Mental health

Management of drug withdrawal

Question 2: What interventions are safe and effective for drug withdrawal (cannabis, amphetamines, cocaine, benzodiazepines, and inhalants)?

Management of substance abuse

  • Population: persons dependent on cannabis, stimulants, benzodiazepines or inhalants
  • Interventions: medications for the treatment of withdrawal
  • Comparison: placebo or no treatment or treatment as usual
  • Outcomes:
    • withdrawal severity
    • completion of withdrawal
    • complications of withdrawal
    • drug use.

Recommendation(s)

Withdrawal from cannabis, cocaine or amphetamines is best undertaken in a supportive environment. No specific medication is recommended for the treatment of withdrawal from these drugs.
Strength of recommendation: STANDARD

Relief of symptoms (e.g. agitation, sleep disturbance) may be achieved with symptomatic medication for the period of the withdrawal syndrome. Less commonly, depression or psychosis can occur during withdrawal, in these cases the individual needs to be monitored closely and advice sought from relevant specialists, if available.
Strength of recommendation: STANDARD

Withdrawal from benzodiazepines is best undertaken in a planned (elective) manner, using a gradually tapering dose over 8-12 weeks and with conversion to long-acting benzodiazepines, rather than using short-acting ones. Psychosocial support is helpful for individuals undergoing a tapering regime. Benzodiazepine withdrawal syndrome, if uncontrolled, can be severe; if a severe withdrawal develops (or occurs in an unplanned way on sudden stoppage of these drugs), specialist advice should be obtained regarding starting a high-dose benzodiazepine sedation regime and hospitalisation.
Strength of recommendation: STRONG

In individuals withdrawing from benzodiazepines, the presence of physical comorbidity (such as seizures or chronic pain) or psychiatric comorbidity may be an additional indication for hospitalisation.
Strength of recommendation: STANDARD

Evidence profile

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