Fresh Start has been involved in a number of clinical studies, which have helped to shape the evidence base of treatments we provide at our clinic and improves patient outcomes. Over the years, we have published numerous studies in peer-reviewed journals. Supporting and continuing research at Fresh Start is an important aspect of what we do and we will continue to support and train our future researchers. Research that has been conducted at Fresh Start AlcoholChanges in hospital outpatient events and costs following implant naltrexone treatment for problematic alcohol use https://journals.sagepub.com/doi/full/10.1177/0269881114536791 Main finding: Costs associated with hospital and emergency department admissions post-treatment were significantly reduced compared to pre-treatment. AmphetaminesA retrospective assessment of the use of naltrexone implants for the treatment of problematic amphetamine use https://onlinelibrary.wiley.com/doi/full/10.1111/j.1521-0391.2013.00320.x Main finding: Treatment was associated with abstinence from amphetamines for at least one months in 65.9% of participants. 48.3% reported abstinence at six months. Anxiety and Benzodiazepine WithdrawalLong-Term Management of Generalised Anxiety Disorder with Low-Dose Continuous Infusions of Flumazenil: A Case Series https://www.mdpi.com/2076-328X/12/11/430/htm Main finding: In eight cases of generalised anxiety disorder, flumazenil was safe and all patients responded to treatment; however, most cases required multiple infusions in a six-month period. Is the Precipitation of Anxiety Symptoms Associated with Bolus Doses of Flumazenil a Barrier to Its Use at Low Continuous Doses in Benzodiazepine Withdrawal?https://www.mdpi.com/2077-0383/11/19/5948/htm Main finding: there is no evidence that flumazenil causes anxiety during benzodiazepine withdrawal and may work to alleviate anxiety during and after treatment. A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept https://www.sciencedirect.com/science/article/pii/S0376871622002381 Main finding: benzodiazepine use in was significantly reduced in high-dose benzodiazepine users compared to placebo. Outcomes of patients treated with low-dose flumazenil for benzodiazepine detoxification: A description of 26 participants https://www.sciencedirect.com/science/article/pii/S037687162200254X Main finding: Abstinence rate from benzodiazepines at three months was between 46.2% and 61.5%. Pharmacological uses of flumazenil in benzodiazepine use disorders: A systematic review of limited data https://journals.sagepub.com/doi/full/10.1177/0269881120981390 Main finding: The treatment is promising for benzodiazepine withdrawal; however, more randomised control trials are required before a definitive recommendation can be made around its use. A theory of the anxiolytic action of flumazenil in anxiety disorders https://journals.sagepub.com/doi/full/10.1177/02698811221082466 Main finding: Chronic stress may lead to dysfunction receptors, which are implicated in anxiety. Treatment may reset these receptors and have an anti-anxiety effect. The role of flumazenil in the treatment of benzodiazepine dependence: physiological and psychological profiles https://journals.sagepub.com/doi/abs/10.1177/0269881108100322 Main finding: treatment appears to be safe and effective, resulting in lesser severity withdrawal symptoms that other cessation methods currently available. OpioidsHospital psychiatric comorbidity and its role in heroin dependence treatment outcomes using naltrexone implant or methadone maintenance Access the full article here A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons Access the full article here Sustained-release naltrexone; novel treatment for opioid dependence Access the full article here A retrospective cohort study of mortality Rates in patients with an opioid use disorder treated with implant naltrexone oral methadone or sublingual buprenorphine Access the full article here Self-injuring behaviour and Mental Illness In Opioid-Dependent Patients Treated With Implant Naltrexone Methadone and Buprenorphine in Western Australia Access the full article here Fatal and non-fatal opioid overdose in Opioid dependent patients Access the full article here Naltrexone: A review of existing sustained drug delivery systems and emerging nano-based systems Access the full article here Improving clinical outcomes in treated heroin dependence: Randomised, control trial of oral or implant naltrexone https://jamanetwork.com/journals/jamapsychiatry/article-abstract/210360 Main finding: Sustained release treatment reduced relapse to regular opioid use compared to the oral preparation and was not associated with any major adverse events. Blood naltrexone and 6-β-naltrexol levels following naltrexone implant: comparing two naltrexone implants https://onlinelibrary.wiley.com/doi/abs/10.1080/13556210410001674103 Main finding: One of the preparations was able to provide therapeutic levels of the drug for 6.3 months compared to only 3 months. Other ResearchThe role of flumazenil in generalised anxiety disorder: a pilot naturalistic open-label study with a focus on treatment resistance Access the full article here Hyperbolic dose reduction of escitalopram mitigates withdrawal syndrome: A case report https://www.sciencedirect.com/science/article/pii/S2773021222000098 Main finding: In this case study, a patient who was sensitive to withdrawal from “antidepressants” did not experience a withdrawal syndrome when reducing their dose in a different way to usual dose reduction strategies. Research In ProgressWe are currently working on writing and publishing several articles related to benzodiazepine withdrawal and anxiety. A brief description of these is below: Data from a series of participants receiving treatment for generalised anxiety disorder, some with treatment resistance, and the short-term outcomes up to one-month (submitted for publication).
