Institute of Internal Medicine, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
We read with great interest the recent case reported by Price (2000) concerning the utility of diazepam in suppressing gammahydroxybutyrate (GHB) dependence and related withdrawal symptoms. Before describing the case Price states, "I believe this to be the first reported case of in-patient detoxification". However, the first report on the utility of the same doses of diazepam in treating GHB withdrawal syndrome was published a year earlier by our group in a patient taking about 181 g/day GHB for 4 months, for its euphoric and anxiolytic effects (Addolorato et al, 1999). On discontinuation of GHB, the patient showed a withdrawal syndrome consisting of high anxiety levels, tremor, sweating, tachycardia and nausea. Complete disappearance of drug withdrawal symptoms was achieved within 2 hours in the first day of treatment with diazepam 20 mg orally administered, and the patient was treated with the same dose of diazepam for another 6 days. After suspension of the diazepam, the symptoms did not recur. Also in this case, the detoxification programme was safe. We are very pleased to know that our findings are in perfect agreement with that of Price; since several cases of GHB misuse and dependence have been described in recent years (see Addolorato et al, 2000), we think that these reported experiences, as well as the recent case described by Hutto et al (2000) about the utility of chloral hydrate, could be of clinical relevance, particularly considering the difficult management of these patients.
REFERENCES
Addolorato, G., Caputo, F., Capristo, E., et al (1999) A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration. Clinical Neuropharmacology, 22, 60-62.[Medline]
Addolorato, G., Caputo, F., Capristo, E., et al (2000) Gamma-hydroxybutyric acid: efficacy, potential abuse and dependence in the treatment of alcohol addiction. Alcohol, 20, 17-217-222.
Hutto, B., Faichild, A. & Bright, R. (2000)
Gamma-hydroxybutyrate withdrawal and chloral hydrate. American
Journal of Psychiatry, 157,
1706.
Price, G. (2000) In-patient detoxification
after GHB dependence (letter). British Journal of
Psychiatry, 177,
181.