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Gamma-butyrolactone (GBL) dependence and withdrawal.

AIM
To describe morbidity associated with gamma-butyrolactone (GBL) dependence, and outcomes of withdrawal.


DESIGN
Case series.


SETTING
Specialist out-patient clinic and affiliated in-patient detoxification unit. Patients with home support were offered the option of out-patient withdrawal management, based on high-dose diazepam and baclofen, titrated against withdrawal severity in an initial session lasting approximately 4 hours. Patients were then reviewed daily during the first 3 days of treatment, offered weekly follow-up for 4 weeks, and telephoned 2-4 months later.


PARTICIPANTS
People dependent on GBL seeking detoxification.


MEASUREMENTS
Drug history and social functioning were obtained by self-report in clinical interviews with a single clinician. Treatment completion, outcomes and adverse events associated with withdrawal are reported.


FINDINGS
Patients reported impaired social functioning associated with GBL dependence and difficulty in accessing treatment. Nineteen patients commenced detoxification; 17 initially declined admission and were treated as out-patients. Mean diazepam dose in the first 24 hours was 75 mg (range 40-110 mg). Sixteen patients completed withdrawal, although several had lapses to GBL use during treatment. One patient developed delirium and required transfer to the in-patient detoxification unit. Most patients had persisting insomnia, anxiety and depression for weeks after withdrawal.


CONCLUSIONS
GBL withdrawal can be managed in ambulatory settings, but needs to be backed up with seamless access to in-patient treatment if required.