Dr Alfred Balston

I am an NIHR Academic Clinical Fellow in Clinical Pharmacology at Guy’s and St Thomas’ NHS Foundation Trust. I am particularly interested in the toxicology of “party” drugs and how to best support people who use them during unplanned hospital admissions, as well as how to facilitate safe outpatient detoxification from less commonly used drugs such as GBL. I hope to investigate a more specific way to measure and monitor GBL withdrawal (as the CIWA-Ar score does for alcohol withdrawal).

The use of chlordiazepoxide for outpatient gamma-butyrolactone (GBL) detoxification: an observational study

Delegate Poster Prize-winner (non-student), 2022: Best visual design

Background and aims

Various pharmacological regimens for gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) detoxification have been described, employing diazepam, barbiturates, baclofen, and GHB itself. However, these regimens are primarily derived from inpatient case reports, and literature on outpatient GBL detoxification is sparse with no previous reports on chlordiazepoxide. We aimed to describe the characteristics of outpatient GBL detoxification using chlordiazepoxide.


Observational study of patients attending for GBL detoxification between August 2015 and November 2017.


A specialist outpatient addiction service in South London, predominantly treating alcohol, opioid, and stimulant dependence.


In the study period there were 17 attendances for GBL detoxification, 14 of which were undertaken in the outpatient setting. Twelve (86%) patients who had an outpatient detoxification were male.


Routinely collected clinical data including demographics, GBL usage, daily chlordiazepoxide prescribed, and Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) score.


Of 14 outpatient GBL detoxifications managed with chlordiazepoxide, 10 were completed. One patient that did not complete outpatient detoxification required inpatient treatment in an acute hospital. For patients who completed a detoxification, the median maximum CIWA-Ar score on day one of the detoxification was 11 (range 2-17), and the mean chlordiazepoxide dose on day one was 140mg (range 80-225mg). The average length of a completed detoxification was 10 ± 3.1 days.


Chlordiazepoxide can be used for outpatient GBL detoxification in combination with a provision for crisis admissions. CIWA-Ar score can be applied to GBL withdrawal to measure severity and inform a reducing regimen of chlordiazepoxide.