GHB is usually available as an odorless, colorless, and nearly tasteless liquid. Sometimes the substance is available as a powder, or in a capsule. GHB is sold as GHB’ or ‘grievous bodily harm’. GHB has gained limited popularity in the United Kingdom, where it has been sold at raves as ‘liquid ecstasy’. Illicit use has only been reported by the oral route.
Consistent with known psychopharmacology, adverse effects reported include dizziness, nausea, vomiting, weakness, tonic-clonic seizure-like activity, loss of peripheral vision, confusion, agitation, hallucinations, bradycardia, decreased respiratory effort, unconsciousness and coma. Theses effects can appear within 15 minutes of oral ingestion of the drug and acute symptoms appear to remit after 7 hours, although some cases have been reported lingering dizziness for up to 2 weeks.
GHB can cause a variety of adverse effects, including potentially fatal respiratory depression, seizure activity, vomiting and dis-co-ordination. Combining GHB with alcohol, methamphetamine or MDMA may increase the incidence of adverse effects. The antagonism of marijuana’s effects is intriguing and may indicate a relationship between pathways involving GHB and THC receptors. Tolerance and physical dependence, as evidenced by a withdrawal syndrome that may include insomnia, muscular cramping, tremor and anxiety, can develop.
GHB may be misrepresented as a safe, natural and non-addictive hypnotic or anabolic. Several points will be important to emphasize in educational campaigns to reduce abuse of, and harm from, GHB. Psychostimulants, such as methamphetamine, may increase the risk of seizures from GHB; concurrent use with alcohol the risk of vomiting and respiratory depression; the therapeutic index of this compound is low; accurate dosages estimates are difficult with illicit supplies, particularly when sold in solution; and physical dependence is a possibility.
High doses of naloxone have been reported to reverse GHB’s EEG (Snead & Bearden, 1980) and cerebral metabolic (Crosby et al., 1983) effects in the rat, although naloxone does not reverse GHB-induced sleep or striatal dopamine changes in mice (Devoto, Colombo, Cappai, & Gessa, 1994).
In 1990, the FDA issued a warning stating that GHB had been promoted as a legal psychedelic but had caused more than 30 people in California, Florida, and Georgia to become ill with symptoms ranging from nausea and vomiting to severe respiratory problems, seizures, and coma. GHB has gone by other names including sodium oxybate, sodium oxybutyrate, gamma hydroxybutyrate sodium, gamma hydroxybutyric acid, gamma-oh, 4-hydroxybutyrate, gamma hydrate, somatomax pm, and 4-hydroxybutyric acid.
Once the diagnosis is confirmed, sedatives and benzodiazepines should be probably avoided or used conservatively as needed. We considered naloxone to block further DA release, but we decided eventually not to experiment and continued low-dose neuroleptization for the psychotic syndrome.
To conclude, in our opinion the differential diagnosis of a sudden onset cluster of drowsiness, "high" states, confusion, urgency, rapid and mumbling speech and temporary amnesia should include GHB intoxification.
For additional information on GHB Anya Shortridge web page and links has the most up-to-date scientific data on the harmful effects of GHB.
URL http://www.ashesonthesea.com/ghb/
References
Addolorato, G.; Castelli, E.; Stefanini, G.F.; et al.
An open multicentric study evaluating 4-hydroxybutyric acid sodium salt in the medium-term
treatment of 179 alcohol dependent subjects. In Alcohol and Alcoholism; issn 0735-0414. 31
(4) July 1996: 341-345.
Australian illicit drug report 1996-97.. -- Canberra: Australian Bureau of Criminal Intelligence, 1997. 159 p. File No: Book for Loan 364.1770994 AUS
Dunn, M.
Illicit drugs and the Internet. In Australian Pharmacist; issn 0728-4632. 17 (2)
March 1998: 89 - 90.
Frau, M.; Colombo, G.; Marchese, G.; et al.
Different affinity of cortical GHB binding sites in Sardinian alcohol-preferring (sP) and
non-preferring (sNP) rats. In Alcohol and Alcoholism. 30 (1) January 1995: 133-137.
Friedman, J.; Westlake, R.; Furman, M.
"Grievous bodily harm:" Gamma hydroxybutyrate abuse leading to a
Wernicke-Korsakoff syndrome. In Neurology. 46 (2) February 1996: 469-471. File No.
VF 1997-54.
Gallimberti, L.; Ferri, M.; Ferrara, S.D.; et al.
Gamma-hydroxybutyric acid in the treatment of alcohol dependence: a double-blind study. In
Alcoholism: Clinical and Experimental Research. 16 (4) July/August 1992: 673-676.
Galloway, G.P.; Frederick, S.L.; Staggers, F.E.; et al.
Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. In Addiction;
issn 0965-2140. 92 (1) January 1997: 89-96.
Greenblatt, J.C.
Gamma Hydroxy Butyrate (GHB) abuse in the United States.. -- s.l.: SAMHSA’s
National Clearinghouse for Alcohol and Drug Information, 1997. 4 leaves. File No. VF
1998-317.
Hernandez, M.; McDaniel, C.H.; Costanza, C.D.; Hernandez, O.J.
GHB-induced delirium: a case report and review of the literature on gamma hydroxybutyric
acid. In American Journal of Drug and Alcohol Abuse; issn 0095-2990. 24 (1) 1998:
179-183.
Poldrugo, F.
Effect of ethanol on brain gamma-hydroxybutyric acid concentration. In Alcohol and
Alcoholism. 2 (3) 1987: 227-229.
Rosen, M.I.; Pearsall, H.R.; Woods, S.W.; Kosten, T.R.
Effects of gamma-hydroxybutyric acid (GHB) in opioid-dependent patients. In Journal of
Substance Abuse Treatment; issn 0740-5472. 14 (2) March/April 1997: 149-154.
Sanguineti, V.R.; Angelo, A.; Frank, M.R.
GHB: a home brew. In American Journal of Drug and Alcohol Abuse; issn 0095-2990. 23
(4) 1997: 637-642.
Shapiro, H.
GHB ("GBH") In Druglink. 9 (4) July/August 1994: between 12-13.
Stell, I.M.; Ryan, J.M.
Gamma-Hydroxybutyrate is a new recreational drug that may lead to loss of consciousness.
In BMJ: British Medical Journal; issn 0959-8146. 313 (7054) August 1996: 424. Note:
Letter to the Editor.
