GHB Abuse and Addiction

A colorless liquid or white powder often dissolved in liquid, GHB (gamma-hydroxybutyrate) gained popularity in the late 1980s when it was marketed and sold in health food stores as a supplement to aid in body building.1 It quickly gained popularity as a club drug in the 1990s for its short-lived sedative and hypnotic effects.1,2

GHB has also been used in sexual assault, particularly in date rape.2 In March 2000, GHB was added to the list of Schedule 1 depressants by the United States Drug Enforcement Administration.3 This means that it has no accepted medicinal uses and is considered to have a very high possibility for abuse and addiction.

A pharmaceutical form of GHB—sodium oxybate (Xyrem) is approved by the U.S. Food and Drug Administration (FDA) to treat narcolepsy.1 Sodium oxybate is a Schedule 3 drug but trafficking it is subject to Schedule 1 penalties.3 On the street, GHB may be referred to as liquid ecstasy, grievous bodily harm and, simply, G.

GHB has effects that are similar to other central nervous system (CNS) depressants, which slow heart rate, lower body temperature and can lead to life-threatening respiratory arrest.1,3

GHB Effects, Side Effects and Overdose

Desired effects of GHB typically include relaxation, euphoria, sedation, lowered inhibition and increased sociability.1 These effects begin within 15 minutes of ingestion and last for 2 to 4 hours.

GHB can also impair memory and a person may not remember events that occurred while intoxicated.1 This anterograde amnesia has been linked to the drug’s use in sexual assault.1

Side effects of low to moderate doses of GHB include:1

  • Headache.
  • Dizziness.
  • Involuntary muscle movement.
  • Decreased muscle tone.
  • Nausea and vomiting.
  • Aggressive behavior.

Higher doses of GHB cause intense sleepiness, confusion, and hallucinations.1 Unintended overdose may occur from underestimating the drug’s potency or by using it in conjunction with alcohol. Alcohol and other CNS depressants intensify the effects of GHB.1,2

An overdose of GHB, or GHB in combination with another CNS depressant, is life-threatening and may result in:1,2

  • Inability to control bodily functions.
  • Decreased blood pressure and pulse.
  • Lowered body temperature.
  • Respiratory depression (including slow and irregular breathing).
  • Seizures.
  • Coma.

GHB Withdrawal

Repeated dosing of GHB will lead to withdrawal symptoms that include:1

  • Anxiety.
  • Restlessness.
  • Insomnia.
  • Involuntary eye movements.
  • Racing heart rate.
  • Tremor.
  • High blood pressure.

These symptoms appear approximately 2 to 12 hours following the last dose and gradually resolve over 1 to 2 weeks.1

A more severe withdrawal syndrome may be experienced with higher or more frequent dosing of GHB. Severe withdrawal symptoms include:1

  • Delirium with hallucinations.
  • Agitation.
  • Psychosis.
  • Seizures.

Dependence, Addiction and Treatment

Repeated daily or more frequent dosing will lead to the body developing a dependence within 1 week. This means that the body adapts to the drug and requires higher doses to produce similar effects. It also means that a person will experience withdrawal when they stop taking GHB.

An individual who is dependent on GHB, may also have a substance use disorder and suffer from addiction, a chronic brain disease marked by habitual and compulsive use despite harmful consequences.

Medical management of withdrawal (i.e., medical detox) may be beneficial for chronic or individuals who compulsively use GHB and have become dependent on it. Benzodiazepines may be used to manage the powerful withdrawal symptoms.1

Outpatient and inpatient treatment for GHB abuse and addiction, including therapy and attending meetings held by mutual support groups (e.g., Narcotics Anonymous) can set and keep a person on the path toward a long and prosperous recovery.

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. Mason, P. E. & Kerns 2nd, W. P. (2002). Gamma Hydroxybutyric Acid (GHB) Intoxication. Academic Emergency Medicine, 9(7), 730–739.
  3. Diversion Control Division, U.S. Drug Enforcement Administration. (2018). Gamma Hydroxybutyric Acid.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More