This document discusses the Club Drug Clinic and two of its projects: NEPTUNE and the GHB Trial. The Clinic treats patients with issues related to emerging drugs like novel psychoactive substances and club drugs. Project NEPTUNE aims to improve clinical management of these substances through evidence-based guidance. The GHB Trial is a feasibility study testing whether adding the drug baclofen to benzodiazepines improves outcomes for patients withdrawing from GHB dependence.

1. Club Drug Clinic, project
NEPTUNE and the G trial
Dr Owen Bowden-Jones
Consultant Psychiatrist
CNWL and Imperial College London
The GHB Trial

2. Club Drug Clinic
• Founded in 2010
• Emerging drug trends
– NPS, club drugs
• Multi-disciplinary service
– psychiatrists, nurses, family
therapists, drug workers,
mindfulness practitioner
• Structured drug treatment
– (e.g. CBT, detoxifications)
• Treated about 1000 patients
• Large number of MSM
attending with issue relating
to ‘chemsex’

3. MSM- drugs enhanced sexual
behaviours
• Methamphetamine, mephedrone, GHB/GBL
• Sexual behaviours and injecting
– 75% new to treatment
– 50% had injected at least once, a third in four
week before attending
– 50% of current injectors had shared injecting
equipment
– 60% HIV positive
– 75% used drug in a sexual context

4. Response to ‘chemsex’
• Co-location of clinics with sexual health
• Sharing of expertise
• Cultural competence
• Harm reduction approaches specific to
methamphetamine, mephedrone, GHB/GBL
• Links to others- London Friend, CMA

5. Project NEPTUNE
Novel Psychoactive Treatment: UK Network

6. NEPTUNE I
• Raise standards in clinical
management of ‘club drugs’
including NPS across the
health system, by…
• ..undertaking a
comprehensive review of
treatment research literature
for NPS and club drugs,
leading to…
• ..development of evidence-
based clinical guidance
• Where evidence lacking, use
expert consensus

7. www.neptune-clinical-guidance.co.uk
reports

8. NEPTUNE I Expert group membership
Dr Owen Bowden-Jones Dr Dima Abdulrahim
Dr James Bell Dr Nigel Borley
Dr Steve Brincksman Ms Emma Crawshaw; Laura Day
Ms Annette Dale-Perera Mr Mark Dunn
Ms Stacey Hemmings Mr Salvo Larosa
Dr Luke Mitcheson Mr. Monty Moncrieff
Mr David MacKintosh Prof David Nutt
Dr John Ramsey Dr John Roche
Prof Fabrizio Schifano Mr David Stuart
Dr Ann Sullivan Dr Tim Williams
Dr Christopher Whiteley Dr Adam Winstock
Dr David Wood Dr Dan Wood
Other contributors: Dr Marta Buffito; Lindsey Hines; Josh Hulbert
8

9. NEPTUNE II expert group
Members
Owen Bowden-Jones
Dima Abdulrahim
Alex Baldacchino
Seth Bhunnoo
Steve Brinksman
Emma Crawshaw
Paul Dargan
Jonathan Dewhurst
Dominic Dougall
Caroline Frayne
Mike Flanagan
Sarah Flowers
Sanjay Kumar
Salvo Larosa
Luke Mitcheson
Monty Moncrieff
David Nutt
John Ramsey
John Roche
Fabrizio Schifano
Josie Smith
Ann Sullivan
Tim Williams
Christopher
Whiteley
Rosie Smith
Adam Winstock
David Wood
Dan Wood
Observers
Public Health
England
• Pete
Burnkinshaw
Department of
Health
• John
McCracken;
• Mark Prunty
Home Office
• Melanie
Roberts

10. The GHB Trial
Improving GHB withdrawal with baclofen
Chief Investigator
Prof Anne Lingford-Hughes
Principal Investigators
Dr Owen Bowden-Jones , Dr David Wood, Dr Paul Dargan
Key partners

11. GHB/GBL withdrawal
• Rapid onset
• Tremor, agitation,
sweating
• Delirium
• Medical emergency/ICU
• Benzodiazepine,
baclofen
• High levels of craving
and relapse

12. Rationale for GHB Trial
• Very limited evidence for clinical management
• Benzodiazepines usually used, but may be inadequate
• Some evidence suggesting Baclofen may a useful
addition
Aim of GHB Trial
• Is it feasible to add baclofen to benzodiazpines for GHB
detox
• Does adding baclofen improve outcomes in GHB detox

13. Trial Design
The GHB trial is a feasibility study which is randomised, double-blind, placebo-
controlled.
Total 88 patients in GHB
trial
Unplanned withdrawal
St Thomas’ Hospital
28 patients
Planned withdrawal
CNWL Club Drug Clinic
60 patients
Baclofen – 20 patients
(on Friday - 2 days prior to
start of detoxification)
Placebo – 40 patients
(on Friday - 2 days prior to
start of detoxification)
Benzodiazepine
+ Baclofen
- 20 patients
Benzodiazepine
+ Baclofen
- 20 patients
Benzodiazepine
+ Placebo
- 20 patients
Benzodiazepine
+ Baclofen
- 14 patients
Benzodiazepine
+ Placebo
- 14 patients
PreloadDetox

14. Inclusion criteria
• Over 18 years old
• Agrees to participate
• Clinically appropriate
• GHB/GBL dependence
• Under care of drug service

16. Owen.bowdenjones@nhs.net
Clubdrugclinic.cnwl@nhs.net
www.clubdrugclinic.com
@ClubDrugClinic