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Management of Withdrawal from Alcohol and Other Drugs

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Management of Withdrawal from Alcohol and Other Drugs Management of withdrawal from alcohol and other drugs An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. September 2019. An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. September 2019. This report was prepared by: Nicholas Lintzeris, Sandra Sunjic, Apo Demirkol, Mira Branezac, Nadine Ezard, Krista Siefried, Liam Acheson, Florence Bascombe, Chris Tremonti, and Paul Haber. September 2019 © Sax Institute 2019 This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusions of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the copyright owners. Enquiries regarding this report may be directed to the: Manager Knowledge Exchange Program Sax Institute www.saxinstitute.org.au [email protected] Phone: +61 2 9188 9500 Suggested Citation: Lintzeris N, Sunjic S, Demirkol A, Branezac M, Ezard N, Siefried K, Acheson L, Bascombe F, Tremonti C, and Haber P. Management of withdrawal from alcohol and other drugs: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the NSW Ministry of Health, 2019. Disclaimer: This Evidence Check Review was produced using the Evidence Check methodology in response to specific questions from the commissioning agency. It is not necessarily a comprehensive review of all literature relating to the topic area. It was current at the time of production (but not necessarily at the time of publication). It is reproduced for general information and third parties rely upon it at their own risk. Management of withdrawal from alcohol and other drugs An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. September 2019. This report was prepared by Nicholas Lintzeris, Sandra Sunjic, Apo Demirkol, Mira Branezac, Nadine Ezard, Krista Siefried, Liam Acheson, Florence Bascombe, Chris Tremonti, and Paul Haber. Contents Executive summary.................................................................................................................................................................................... 9 Abbreviations ........................................................................................................................................................................................... 30 Glossary....................................................................................................................................................................................................... 31 Background ............................................................................................................................................................................................... 36 Methods ..................................................................................................................................................................................................... 38 Chapter 1. Overview of interventions for withdrawal management .................................................................................. 40 1.1 Treatment settings .......................................................................................................................................................... 40 1.2 Psychosocial interventions .......................................................................................................................................... 43 1.3 Physical therapies ............................................................................................................................................................ 46 1.4 Symptomatic medications ........................................................................................................................................... 55 1.5 Special populations ........................................................................................................................................................ 55 Chapter 2. Alcohol .................................................................................................................................................................................. 60 Description of the withdrawal syndrome ................................................................................................................................. 60 Summary of the evidence ............................................................................................................................................................... 74 2.1 Treatment setting ............................................................................................................................................................ 74 2.2 Psychosocial interventions .......................................................................................................................................... 75 2.3 Physical therapies ............................................................................................................................................................ 76 2.4 Medications ....................................................................................................................................................................... 77 Chapter 3. Opioids ................................................................................................................................................................................ 82 Description of the withdrawal syndrome ................................................................................................................................. 82 Summary of the evidence ............................................................................................................................................................... 89 3.1 Treatment setting ............................................................................................................................................................ 89 3.2 Psychosocial interventions .......................................................................................................................................... 93 3.3 Physical therapies ............................................................................................................................................................ 94 3.4 Medications ....................................................................................................................................................................... 96 Chapter 4. Cannabis ............................................................................................................................................................................. 103 Description of the withdrawal syndrome ............................................................................................................................... 103 Summary of the evidence ............................................................................................................................................................. 107 4.1 Treatment setting .......................................................................................................................................................... 107 4.2 Psychosocial Interventions ........................................................................................................................................ 108 4.3 Physical therapies .......................................................................................................................................................... 108 4.4 Medications ..................................................................................................................................................................... 108 4 MANAGEMENT OF WITHDRAWAL FROM ALOCOHOL AND OTHER DRUGS 2019 | SAX INSTITUTE Chapter 5. Benzodiazepines ............................................................................................................................................................. 114 Description of the withdrawal syndrome ............................................................................................................................... 114 Summary of the evidence ............................................................................................................................................................. 116 5.1 Treatment setting .......................................................................................................................................................... 116 5.2 Psychosocial interventions ........................................................................................................................................ 116 5.3 Physical therapies .......................................................................................................................................................... 116 5.4 Medications ..................................................................................................................................................................... 116 5.5 Special Populations ...................................................................................................................................................... 117 Chapter 6. Amphetamines and methamphetamine ..............................................................................................................
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