Drink and Drugs News DDN March 2020 | Page 14

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. WWW.DRINKANDDRUGSNEWS.COM