There are two forms of the central nervous system depressant gamma-hydroxybutyrate (GHB). Gamma-hydroxybutyrate sodium and sodium oxybate are the chemical drug names for the pharmaceutical version of the drug Xyrem, which is used in the United States as a treatment for the sleep disorder narcolepsy. GHB also refers to the illegal formulations of the drug that are used for a number of illicit purposes and nonmedicinal uses.
The differences in the pharmaceutical version of GHB and the illicit version of GHB are based on how the drug is manufactured, its purity, and some minor chemical differences in the composition of the drug. The pharmaceutical version of GHB (Xyrem) is classified as a Schedule III controlled substance by the United States Drug Enforcement Administration (DEA), whereas the illicit versions are classified as Schedule I controlled substances by the DEA. The pharmaceutical version of GHB can only be obtained with a prescription from a physician and its distribution is monitored; illicit versions of GHB are illegal to possess in any form. Xyrem is also used as a withdrawal management drug in European countries, such as Italy.
GHB, GABA, and Some Illicit Uses
GHB is actually a metabolite of the neurotransmitter gamma-aminobutyric acid (GABA), which is the most prevalent inhibitory neurotransmitter occurring in the central nervous system. An inhibitory neurotransmitter functions to modulate the firing of other neurons in the brain and spinal cord by suppressing the activity of the neurons. This results in a slowing of the system. GHB was used for a number of medicinal purposes including as an anesthetic; however, its use was associated with a number of side effects, including abnormal patterns on electroencephalograms (EEG), and use of the drug for medicinal purposes was discontinued.
In the 1980s, GHB received some notoriety as a drug that could improve athletic performance. The drug became popular with athletes and bodybuilders. It even got a reputation as being a steroid as it was believed to reduce fatigue and increase muscle mass; however, it is not an anabolic steroid. The drug also received a reputation as an aphrodisiac; and in the late 1990s and early 2000s, its use as a date rape drug increased.
In 2000, the DEA classified GHB is a Schedule I controlled substance, outlawing its use. Later, formulations of GHB (sodium oxybate) were found to be useful in the treatment of narcolepsy and were approved by the FDA in 2002 for that purpose. These formulations were classified as Schedule III controlled substances to allow them to be administered for the treatment of individuals who had complications from narcolepsy. The drug also underwent clinical trials investigating its use for treating fibromyalgia, but it did not receive FDA approval.
Individuals who abuse GHB come from three general categories:
- Bodybuilders and other athletes: GHB still has a reputation as a drug that can enhance athletic performance and assist in the development of muscle mass. It is also sometimes sold at bodybuilding gyms as a weight reduction or fat-burning product. These sales are entirely illegal; the drug sold for these purposes is either obtained illegally or manufactured in home laboratories. There is no evidence that the drug serves these purposes.
- Those who use it as a rave party drug: GHB has a reputation among younger individuals as an alternative to the illicit drug ecstasy. GHB produces feelings of euphoria and gregariousness, and it is still reputed to be an effective aphrodisiac.
- Those who use it as a date rape drug: Sexual predators use GHB as a potential date rape drug as it produces sedation and antereograde amnesia (memory loss for recent events).
GHB is illegally marketed under a number of different street names that include Georgia home boy, liquid ecstasy, grievous bodily harm (GBH), lollipops, and others.
GHB abuse has a number of potential dangers associated with it. The drug is potentially toxic in very small amounts, and the differences in the dosage ranges that are safe to take and those that are potentially toxic are quite small. Other effects are outlined below.
- The drug crosses the blood-brain barrier, entering the central nervous system and releasing large amounts of neurotransmitters, especially serotonin and dopamine.
- GHB use results in the release of serotonin, which leads to a release of the hormone OxyContin, which is responsible for the drug’s euphoric effects and increased feelings of sociability.
- The release of dopamine is associated with the drug’s reinforcing effect. It also helps individuals to focus on certain aspects of their environment when the drug is used in very small doses; however, in larger doses, the effects of the drug lead to amnesia.
- At very small amounts, the drug produces euphoria, sociability, and feelings of wellbeing for a short time. At moderate amounts, issues with lethargy, sedation, and control occur.
- GHB also affects the hypothalamus, which is involved in a number of regulatory functions in the body. Taking large amounts of the drug will result in an individual becoming easily overheated due to its effects on the hypothalamus.
- Combined with feelings of sociability, euphoria, and sedation, GHB is also known to produce a loss of inhibitions in users. This loss of inhibitions combined with the drug’s potential to produce issues with memory can lead to individuals engaging in potentially dangerous activities. These effects also bolster the drug’s use as a date rape drug.
- Chronic use of the drug leads to confusion, hallucinations, aggressive outbursts, depression, and potential seizures.
- Because use of GHB often occurs in nightclubs or parties, it is often used in conjunction with alcohol. This increases the effects of both substances.
The typical course associated with taking GHB is initially feeling focused, happy, and sociable; however, as the drug continues to exert its effects, people begin to experience depression, irritability, and even violent behavior in place of the euphoric effects. Later, sedation and other issues occur.
Individuals who procure the drug illegally do so from several sources. The legal version of the drug can be procured illegally on the street from individuals who sell illegally obtained prescription drugs or even from individuals with prescriptions who sell their drugs. The Internet is also a big source for the drug, and individuals can learn how to manufacture the drug through a number of potential sources.
Despite a number of online sources reporting that GHB is safe to use, there are a number of documented reports that indicate that chronic use of GHB is associated with the development of physical dependence. Tolerance to GHB appears to occur very rapidly, and this results in individuals taking increasingly larger amounts of the drug. As tolerance increases, the individual’s system adjusts, and the person will experience withdrawal symptoms if the drug is discontinued or when the normal detoxification process eliminates a specific amount of the drug from the body.The withdrawal syndrome from GHB appears to be similar to withdrawal from benzodiazepines and alcohol. It consists of:
- An acute phase: This phase can begin within a few hours of discontinuation or take up to 24 hours to appear.
- A moderate phase: The symptoms generally peak 1-6 days following discontinuation.
- An extended phase: Symptoms begin to decrease in their intensity 2-7 days following discontinuation, but they may still continue at lower levels for days to weeks. In some cases, intermittent symptoms like occasional cravings may occur for weeks, months, and even years after discontinuation.
A number of symptoms can occur during withdrawal, including nausea, vomiting, stomach cramps, fever, chills, anxiety, depression, hallucinations, and potentially dangerous seizures. Those abusing GHB are urged to seek medical help when attempting to discontinue the drug.
There are a number of potential signs associated with the development of a substance use disorder (addiction) to GHB. These include:
- Repeated cravings to use GHB
- Issues with controlling use of GHB
- Repeatedly using GHB in situations where it is inappropriate or dangerous to do so
- Repeatedly using GHB to deal with everyday stressors
- The development of tolerance
- The development of withdrawal symptoms
- Experiencing memory loss after GHB use
- Significant periods of slurred speech, incoherence, and/or aggressive behaviors using GHB
- Periods of unconsciousness associated with GHB use
Experiencing two or more of these symptoms suggests that there may be a substance use disorder present. Anyone who experiences two or more of these issues should seek consultation with a licensed mental healthcare professional.
Treatment for a Substance Use Disorder
Because those who have developed an addiction involving GHB will potentially display a significant withdrawal syndrome when the drug is discontinued, the initial treatment for GHB should include a physician-assisted detox program. The detox program will assist the individual in withdrawing from the drug safely.
Often, the physician will prescribe benzodiazepines or anticonvulsant medications and administer these on a tapering basis as the individual goes through the withdrawal process.
These drugs reduce the symptoms of withdrawal from GHB and can also prevent any potential dangerous issues, such as seizures.
Other aspects of treatment that should be included in a recovery program are:
- Therapy: An essential component of addiction treatment is substance use disorder therapy. This therapy can only be administered by trained and licensed mental health professionals. This therapy addresses a number of issues, including the reasons the person turned to drug use, changing the individual’s irrational belief system, focusing on relapse prevention, and addressing other psychological issues that often co-occur with a substance use disorder.
- Medical management: Continued medical management of any co-occurring physical or psychological disorders is an important component of treatment. Those recovering from a substance use disorder should be treated as an entire person, and all potential issues that can result in stress and relapse should be addressed.
- Social support: Those recovering from substance use disorders need to develop a strong support system that fosters their recovery. This can be accomplished in a number of different manners, such as via support from friends and family, group therapy, family therapy, and participation in social support groups, such as 12-Step groups. Peer support or 12-Step groups can be a significant component of long-term recovery, as individuals who attend these groups make lifelong connections that foster their ongoing recovery and can continue to attend these groups for years after formal therapy has been discontinued.
- Other forms of support, as needed: Other needed forms of support should be given, as appropriate for the individual case. This can include vocational rehab, tutors for school, career guidance, physical and/or occupational therapy, etc.