GHB or Gamma-Hydroxybutyrate
Common or street names: Liquid X, Liquid ecstasy, Georgia home boy, Oop, Gamma-oh, Grievous bodily harm, Mils, G, Liquid G, Fantasy
What is GHB?
GHB or Gamma Hydroxybutyrate (C4H8O3) is a central nervous system (CNS) depressant that is commonly referred to as a “club drug” or “date rape” drug. GHB is abused by teens and young adults at bars, parties, clubs and “raves” (all night dance parties), and is often placed in alcoholic beverages. Euphoria, increased sex drive, and tranquility are reported positive effects of GHB abuse.1,2 Negative effects may include sweating, loss of consciousness (reported by 69 percent of users), nausea, hallucinations, amnesia, and coma, among other adverse effects.
Xyrem (sodium oxybate), a brand name prescription drug was approved by the Food and Drug Administration (FDA) in 2002 for the treatment of narcolepsy, a sleep disorder that causes excessive sleepiness and recurring daytime sleep attacks. It is the sodium salt of gamma hydroxybutyrate. Xyrem is a highly regulated drug in the U.S. It is a Schedule III controlled substance, and requires patient enrollment in a restricted access program.
GHB is also a naturally-occurring metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) found in the brain. The naturally-occurring metabolite GHB is present in much lower concentrations in the brain than those levels found when the drug is abused. As a result of fermentation, natural GHB may also be found in small but insignificant quantities in some beers and wines.1
Methods of GHB Abuse
GHB is available as an odorless, colorless drug that may be combined with alcohol and given to unsuspecting victims prior to sexual assaults. It may have a soapy or salty taste. Use for sexual assault has resulted in GHB being known as a “date rape” drug. Victims become incapacitated due to the sedative effects of GHB, and they are unable to resist sexual assault. GHB may also induce amnesia in it’s victim. Common user groups include high school and college students and rave party attendees who use GHB for its intoxicating effects.3
GHB has also been postulated to have anabolic effects due to protein synthesis, and has been used by body-builders for muscle building and reducing fat.1, 3
GHB is bought on the streets or over the Internet in liquid form or as a white powdered material for illicit use. It is taken orally and is frequently combined with alcohol. Much of the GHB found on the streets or over the Internet is produced in illegal labs. GHB may be adulterated with unknown contaminants that may worsen it’s toxicity.3 The production of GHB usually involves the use of lye or drain cleaner mixed with GBL, a chemical cousin of GHB and an industrial solvent often used to strip floors.4
In 1990, the Food and Drug Administration (FDA) issued an advisory declaring GHB use unsafe and illegal except under FDA-approved, physician-supervised protocols. In March 2000, GHB was placed in Schedule I of the Controlled Substances Act. The sodium salt of GHB, the brand product Xyrem (sodium oxybate), is a Schedule III drug when prescribed and used legally in a patient restricted-access program. Xyrem is not available at regular retail pharmacies. If Xyrem is trafficked as a recreational drug, it’s status converts to Schedule I and it becomes an illegal drug.
GHB acts at two receptor sites in the brain, the GABAB and specific GHB receptors. Action at these two receptor sites leads to the CNS depressant, stimulant and psychomotor impairment effects of GHB. Roughly 95 percent of GHB is metabolized in the liver, and it’s half-life ranges from 30 to 60 minutes. Only five percent of the parent drug is excreted via the kidneys. Detection of GHB in the urine may be difficult after 24 hours due to it’s short half-life.1
Health Hazards Due to GHB Use
Euphoria, increased sex drive, and tranquility are reported positive effects of GHB abuse. However, immediate negative effects of GHB use may include sweating and loss of consciousness (reported by 69 percent of users), nausea, auditory and visual hallucinations, headaches, vomiting, exhaustion, sluggishness, amnesia, confusion, and clumsiness.4
GHB can have an addictive potential if used repeatedly. Withdrawal effects may include insomnia, anxiety, tremors, and sweating. Withdrawal can be severe and incapacitating.
Combined use with alcohol, other sedatives or hypnotics (such as barbiturates or benzodiazepines) and other drugs that possess CNS depressant activity may result in nausea, vomiting and aspiration, and dangerous CNS and respiratory depression.
High doses of GHB, even without other illicit substances or alcohol, may result in profound sedation, seizures, coma, severe respiratory depression and death. Emergency department episodes related to the use of club drugs usually involve the use of multiple substances, such as marijuana, cocaine, and other club drugs, such as methamphetamine, Ecstasy, or Rohypnol.5
GHB detection methods for emergency room use are not readily available. Emergency room physicians may be unaware that GHB has been abused when a patient presents to the hospital, as well. Due to the short half-life of the drug, detection in the urine may be difficult. Supportive care and keeping airways open are the primary measures used in the emergency overdose situation.4
Extent of GHB Abuse
GHB, typically with alcohol use, was linked to more than 60 deaths from January 1992 to May 2001. Roughly 60 percent of the deaths were in people between the ages of 20 and 29.4 According to one report, the number of emergency department visits in which GHB or GBL is mentioned increased from 56 in 1994 to 4,969 in 2000.5
GHB use has been surveyed since the year 2000 in the Monitoring the Future Survey, and rates have remained historically low in the 8th to 12th grade U.S. population. The annual prevalence of GHB use in 2010 was 0.6%, 0.6%, and 1.4% in grades 8, 10, and 12, respectively. Comparatively, in 2009, 0.7 percent of 8th graders and 1.1 percent of 12th graders reported past-year use of GHB. The highest reported GHB use for 12th graders was in 2004 at 2 percent, for 8th graders in 2000 at 1.2 percent, and for 10th graders in 2002 and 2003 at 1.4 percent.3
GHB Use in Pregnancy
Effects of GHB use in human pregnancy are not known. Women should not use GHB during pregnancy. Pregnant women, or those who are considering pregnancy, and who use GHB should seek the immediate advice of a health care provider.
Treatment Option for GHB Abuse
Little information is available on treatment options for persons addicted to any club drug, including GHB. Some users of GHB are not physically dependent upon it, and can be treated and informed on an outpatient basis. Chronic use may result in severe withdrawal symptoms upon detoxification, and close medical supervision and supportive care is required for these patients. Hospitalization may range from 7 to 14 days.4
Withdrawal effects are reported as severe and patients may attempt to self-detoxify using benzodiazepines or alcohol. Using these additional substances may worsen withdrawal, and lead to respiratory depression, coma and death. Medications such as benzodiazepines, antihypertensive medications, and/or anticonvulsants may be needed during detoxification, but only under medical supervision.4
Baclofen has been noted in a case report as a possible treatment for GHB withdrawal. This is not a current FDA-approved treatment use. Baclofen is a GABAB agonist, as is GHB. Baclofen can occupy GABAB receptor sites, replacing GHB, while GHB withdrawal takes place. In the case report, the addition of baclofen allowed the rapid decreases in the GHB dose without seizure or delirium and resulted in long-term improvement of tremors.6
Amnesia or memory loss is a complication of treatment that may result in relapse, with the patient returning to GHB use, unaware of the consequences of GHB addiction. Continued patient education is necessary to overcome this adverse effect.5
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- National Institute on Drug Abuse (NIDA). NIDA InfoFacts: Club Drugs (GHB, Ketamine, and Rohypnol) Accessed online 12/17/2011: http://www.drugabuse.gov/infofacts/clubdrugs.html
- Miotto, K.; Darakjian, J.; Basch, J.; Murray, S.; Zogg, J.; and Rawson, R. “Gamma-hydroxybutyric Acid: Patterns of Use, Effects, and Withdrawal.” American Journal on Addictions 10(3):232-41, 2001.
- Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2010. http://monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf Accessed December 17, 2011
- Center for Substance Abuse Treatment, “GHB: A Club Drug To Watch.” Substance Abuse Treatment Advisory. Volume 2, Issue 1, November 2002.
- Drug Abuse Warning Network (DAWN). The DAWN Report - Club Drugs. December 2000. Accessed online 12/17/2011: http://www.samhsa.gov/data/dawn/clubdrug.pdf
- LeTourneau JL, Hagg DS, Smith SM. Baclofen and Gamma-Hydroxybutyrate Withdrawal. Neurocrit Care. 2008 ; 8(3): 430-433. Accessed online 12/18/2011: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630388/pdf/nihms-82782.pdf