T1）和 2.5 小时后给予极低剂量的药物 GHB 后（T2），评估共同使用对戒断症状严重程度的附加影响。
GO 组在 T1 和 T2 时均报告有严重的运动迟滞症状，T1 时还报告有强烈的渴求、激动和不安，T2 时报告有焦虑。GSE 组在 T1 和 T2 时均报告有最高的自主神经失调症状评分，而 GST 组在 T2 时报告有最高的精神运动应激因素评分。在 GSE 和 GO 组中，在 T1 和 T2 时，所有症状群的戒断强度均无显著差异。然而，在 5 小时后，GST 组报告除精神运动应激外，所有症状的强度均显著降低。在 T1 时，GST 和 GSE 组报告的肌肉抽搐比 GO 组多，这是 GHB 戒断的一个显著附加效应。在 T2 时，GST 组比 GO 组报告更多的激动（P=0.009）、不安（P=0.001）和快速脉搏（P=0.034）。
在最初的 5 小时内，共同使用，特别是兴奋剂，对 GHB 戒断症状产生了附加影响。
