DETOX
SYNTHETIC SOLUTIONS
With research evidence around NPS still thin on the ground,
a Nottingham service has been evaluating its synthetic
cannabinoid detox protocol. Dr Daniel Masud reports
an as-required basis (typically
for the first 72 hours) to address
more severe and acute withdrawal
symptoms.
Since opening in 2018 Edwin
House has admitted 22 patients
who required detoxification for
‘black mamba’ NPS, and to assess
the impact of the existing protocol
we completed a retrospective case
study analysis. There were 16 males
and six females included in the
study – more than half were in the
36-45 age group, with a further
27 per cent aged 46-55. Mamba
was identified as the primary drug
of choice and reason for detox
in 18 patients and a secondary
drug of choice in four. Across all
22 referrals additional substances
were identified as ‘problematic’,
T
he research evidence
on synthetic
cannabinoids is
currently limited
to case reports and
case series, as well
as retrospective toxicology surveys,
human and animal laboratory
studies, and interviews with users.
There are no longitudinal studies or
randomised controlled trials.
At Edwin house, a specialist
care and reablement facility in
Nottingham, our inpatient detox
unit comprises 14 beds and our
synthetic cannabinoid detoxification
protocol is formulated by local
clinician consensus on evidence
gathered from Project Neptune and
the Home Office.
Evidence to date indicates
that chlordiazepoxide is the first-
line medicine of choice to most
effectively manage symptoms of
withdrawal during NPS detox – this
is prescribed on a variable dose-
reducing regimen over a period of
seven to ten days with additional
chlordiazepoxide prescribed on
14 • DRINK AND DRUGS NEWS • MARCH 2020
We were confident
that withdrawal
symptoms would
be primarily
physical, yet
psychological
withdrawal was
also evident.
Symptoms lasted
from 24 hours in six
cases to more than
72 in eight.
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