This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Gamma-hydroxybutyrate (GHB) and GHB precursors such as 1,4-butanediol, gamma-butryolactone (GBL) are emerging drugs of abuse used across the country. Unfortunately many treatment centers are not familiar with this drug or the signs and symptoms of withdrawal from GHB or its precursors. Dependent users develop a withdrawal syndrome similar to alcohol withdrawal. Withdrawal symptoms typically begin one to six hours after last use. Early symptoms include anxiety, tremor, insomnia, and nausea; as well as sweating, elevated heart rate and blood pressure. In cases of severe withdrawal, delirium can occur including confusion, hallucinations and agitation. There are no evidence-based treatment guidelines for the treatment of GHB withdrawal. However, patients presenting for treatment generally are treated with a benzodiazepine. The purpose of these studies are to quantify the signs and symptoms of GHB withdrawal, identify predictors of withdrawal severity and evaluate the safety and feasibility of drug treatment for GHB detoxification. The study involves three phases. In the first phase of the study participants will be given lorazepam for the treatment of 'mild' GHB withdrawal. Lorazepam is a benzodiazepine similar to Valium. All participants will be treated with the goal of attenuating symptoms and preventing withdrawal progression. However, some participants will progress into 'moderate' or 'severe' withdrawal.
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