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Reid MJ, Dunn KE, Abraham L, Ellis J, Hunt C, Gamaldo CE, Coon WG, Mun CJ, Strain EC, Smith MT, Finan PH, Huhn AS. Suvorexant alters dynamics of the sleep-electroencephalography-power spectrum and depressive-symptom trajectories during inpatient opioid withdrawal. Sleep 2024; 47:zsae025. [PMID: 38287879 PMCID: PMC11009034 DOI: 10.1093/sleep/zsae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/21/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY OBJECTIVES Opioid withdrawal is an aversive experience that often exacerbates depressive symptoms and poor sleep. The aims of the present study were to examine the effects of suvorexant on oscillatory sleep-electroencephalography (EEG) band power during medically managed opioid withdrawal, and to examine their association with withdrawal severity and depressive symptoms. METHODS Participants with opioid use disorder (N = 38: age-range:21-63, 87% male, 45% white) underwent an 11-day buprenorphine taper, in which they were randomly assigned to suvorexant (20 mg [n = 14] or 40 mg [n = 12]), or placebo [n = 12], while ambulatory sleep-EEG data was collected. Linear mixed-effect models were used to explore: (1) main and interactive effects of drug group, and time on sleep-EEG band power, and (2) associations between sleep-EEG band power change, depressive symptoms, and withdrawal severity. RESULTS Oscillatory spectral power tended to be greater in the suvorexant groups. Over the course of the study, decreases in delta power were observed in all study groups (β = -189.082, d = -0.522, p = <0.005), increases in beta power (20 mg: β = 2.579, d = 0.413, p = 0.009 | 40 mg β = 5.265, d = 0.847, p < 0.001) alpha power (20 mg: β = 158.304, d = 0.397, p = 0.009 | 40 mg: β = 250.212, d = 0.601, p = 0.001) and sigma power (20 mg: β = 48.97, d = 0.410, p < 0.001 | 40 mg: β = 71.54, d = 0.568, p < 0.001) were observed in the two suvorexant groups. During the four-night taper, decreases in delta power were associated with decreases in depressive symptoms (20 mg: β = 190.90, d = 0.308, p = 0.99 | 40 mg: β = 433.33, d = 0.889 p = <0.001), and withdrawal severity (20 mg: β = 215.55, d = 0.034, p = 0.006 | 40 mg: β = 192.64, d = -0.854, p = <0.001), in both suvorexant groups and increases in sigma power were associated with decreases in withdrawal severity (20 mg: β = -357.84, d = -0.659, p = 0.004 | 40 mg: β = -906.35, d = -1.053, p = <0.001). Post-taper decreases in delta (20 mg: β = 740.58, d = 0.964 p = <0.001 | 40 mg: β = 662.23, d = 0.882, p = <0.001) and sigma power (20 mg only: β = 335.54, d = 0.560, p = 0.023) were associated with reduced depressive symptoms in the placebo group. CONCLUSIONS Results highlight a complex and nuanced relationship between sleep-EEG power and symptoms of depression and withdrawal. Changes in delta power may represent a mechanism influencing depressive symptoms and withdrawal.
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Affiliation(s)
- Matthew J Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liza Abraham
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Hunt
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Charlene E Gamaldo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William G Coon
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Chung Jung Mun
- Arizona State University, Edson College of Nursing and Health Innovation, Pheonix, AZ, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hall OT, Vilensky M, Teater JE, Bryan C, Rood K, Niedermier J, Entrup P, Gorka S, King A, Williams DA, Phan KL. Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-13. [PMID: 38502911 DOI: 10.1080/00952990.2023.2298257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/19/2023] [Indexed: 03/21/2024]
Abstract
Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (rs (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (rs (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (rs (119) = 0.421, p < .001), history of leaving the hospital against medical advice (rs (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (rs (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Vilensky
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie E Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kara Rood
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Niedermier
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Parker Entrup
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anthony King
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Bahrami M, Kheirabadi G, Safari A, Maracy MR. Effect of add-on amantadine to clonidine on opioid withdrawal symptoms in opioid-dependent patients detoxified with buprenorphine: a randomized controlled trial. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Mahboobe Bahrami
- Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Kheirabadi
- Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezoo Safari
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad R Maracy
- Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Development of an intravenous low-dose buprenorphine initiation protocol. Drug Alcohol Depend 2022; 237:109541. [PMID: 35753281 DOI: 10.1016/j.drugalcdep.2022.109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine is a life-saving treatment for opioid use disorder (OUD). Low-dose initiation (LDI) is an emerging buprenorphine initiation strategy that circumvents barriers associated with standard initiation. This study aims to describe tolerability and completion of LDI using intravenous (IV) buprenorphine and to define dosing protocols in a cohort of patients hospitalized in an urban academic hospital. METHODS Data was collected via retrospective chart review for IV buprenorphine LDI cases initiated between September 1, 2020 and February 28, 2021. Cases were excluded if diagnostic criteria for OUD was not met, Clinical Opiate Withdrawal Scale (COWS) scores were not recorded, or sublingual (SL) buprenorphine was given within 24 h before IV buprenorphine. Completion of LDI and COWS data were assessed for all cases. Cases were categorized based on adherence to a dosing strategy and LDI indication, including OUD and acute pain, non-prescribed fentanyl exposure, and transition from methadone. RESULTS Seventy-two cases were identified, and thirteen cases were excluded, leaving 59 cases in the population. Of these cases, 72.9% (43/59) tolerated LDI, and 91.5% (54/59) completed buprenorphine initiation. Forty-four (44/59, 75%) cases were adherent. Median duration of LDI within the adherent group was 23.7 h (IQR 22.8-27.0), 37.1 h (IQR 36.2-40.9), and 48.8 h (IQR 47.0-52.4) for the "rapid," "moderate," and "slow" dosing strategies, respectively. CONCLUSIONS IV buprenorphine LDI was tolerated and completed in a majority of patients. Dosing protocols allowed for rapid transition to sublingual buprenorphine. Acute pain or recent methadone or fentanyl exposure may inform IV LDI dosing strategy selection.
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Characterization of the GHB Withdrawal Syndrome. J Clin Med 2021; 10:jcm10112333. [PMID: 34073640 PMCID: PMC8199158 DOI: 10.3390/jcm10112333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
The gamma-hydroxybutyric acid (GHB) withdrawal syndrome can have a fulminant course, complicated by severe complications such as delirium or seizures. Detoxification by tapering with pharmaceutical GHB is a safe way to manage GHB withdrawal. However, a detailed description of the course of the GHB withdrawal syndrome is currently lacking. This study aimed to (1) describe the course of GHB withdrawal symptoms over time, (2) assess the association between vital signs and withdrawal symptoms, and (3) explore sex differences in GHB withdrawal. In this observational multicenter study, patients with GHB use disorder (n = 285) were tapered off with pharmaceutical GHB. The most reported subjective withdrawal symptoms (SWS) were related to cravings, fatigue, insomnia, sweating and feeling gloomy. The most prevalent objective withdrawal symptoms (OWS) were related to cravings, fatigue, tremors, sweating, and sudden cold/warm feelings. No association between vital signs and SWS/OWS was found. Sex differences were observed in the severity and prevalence of specific withdrawal symptoms. Our results suggest that the GHB withdrawal syndrome under pharmaceutical GHB tapering does not strongly differ from withdrawal syndromes of other sedative drugs. The lack of association between vital signs and other withdrawal symptoms, and the relative stability of vitals over time suggest that vitals are not suitable for withdrawal monitoring. The reported sex differences highlight the importance of a personalized approach in GHB detoxification.
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Hakvoort L, de Jong S, van de Ree M, Kok T, Macfarlane C, de Haan H. Music Therapy to Regulate Arousal and Attention in Patients With Substance Use Disorder and Posttraumatic Stress Disorder: A Feasibility Study. J Music Ther 2020; 57:353-378. [PMID: 32651585 DOI: 10.1093/jmt/thaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patients diagnosed with both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) often experience hypervigilance, increased fear, and difficulties regulating emotions. This dual diagnosis increases treatment complexity. Recently, a short-term music therapy intervention for arousal and attention regulation (the SMAART intervention) was designed based on neurobiological findings. Twelve patients with SUD and PTSD (50% females) in outpatient treatment participated in six weekly one-hour sessions of the SMAART intervention. Six patients completed the study. PTSD symptom severity was evaluated with the Posttraumatic Stress Disorder Symptom Scale Interview for DSM-5 (PSSI-5) pre- and post-intervention, and sustained attention was evaluated with the Bourdon-Wiersma (BW) test. A significant difference in measurements for the PSSI-5 overall symptom severity was found pre- and post-intervention. Furthermore, participants showed significant improvement on subscales of hyperarousal, mood and cognition, and attention. The BW test completion time decreased significantly. Two participants dropped out before the end of the intervention due to craving. Concerning future research, it is recommended to define the role of the music more explicitly and to change the design to a randomized controlled trial. A risk for future larger studies is a high dropout rate (50%). Several limitations of the study are discussed.
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Affiliation(s)
| | - Sirik de Jong
- ArtEZ University of the Artsm, Enschede, The Netherlands
| | - Maartje van de Ree
- ArtEZ University of the Artsm, Enschede, The Netherlands.,Tactus, Addiction Care Twente, Enschede, The Netherlands
| | - Tim Kok
- Tactus, Addiction Care Twente, Enschede, The Netherlands
| | - Clare Macfarlane
- Penitentiary Psychiatric Center Institution Vught & Vrije Universiteit, Amsterdam, The Netherlands
| | - Hein de Haan
- Tactus, Addiction Care Twente, Enschede, The Netherlands
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Detoxification of a Patient With Comorbid Dependence on Phenibut and Benzodiazepines by Tapering With Baclofen: Case Report. J Clin Psychopharmacol 2020; 39:511-514. [PMID: 31433344 DOI: 10.1097/jcp.0000000000001104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bienek N, Maier C, Kaisler M, Michel-Lauter B, Schwarzer A, Meyer-Frießem CH. Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain—Individualized or Fixed Starting Dosage? PAIN MEDICINE 2019; 20:2438-2449. [DOI: 10.1093/pm/pny320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjectiveControlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility.MethodsTwo protocols were compared: FSD (2014–2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010–2014): N = 127, starting dose: 70% of the patient’s daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0–64); secondary: change in pain intensity on a numeric rating scale (0–10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P < 0.05.ResultsThe mean daily SOWS score was lower in the FSD group (14.9 ± 9.4 vs 16.1 ± 10, P < 0.05) due to a lower rate of high-intensity withdrawal symptoms (12.4% vs 17.6%, P < 0.01), particularly in patients on >180 mg MED (9.7% vs 18.4%, P < 0.01). Pain intensity decreased after withdrawal, and the incidence of SAEs and dropouts was low in both groups.ConclusionsThe FSD protocol provides a lesser burden of withdrawal symptoms and equal patient safety. It can be recommended for OW in CNCP patients.
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Affiliation(s)
- Natalia Bienek
- Department of Pain Medicine, Ruhr-University Bochum
- Department of Anaesthesiology and Intensive Care, Klinikum Dortmund, Dortmund, Germany
| | | | | | | | | | - Christine H Meyer-Frießem
- Department of Pain Medicine, Ruhr-University Bochum
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
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Dijkstra BAG, Kamal R, van Noorden MS, de Haan H, Loonen AJM, De Jong CAJ. Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: The Dutch GHB monitor project. Drug Alcohol Depend 2017; 170:164-173. [PMID: 27923198 DOI: 10.1016/j.drugalcdep.2016.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Gamma-hydroxybutyrate (GHB) detoxification procedures have been insufficiently studied for effectiveness and safety. Based on case reports, benzodiazepines are generally regarded as first-choice agents in GHB detoxification. Detoxification by titration and tapering (DeTiTap) with pharmaceutical GHB in an open-label consecutive case series of 23 GHB-dependent patients showed to be feasible, effective and safe. This study further explored the feasibility, effectiveness and safety of this detoxification procedure in a large group of patients. METHOD A large observational multicenter study was carried out in six addiction treatment centers in the Netherlands. GHB-dependent inpatients (229 unique patients, 274 admissions) were titrated on and tapered off with pharmaceutical GHB. RESULTS Successful detoxification was achieved in 85% of cases. Detoxification was carried out in 12.5days in most patients. The DeTiTap procedure proved to be feasible and significantly reduced the experienced withdrawal symptoms and craving (p≤0.001). Several symptoms were found to influence the course of subjective withdrawal symptoms. During detoxification, psychological symptoms such as depression, anxiety, and stress decreased (p≤0.05). The main complications were hypertension and anxiety. Six patients were sent to the general hospital for observation, but all six were able to continue detoxification in the addiction treatment centers. Most patients (69%) relapsed within three months after detoxification. CONCLUSIONS The DeTiTap procedure using pharmaceutical GHB seems a safe alternative to benzodiazepines as a GHB detoxification procedure. However, the high relapse rates warrant further investigation.
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Affiliation(s)
- Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Novadic-Kentron, Network for Addiction Treatment Services, PO Box 243, 5260 AE Vught, the Netherlands.
| | - Rama Kamal
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Novadic-Kentron, Network for Addiction Treatment Services, PO Box 243, 5260 AE Vught, the Netherlands
| | - Martijn S van Noorden
- Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Hein de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Tactus Addiction Treatment, PO Box 154, 7400 AD Deventer, the Netherlands
| | - Anton J M Loonen
- Pharmacotherapy of Psychiatric Patients, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Cor A J De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, 6525 ED Nijmegen, the Netherlands; Department of Clinical Psychology, Radboud University Nijmegen, 6525 HR Nijmegen, the Netherlands
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The Effect of Co-occurring Substance Use on Gamma-hydroxybutyric Acid Withdrawal Syndrome. J Addict Med 2016; 10:229-35. [DOI: 10.1097/adm.0000000000000214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fresquez-Chavez KR, Fogger S. Reduction of opiate withdrawal symptoms with use of clonidine in a county jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2014; 21:27-34. [PMID: 25431436 DOI: 10.1177/1078345814557630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increasingly, addicted inmates admitted to jail in New Mexico are in the process of opiate withdrawal. While the standard for opiate detoxification is a narcotic taper, correctional policy restricts opiate use for safety reasons. An alternative for withdrawal is a supportive intervention with clonidine, a non-opiate. Could clonidine be beneficial for acute opiate withdrawal symptoms in this population? Fifty-five inmates (37 male and 18 female) volunteered to participate in assessing clonidine for the reduction of withdrawal symptoms. Symptoms were assessed with the Subjective Opiate Withdrawal Scale and treated with a standard clonidine protocol. Clonidine significantly decreased the mean scores at 1 and 4 hours after medication use. Clonidine for opiate withdrawal reduces symptoms when opiate-assisted detoxification is not available.
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de Haan HA, van der Palen J, Wijdeveld TGM, Buitelaar JK, De Jong CAJ. Alexithymia in patients with substance use disorders: state or trait? Psychiatry Res 2014; 216:137-45. [PMID: 24534122 DOI: 10.1016/j.psychres.2013.12.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/25/2013] [Accepted: 12/29/2013] [Indexed: 01/12/2023]
Abstract
Previous research on substance use disorders (SUD) has yielded conflicting results concerning whether alexithymia is a state or trait, raising the question of how alexithymia should be addressed in the treatment of SUD-patients. The absolute and relative stabilities of alexithymia were assessed using the Toronto Alexithymia Scale (TAS-20) and its subscales. In total, 101 patients with SUD were assessed twice during a 3-week inpatient detoxification period while controlling for withdrawal symptoms and personality disorder traits. The relative stability of the total TAS-20 and subscales was moderate to high but showed remarkable differences between baseline low, moderate, and high alexithymic patients. A small reduction in the mean levels of the total TAS-20 scores and those of one subscale revealed the absence of absolute stability. The levels of alexithymia were unrelated to changes in withdrawal symptoms, including anxiety- and depression-like symptoms. The differences between low, moderate, and high alexithymic patients in terms of the change in alexithymia scores between baseline and follow-up indicated a strong regression to the mean. The findings suggest that alexithymia in SUD patients as measured using the TAS-20 is both a state and trait phenomenon and does not appear to be related to changes in anxiety- and depression-like symptoms.
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Affiliation(s)
- Hein A de Haan
- Tactus Addiction Treatment, 7400 AD Deventer, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands.
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, 7500 AE Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, 7513 ER Enschede, The Netherlands
| | - Toon G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Radboud University Nijmegen Medical Centre, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Cor A J De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
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Abstract
OBJECTIVES : Opioid detoxification with subsequent naltrexone is found to be an effective method as the first step in an abstinence-oriented approach. The aim of this study is to investigate the predictive value of variables for abstinence in opioid-dependent patients. METHODS : Opioid-dependent patients were followed up to 1 month after detoxification. Predictor variables were assessed at baseline, during detoxification, and at discharge. Primary outcome was abstinence assessed by analyzing urine samples and self-reports. Logistic regression was used to identify predictors of abstinence. RESULTS : Of 272 participants, 211 could be rated as abstinent (59.2%) or nonabstinent (40.8%) at 1 month follow-up. Significant baseline predictors were severity score of justice/police (ASI) and physical quality of life (SF-36); discharge predictors were general quality of health (SF-36) and sleeping problems (SCL-90); change in sleeping problems (SCL-90) during detoxification was also a predictor. The explained variance of these predictors was very low and clinical significance was limited. CONCLUSIONS : Considering the results it seems not possible to predict who will be abstinent or not 1 month after detoxification. Because rapid detoxification is found to be an effective detoxification method in selected patients, it seems warranted to recommend that patients with similar characteristics (ie, patients motivated for an abstinence-based treatment and low non-drug-related severity scores on the ASI) should be regarded as eligible for rapid detoxification.
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Huang WL, Lin YH, Kuo TBJ, Chang LR, Chen YZ, Yang CCH. Methadone-mediated autonomic functioning of male patients with heroin dependence: the influence of borderline personality pattern. PLoS One 2012; 7:e37464. [PMID: 22629400 PMCID: PMC3358307 DOI: 10.1371/journal.pone.0037464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 04/20/2012] [Indexed: 11/18/2022] Open
Abstract
Background We hypothesize that the population with borderline personality shows different autonomic response to methadone compared to individuals with other personalities. This study applies heart rate variability (HRV) measurements and the Tridimensional Personality Questionnaire (TPQ) to examine this hypothesis. Methodology/Principal Findings Forty-four male patients with heroin dependence were recruited from a methadone maintenance treatment program. Eight personality patterns were classified according to the TPQ norm used in Taiwan. The borderline pattern (BP, composed of high novelty seeking, high harm avoidance and low reward dependence) and the other personality patterns (OP) were separated into two groups. We compared the HRV profiles between the BP and OP groups. Correlation and regression analysis were performed to clarify relationship between HRV differences and the borderline index (BI, a new concept defined by us, which is calculated as novelty seeking + harm avoidance – reward dependence). The HRV targets investigated included low frequency (LF) power, high frequency (HF) power, total power (TP), normalized LF (LF%), and LF/HF. No baseline HRV parameters showed any inter-group difference. The BP group had a significantly lower ΔHF and a higher ΔLF/HF than the OP group. The personality dimension, reward dependence, showed a negative correlation with ΔLF/HF and ΔLF%. BI was negatively correlated with ΔHF and positively correlated with ΔLF/HF and ΔLF%. Conclusions/Significance Borderline personality individuals show increased sympathetic activity and decreased parasympathetic activity compared to other personalities after taking methadone. The results support the hypothesis that there is an interaction between borderline personality and autonomic modulation.
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Affiliation(s)
- Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hsuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Research Center for Adaptive Data Analysis, National Central University, Taoyuan, Taiwan
| | - Li-Ren Chang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Ying-Zai Chen
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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15
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de Jong CAJ, Kamal R, Dijkstra BAG, de Haan HA. Gamma-hydroxybutyrate detoxification by titration and tapering. Eur Addict Res 2012; 18:40-5. [PMID: 22142784 DOI: 10.1159/000333022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effectiveness and safety of a new detoxification procedure in γ-hydroxybutyrate (GHB)-dependent patients. GHB is an endogenous inhibitory neurotransmitter and anesthetic agent that is being abused as a club drug. In many GHB-dependent patients a severe withdrawal syndrome develops that does not respond to treatment with high dosages of benzodiazepines and often requires an admission to an intensive care unit. METHODS Based on the knowledge of detoxification procedures in opioid and benzodiazepine dependence, we developed a titration and tapering procedure. A consecutive series of 23 GHB-dependent inpatients were transferred from illegal GHB (mostly self-produced) in various concentrations to pharmaceutical GHB. They were given initial doses that resulted in a balance between sedation and withdrawal symptoms. After this titration period, patients were placed on a 1-week taper. RESULTS We have found that after titration the patients experienced a low level of withdrawal symptoms. During tapering these symptoms decreased significantly and no patient developed a delirium or a psychosis. None of the patients had to be transferred to a medium or intensive care unit. CONCLUSIONS This detoxification procedure proved to be safe and convenient in patients with moderate to severe GHB dependence.
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Affiliation(s)
- Cor A J de Jong
- Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands.
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