GHB Research in the Netherlands
By: Harmen Beurmanjer MSc. & dr. Boukje A.G. Dijkstra
Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA)
The drug GHB (Gamma hydroxybutyrate) emerges during the mid-90s in the Dutch nightlife. At that time GHB was ‘advertised’ as a "relaxant energizer with erotic qualities" (Nabben, 2010). In small amounts GHB was found to provide a peaceful feeling and a sexually stimulating effect. At higher doses of GHB nausea and dizziness may occur, and can lead to a comatose sleep. Upon waking one often is very alert and sometimes aggressive.
In the spring of 1996 there are a series of incidents were users ended up unconscious in the hospital due to GHB use. These incidents led to the prohibition of selling GHB by the Ministry of Health. The substance only came back in the media around 2000 as the "date rape drug", although clear evidence for this statement is lacking. In 2003 there were signals that the drug was getting increasingly popular again. The increased use is not much later noticed by the addiction care centres, where more and more people show up with problematic use of GHB (Nabben, 2010). The rise in dependent patients contradicted the earlier assumption that GHB was not addictive.
From 2007 onwards patients with a dependence on GHB are showing up all over the Netherlands (Wisselink et al, 2012). In the period 2008-2010 the number of GHB dependent patients in addiction care doubled. By 2011 the problems have spread to most cities throughout the Netherlands. Following this increase in the number of GHB dependent patients the Dutch ministry of health financed a nationwide project, called the GHB monitor.
This research project was executed by the Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA) in order to develop and test a protocol for save detoxification of GHB dependent patients. During the project protocols were developed for addicts using the DeTiTap method (Kamal, Dijkstra & De Jong, 2013). The patients are initiated on pharmaceutical GHB and then have their dosage gradually reduced within two weeks to zero.
The DeTiTap method proved to be reliable, safe and showed few complications. In response to the many incidents at the emergency rooms, the protocol for inpatient detoxification is also made applicable to general hospitals. Since the demands for outpatient detoxification increased during the project, guidelines for ambulatory detoxification with benzodiazepines were also developed. The three protocols are compiled in practice-based recommendations and published by the national quality program “Scoring Results” (Kamal, Dijkstra, Van Iwaarden, Van Noorden & De Jong, 2013).
Besides these successes it was also observed that there was a relapse rate of twenty-five percent within a week after detoxification and two-thirds within three months (Dijkstra et al, 2013). While this study gave a first insight, research and publications on the topic of GHB dependence is still very limited. The knowledge gap makes it all more difficult to create effective relapse prevention for this new patient group. This has become the topic of a new research project, GHB monitor 2.0, in which the treatment after detoxification will be examined. As part of this project a study on baclofen as part of medical relapse management will also be conducted. The study is coordinated by Harmen Beurmanjer, who will write his PhD thesis about this topic. The project is supervised by Dr. Boukje Dijkstra, Dr Arnt Schellekens and Prof. Dr. Cor de Jong of the NISPA and Radboud University Nijmegen, the Netherlands. This will be the second PhD project about GHB dependency in the Netherlands conducted by the NISPA. Dr. Rama Kamal is expected to defend her thesis in 2015 on detoxification of GHB dependent patients.
The protocols mentioned are currently being translated in English, German and French and will be made available for free.
Dijkstra, B., De Weert-van Oene, G.H., Verbrugge, C.A.G., De Jong, C.A.J. GHB Detoxificatie met farmaceutische GHB. Eindrapportage van de monitoring van DeTiTap® in de Nederlandse verslavingszorg. Nijmegen: NISPA, maart 2013.
Kamal, R., Dijkstra, B.A.G., van Iwaarden, J.A., Van Noorden, M.S. & De Jong, C.A.J. (2013). Practice-based aanbevelingen voor de detoxificatie van patiënten met een stoornis in het gebruik van GHB. Amersfoort: Resultaten Scoren.
Kamal, R., Iwaarden van, S., Dijkstra, B.A.G. & De Jong, C.A.J. (2013). Decision rules for GHB (Gamma- hydroxybutyric acid) detoxification: A vignette study. Alcohol and Drug Dependence.
Nabben T. (2010) High Amsterdam. Ritme, roes en regels in het uitgaansleven.
Wisselink D.J., Kuijpers, W.G.T., Mol, A. (2012). Kerncijfers verslavingszorg 2011. Landelijke Alcohol en Drugs Informatie Systeem. Houten.