GHB or Gamma Hydroxybutyrate

What is GHB?

GHB is a substance naturally present in the body. It acts as a depressant, slowing down the activity of the nervous system. It also calms the nervous system.

GHB is usually sold as vials of liquid and measured in milligrams. It is watery and has no has no smell and is tasteless or has a slightly salty or solvent taste that can be easily masked.

It is also available as a white powder or capsule.

Why do people use it?

  • it helps user to relax
  • could improve sleep
  • gives a feeling of happiness and euphoria

What are the health effects of GHB use?

Mental effects

The main mental effects on users may include feeling:

  • dizziness
  • uninhibited (willing to do things they would not normally do)
  • Poor short-term memory

Physical effects

The main physical effects of GHB use may include:

  • decreased blood pressure and heart rate
  • Low heart rate
  • lowered body temperature (users feel cold)
  • slowed breathing
  • nausea, vomiting and diarrhea
  • loss of consciousness
  • delirium
  • jerky muscle movements and loss of coordination

Is it addictive?

Regular use may lead to physical dependence and addiction.

If a drug like GHB is suddenly stopped (withdrawn), the person can experience withdrawal symptoms, including cravings for the drug.

What are symptoms of GHB use?

Individuals who use GHB may present with the following physical and behavioral symptoms:

  • Reduced inhibitions
  • Feeling very relaxed and calm
  • Euphoria
  • Sleepy
  • Slow movements
  • report pasty mouth
  • Nonchalance
  • Disoriented and confused

What are withdrawal symptoms from GHB?

GHB has a short half life (17 min) so withdrawal symptoms occur typically within hours following last use.

Withdrawal symptoms of GHB are very similar to alcohol withdrawal and could present with tremor, sweating, anxiety, agitation and confusion; however, GHB withdrawal is generally more severe, has a more rapid onset and more prominent psychiatric features such as delirium and psychosis.

Mental symptoms of GHB withdrawal may include:

  • anxiety
  • confusion and delirium
  • hallucinations (hearing, seeing or feeling things that are not real)
  • paranoia (feeling suspicious, hostile or fearful)
  • difficulty sleeping
  • Psychosis

Physical symptoms of withdrawal from GHB may include:

  • sweating
  • muscle cramps and trembling
  • nausea, vomiting and diarrhea
  • high blood pressure
  • rapid heartbeat

Death can occur during withdrawal from GHB.

Can GHB cause overdose and death?

At high doses, GHB’s sedative effects may result in a coma or death.

GHB can also cause vomiting. Users who eat or drink before taking the drug or consuming alcohol increase their risk of choking on vomit. Because GHB can also cause unconsciousness, users who choke on their vomit may die.

It is also relatively easy to overdose on GHB, with death as an outcome. The symptoms of overdose include:

  • slowed breathing
  • seizures
  • coma

Taking GHB together with other depressants such as alcohol or a psychoactive drug like benzodiazepine is very dangerous. The combined effects of these drugs on the nervous system can result in:

  • difficulty breathing
  • lowered heart rate
  • convulsions
  • death

Is there any treatment for i?

Treatment of GHB abuse depends on the stage of dependence.

  1. Treatment of withdrawal from GHB
  2. Treatment of intoxication with GHB
  3. Treatment of GHB dependence

Treatment of GBH withdrawal symptoms is mainly symptom therapy to make it safe and comfortable for the patient.

Treatment of GHB intoxication is considered medical emergency and requires acute assessment and management of adverse effects such as problems with low blood pressure, low heart rate, and difficulty breathing.

Treatment of GHJB dependence should focus on:

  1. medications to prevent withdrawal symptoms
  2. counseling
  3. assessment for underlying co-occurring mental health issues.

Prevention

Prevention should focus on two main approaches:

  1. Prevention of initiation
  2. Prevention of relapse after treatment

Medical and psycho-social approaches are needed.

References

  • Novel Psychoactive Treatment UK Network. Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances. 2015. http://neptune-clinical-guidance.co.uk/wp-content/uploads/2015/03/NEPTUNE-Guidance-March-2015.pdf.
  • Wojtowicz JM, Yarema MC, Wax PM. Withdrawal from gamma-hydroxybutyrate, 1,4- butanediol and gamma-butyrolactone: a case report and systematic review. Can J Emerg Med. 2008;10(1):69–74.[PubMed]
  • Bell J, Collins R. Gamma-butyrolactone (GBL) dependence and withdrawal. Addiction. 2011;106(2):442–7. doi: 10.1111/j.1360-0443.2010.03145.x. [PubMed] [Cross Ref]
  • Wood DM, Brailsford AD, Dargan PI. Acute toxicity and withdrawal syndromes related to gamma-hydroxybutyrate (GHB) and its analogues gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) Drug Test Anal. 2011;3(7-8):417–25. doi: 10.1002/dta.292. [PubMed] [Cross Ref]

Important note:

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