GHB: an overview
DOI:
https://doi.org/10.20882/adicciones.459Keywords:
Gamma-hydroxybutyrate (GHB), recreational use, side effects, overdose, dependenceAbstract
This paper gives an overview of the nature, effects and related harms of gamma-hydroxybutyrate (GHB), a drug with depressant effects upon the central nervous system. It also gives a summary of research conducted to date on those who use GHB for recreational purposes. The illicit use of GHB has increased in a number of developed countries over the past decade, largely among users of other illicit drugs. Those using illicit GHB seem to be users of other illicit drugs, who tend to use GHB in combination with other drugs, which may increase the harms associated with such use. Given numerous reports of overdose on GHB, and high rates of self-reported overdose on GHB, it would appear that the risk of overdose on this drug is high. The majority of overdoses reported are non-fatal, and many remit with full recovery, but deaths have been reported and there are a number of possible harms that may occur to users during unconsciousness. Dependence following regular use has been reported and appears to be common among heavy long-term users. Treatments for dependent GHB use remain to be developed, but treatment for withdrawal has been reported and seems important given the seriousness of withdrawal from GHB and related drugs.References
Nicholson, K. & Balster, R. (2001) GHB: A new and novel drug of abuse, Drug and Alcohol Dependence, 63, 1-22.
Bessman, S. & Fishbein, W. (1963) Gamma hydroxybutyrate - a new metabolite in brains, Federal Proceedings, 22, 334-342.
Colombo, C., Agabio, R., Lobina, C., Reali, R. & Gessa, G. L. (1998) Involvement of GABAa and GABAb receptors in the mediation of discriminative stimulus effects of gammahydroxybutyric acid, Physiology and Behavior, 64, 293-302.
Metcalf, B., Stahl, J., Allen, J., Woolfok, D. & Soto, P. (2001) Discrimination of gammahydroxybutyrate and ethanol administered
separately and as a mixture in rats, Pharmacology, Biochemistry and Behavior, 70, 31-41.
Snead, O. & Morely, B. (1981) Ontogeny of gamma-hydroxybutyric acid. Regional concentration in developing rat, monkey and human brain, Brain Research, 227, 579-589.
Galloway, G., Frederick, S., Staggers, F., Gonzales, M., Stalcup, S. & Smith, D. (1997) Gammahydroxybutyrate: An emerging drug of abuse that causes physical dependency, Addiction, 92, 89-96.
Kam, P. & Yoong, F. (1998) Gamma-hydroxybutyric acid: An emerging recreational drug, Anaesthesia, 53, 1195-1198.
Bernasconi, R., Mathivet, P., Bischoff, S. & Marescaux, C. (1999) Gamma-hydroxybutyric acid: An endogenous neuromodulator with
abuse potential?, Trends in Pharmacological Science, 20, 135-141.
Fattore, L., Martellotta, M., Cossu, G. & Fratta, W. (2000) Gamma-hydroxybutyric acid: An evaluation of its rewarding properties in rats and mice, Alcohol, 20, 247-256.
Snead, O. (1977) Gamma-hydroxybutyrate, Life Sciences, 20, 1935-1944.
Gessa, G., Agabio, R., Carai, M., Lobina, C., Pani, M., Reali, R. & Colombo, G. (2000) Mechanism of anti-alcohol effect of gamma
hydroxybutyric acid (GHB), Alcohol, 20, 271-276.
Colombo, G. & Gessa, G. L. (2000) Gammahydroxybutyric acid in alcohol preference, dependence and withdrawal, Addiction Biology,
, 389-403.
Colombo, G., Agabio, R., Lobina, C., Reali, R., Fadda, F. & Gessa, G. (1995) Symmetrical generalisation between the discriminative stimulus effects of gamma-hydroxybutyric acid and ethanol: Occurrence within narrow dose ranges, Physiology and Behavior, 57, 105-111.
Vickers, M. (1969) Gammahydroxybutyric acid, International Anaesthesia Clinics, 7, 75-89.
Mamelak, M. (1989) Gammahydroxybutyrate: An endogenous regulator of energy metabolism, Neuroscience and Biobehavior Review, 13, 187-198.
Mack, R. (1993) Love potion number 8 1/2, North Carolina Medical Journal, 54, 232-233.
Chin, M., Kreutzer, R. & Dyer, J. (1992) Acute poisoning from gamma-hydroxybutyrate overdose, Annals of Emergency Medicine, 31, 716-722.
Scharf, M., Brown, D., Woods, M., Brown, L. & Hirschowitz, J. (1985) The effects and effectiveness of gamma-hydroxybutyrate in patients with narcolepsy, Journal of Clinical Psychiatry, 46, 222-225.
Vickers, M. (1968) Gammahydroxybutyric acid, Proceedings of the Royal Society of Medicine, 61, 821-823.
Laborit, H. (1964) Sodium 4 hydroxybutyrate, International Journal of Neuropharmacology, 43, 433-452.
Hunter, A., Long, W. & Ryrie, C. (1971) An evaluation of gamma hydroxybutyric acid in paediatric practice, British Journal of Anaesthesia, 43, 620-627.
Takahara, J., Yunoki, S., Yakushiji, W., Yamauchi, J., Yamane, Y. & Ofuji, T. (1977) Stimulatory effects of gamma-hydroxybutyric acid on growth hormone and prolactin release in humans, Journal of Clinical Endocrinology and Metabolism, 44, 1014-1017.
Friedman, J., Westlake, R. & Furman, M. (1996) "Grievous bodily harm": Gamma hydroxybutyrate abuse leading to the Wernicke-Korsakoff syndrome, Neurology, 46, 469-471.
Gallimberti, L., Cibin, M. & Pagnin, P. (1993) Gamma hydroxybutyric acid for the treatment of opiate withdrawal syndrome, Neuropsychopharmacology, 9, 77-81.
Gallimberti, L., Cibin, M. & Pagnin, P. (Gamma hydroxybutyric acid for the treatment of opiate withdrawal syndrome) Neuropsychopharmacology, 9.
Maremmani, I., Lamanna, F. & Tagliamonte, A. (2001) Long-term therapy using GHB (sodium gamma hydroxybutyrate) for treatment-resistant chronic alcoholics, Journal of Psychoactive Drugs, 33, 135-142.
Caputo, F., Addolorato, G., Lorenzini, F., Domenicali, M., Greco, G., Del Re, A., Gasbarrini, G., Stefanini, G. & Bernardi, M. (2003) Gammahydroxybutyric acid versus naltrexone in maintaining
alcohol abstinence: An open randomi-sed comparative study, Drug & Alcohol Dependence, 70, 85-91.
United States Department of Health and Human Services (1990) Epidemiologic notes and reports: Multistate outbreak of poisonings
associated with illicit use of gamma hydroxybutyrate, Morbidity and Mortality Weekly Report, 39, 861-863.
Australian Bureau of Criminal Intelligence (2000) Australian Illicit Drug Report 1998-1999 (Canberra, Australian Bureau of Criminal Intelligence).
Breen, C., Topp, L. & Longo, M. (2002) Adapting the IDRS methodology to monitor trends in party drug markets: Findings of a two year feasibility trial. NDARC Technical Report No. 142 (Sydney, National Drug and Alcohol Research Centre, UNSW).
White, B., Degenhardt, L., Breen, C. & Roxburgh, A. (2003) NSW Party Drug Trends 2002: Findings from the Party Drug Initiative. NDARC Technical Report No. 153 (Sydney, National Drug and Alcohol Research Centre, UNSW).
United States Department of Health and Human Services (1997) Gamma hydroxybutyrate use - New York and Texas, 1995-1996, Morbidity and Mortality Weekly Report, 46, 281-283.
Whitten, L. (2001) Conference highlights increasing GHB abuse, NIDA Notes, 16, 10-11.
Thomas, G., Bonner, S. & Gascoigne, A. (1997) Coma induced by abuse of gamma-hydroxybutyrate (GBH or liquid ecstasy): A case report, British Medical Journal, 314, 35.
Weir, E. (2000) Raves: A review of the culture, the drugs and the prevention of harm, Canadian Medical Association Journal, 162, 1843-1848.
Miro, O., Nogue, S., Espinosa, G., To-Figueras, J. & Sanchez, M. (2002) Trends in illicit drug emergencies: the emerging role of gammahydroxybutyrate, Journal of Toxicology - Clinical Toxicology, 40, 129-35.
Ingels, M., Rangan, C., Bellezo, J. & Clark, R. (2000) Coma and respiratory depression following the ingestion of GHB and its precursors: Three cases, Journal of Emergency Medicine, 19, 47-50.
Miotto, K., Darakjian, J., Basch, J., Murray, S., Zogg, J. & Rawson, R. (2001) Gammahydroxybutyric acid: Patterns of use, effects and withdrawal, American Journal on Addictions, 10, 232-241.
Degenhardt, L., Darke, S. & Dillon, P. (2002) GHB use among Australians: Characteristics, use patterns, and associated harm, Drug and Alcohol Dependence, 67, 89-94.
Topp, L., Hando, J., Dillon, P., Roche, A. & Solowij, N. (1999) Ecstasy use in Australia: patterns of use and associated harm, Drug and Alcohol Dependence, 55, 105-115.
Dyer, J. (1991) Gamma-Hydroxybutyrate: A health food product producing coma and seizure-like activity, American Journal of Emergency Medicine, 9, 321-324.
Muller, A. (2003) GHB poisoning: Three recent cases reflect the continuing danger, Journal of Emergency Nursing, 29, 72-74.
Sanguineti, V., Angelo, A. & Frank, M. (1997) GHB: A home brew, American Journal of Drug & Alcohol Abuse, 23, 637-642.
Karch, S., Stephens, B. & Nazareno, G. (2001) GHB: Club drug or confusing artifact?, American Journal of Forensic Medicine and Pathology, 22, 268-269.
Li, J., Stokes, S. & Woeckener, A. (1998) A tale of novel intoxication: Seven cases of gammahydroxybutyrate acid overdose, Annals of Emergency Medicine, 31, 723-728.
Eckstein, M., Henderson, S., Delacruz, P. & Newton, E. (1999) Gamma Hydroxybutyrate (GHB): Report of a mass intoxication and
review of the literature, Preshospital Emergency Care, 3, 357-361.
Chin, M., Sporer, K., Cullison, B., Dyer, J. & Wu, T. (1998) Clinical course of gammahydroxybutyrate overdose, Annals of Emergency
Medicine, 31, 716-722.
Us Drug Enforcement Agency (2001) Drug Intelligence Brief - Club Drugs: An Update (DEA Intelligence Division, Office of Domestic Intelligence, Domestic Strategy Unit).
Ferrara, S., Tedeschi, L. & Frison, G. (1995) Fatality due to gamma-hydroxybutyric acid (GHB) and heroin intoxication, Journal of
Forensic Science, 40, 501-504.
Marwick, C. (1997) Coma-inducing drug GHB may be reclassified, Journal of the American Medical Association, 277, 1505-1506.
Centers for Disease Control (1997) Gamma hydroxybutyrate use - New York and Texas, 1995-1996, Morbidity and Mortality Weekly Report, 46, 281-283.
Degenhardt, L., Darke, S. & Dillon, P. (2003) The prevalence and correlates of GHB overdose among Australian users, Addiction, 98,
-204.
Mansergh, G., Colfax, G. N., Marks, G., Rader, M., Guzman, R. & Buchbinder, S. (2001) The Circuit Party Men's Health Survey:findings and implications for gay and bisexual men, American Journal of Public Health., 91, 953-8.
Caldicott, D. & Kuhn, M. (2001) Gammahydroxybutyrate overdose and physostigmine: Teaching new tricks to an old dog?, Annals of Emergency Medicine, 37, 99-102.
Li, J., Stokes, S. & Woeckener, A. (1998) A tale of novel intoxication: A review of the effects of gamma-hydroxybutyric acid with reocmmendations for management, Annals of Emergency
Medicine, 31, 729-736.
Mcdaniel, C. & Miotto, K. (2001) Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: Five case studies,
Journal of Psychoactive Drugs, 33, 143-149.
Craig, K., Gomez, H., Mcmanus, J. & Bania, T. (2000) Severe gamma-hydroxybutyrate withdrawal: a case report and literature review, Journal of Emergency Medicine, 18, 65-70.
Schneir, A., Ly, B. & Clark, R. (2001) A case of withdrawal from the GHB precursors gammabutyrolactone and 1,4-butanediol, Journal of Emergency Medicine, 21, 31-33.
Catalano, M., Glass, J., Catalano, G., Burrows, S., Lynn, W. & Weitzner, B. (2001) Gamma butyrolactone (GBL) withdrawal syndromes, Psychosomatics, 42, 83-88.
Dyer, J., Roth, B. & Hyme, B. (2001) Gamma-Hydroxybutyrate withdrawal syndrome, Annals of Emergency Medicine, 37, 147-153.
Bowles, T., Sommi, R. & Amiri, M. (2001) Successful management of prolonged gammahydroxybutyrate and alcohol withdrawal, Pharmacotherapy, 21, 254-257.
Slaughter, L. (2000) Involvement of drugs involved in sexual assault, Journal of Reproductive Medicine, 45, 425-430.
