An Inpatient Protocol for the Treatment of Methamphetamine Withdrawal in Patients With and Without Opioid Use Disorder.

OBJECTIVE: Increasing rates of methamphetamine (METH) use, use disorders, and related overdoses are a growing public health problem. There are a lack of protocols addressing METH intoxication and withdrawal symptoms that manifest during acute withdrawal treatment resulting in inpatient management difficulties and premature discharges. This report presents a novel treatment protocol comprised of behavior-targeted and pharmacological components that aims to reduce the intensity and duration of METH intoxication and withdrawal related symptoms during early treatment, improve retention, and provide clinicians with a tool to meet this growing problem. METHODS: The protocol was developed by a team of addiction physicians and other clinical staff. Clinical and administrative staff at a community acute stabilization unit were trained and the protocol was implemented with patients presenting with METH use. Pharmacological interventions, including ascorbic acid, antipsychotics, and other sedatives are discussed, as are behavior-based orders. A retrospective quality assurance examination was conducted on patient characteristics and outcomes as well as focus groups with nursing staff. RESULTS: A total of 23 patients consecutively admitted to the unit used the protocol (100% male). Most patients (67%) displayed symptoms of METH use or withdrawal. Behavior-related interventions were used in 52% of patients, while 48% received behavior-related and pharmacological measures. Patient completion of the protocol was 83%, and the protocol's utility was supported by nursing staff. CONCLUSIONS: This retrospective evaluation of a novel METH withdrawal treatment protocol suggests feasibility, tolerability, and preliminary evidence of effectiveness, providing clinicians with a new tool that requires further study.

Massachusetts' experience through three presidentially declared coastal storm disasters, hazard mitigation, and new initiatives

Massachusetts has approximately 1,500 miles of coastal shoreline. Because of Massachusetts' location at the recessional end of the last major continental glaciation, its shoreline has an extremely varied geographic orientation with diverse geologic landforms of varying elevations. These variables make coastal pre-storm disaster planning, response coordination, post-storm recovery activities and hazard mitigation exceptionally challenging. Massachusetts' developed shore adds to this complexity and makes the storm-induced surge, waves, flooding and erosion associated with hurricanes and northeasters, relative sea level rise, and human activities issues of primary concern in coastal floodplain and hazards management