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GHB: Everything You Need To Know (Effects, Dosage, and Dangers)

Written by Matt Carland, PhD (Neuroscience) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Matt Carland, PhD (Neuroscience) | Last updated:

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GHB is commonly known as a party and “date-rape” drug. Despite its continued popularity as a drug of abuse, many of its users remain unaware of its dangers, such as risky sexual behavior, cognitive impairment, and addiction. GHB use can be highly damaging to a person’s health, and overdoses can be fatal. Read on to learn more about the effects and health impacts of GHB, and the science behind what it does to the brain.

Disclaimer: This post is not an endorsement or recommendation for the use of GHB – in fact, we strongly advise against the recreational abuse of any illegal drugs, GHB or otherwise. We have written this post for informational purposes only, and our goal is solely to inform people about the science behind GHB’s effects, mechanisms, and historical and current uses.

What is GHB?

Gamma-hydroxybutyrate – more commonly known as “GHB” – was first synthesized in 1960 by the French physician Dr. Henri Laborit [1, 2].

Because of its ability to reduce or impair consciousness, it was first used as an anesthetic. However, it was abandoned because of its weak pain-killing (analgesic) effects and its tendency to cause seizures [1, 3, 4].

The drug later gained popularity as a bodybuilding supplement during the ‘80s and ‘90s due to its reported anabolic (muscle-building) effects. It also became a popular recreational drug as its euphoric effects become more widely known [1, 5, 6, 7, 8].

GHB affects a wide variety of biological functions such as sexual behavior and the sleep-wake cycle. The primary effects of GHB can range from mild relaxation to euphoria, but can also include negative effects such as amnesia, hallucinations, and even coma [9, 10].

The effects vary from pleasant to dangerous or even life-threatening according to the dose [9, 11, 12].

This drug also has an extremely high potential for abuse and addiction. In fact, GHB is considered by some to be even more of a public and personal danger than alcohol abuse [13, 14, 15].

Unfortunately, most users remain unaware of the dangers associated with GHB abuse, and this lack of public awareness has led to misconceptions that GHB is safe [16, 17, 18, 19, 20].

As a result, GHB has become a major cause of overdose-related emergency room visits worldwide [21].

Legality

Because of its high abuse potential, GHB is scheduled as an illegal drug in most western countries. It was prohibited in the US by the FDA in 1990, followed by bans on GHB’s alternative forms in 2000. Similar bans on GHB and its analogs were put into place throughout Europe during the late 2000s [22, 1, 8, 23, 5, 18].

Nonetheless, it is still widely sold illegally by drug dealers across the world.

“Street names” of GHB include “Fantasy”, “G”, “Gamma Oh”, “Georgia Home Boy”, and “liquid ecstasy” or “liquid X” [24, 1, 25].

Who Uses It?

This drug is mostly used by young people at clubs and raves. Most users are young males in their 20’s and early 30’s [19, 26, 18, 27].

GHB use is also prominent among the gay population, who often use it to enhance sexual desire and prolong performance [5, 28, 29].

Many users combine GHB with other drugs, which greatly increases its health risks. In fact, 70% of users have a prior history of drug abuse [26, 19, 30, 31].

In recent years, rates of GHB use have been in slight decline, although this may be because some users are moving on to different club drugs such as MDMA (“ecstasy”) [18, 32].

Nonetheless, GHB abuse is still a significant problem worldwide [21, 20, 14, 16].

Natural Sources

GHB occurs naturally in the nervous system and can be found in trace amounts in the brains of humans and other mammals. It is produced from glutamate and is the precursor of GABA, a major inhibitory neurotransmitter [21, 22].

Normally, natural (“endogenous”) GHB is not present in high enough amounts to have noticeable psychological effects; it is only when levels are greatly increased (i.e. by ingesting it) that it becomes a psychoactive compound [33].

GHB is also present in trace amounts in many alcoholic and non-alcoholic drinks, including tonic water and wine. However, its levels are so low that it has no significant psychological or physiological effects [34, 35].

Mechanisms of Action

GHB is a sedative-hypnotic drug that has a depressant (inhibitory) effect on the nervous and respiratory systems [36, 8, 21, 22].

It is primarily a GABA receptor activator, meaning that it increases the amount of GABA-related activity throughout the brain [37, 38, 36, 22, 39, 40, 24, 41].

GABA is a major neurotransmitter that is involved in a wide range of functions including vigilance, anxiety, muscle control, and memory. However, because GABA is inhibitory, this means that GHB effectively “shuts down” or impairs many of these processes [33, 42].

GHB also affects other neurotransmitters, although these mechanisms are still being researched [24]:

  • GHB’s “pleasurable” effects – such as relaxation and euphoria – may be caused by increased brain activity in the insula and the anterior cingulate cortex (ACC), which are key parts of the brain networks involved in emotional experiences such as anxiety and pleasure [43].
  • Its mood-enhancing and pro-social effects may involve increased levels of oxytocin, commonly involved in social bonding in humans [44].
  • Elevated levels of progesterone – a hormone involved in sexual development and behavior – may also be involved in GHB’s pro-social effects [45].
  • GHB also reduces the release of the excitatory glutamate in the ventral tegmental area (VTA), a deep brain structure that distributes dopamine throughout the midbrain and cerebral cortex. This indirect effect on dopamine activity may account for some of GHB’s “rewarding” and addictive properties [46, 47, 48, 49].

Some also suggest that GHB functions as a natural neurotransmitter with its own set of dedicated GHB receptors in the brain. However, this notion is still controversial with ambiguous evidence [8, 21, 21, 7, 4].

The “Positive” Effects of GHB

Note: when we talk about the “positive effects” of GHB, we are referring only to those effects that cause people to abuse this drug recreationally; we are not claiming that these are beneficial for health in any way – nor are we encouraging or endorsing the use of GHB!

The so-called “positive” effects of GHB include:

  • Relaxation [10]
  • Euphoria and mood-enhancing effects [45, 5]
  • Pro-social (“empathogenic”) effects [45]
  • Increased sexual desire [30, 5]
  • Decreased inhibitions [45, 30]
  • Decreased anxiety [30]
  • Heightened awareness of one’s body and sensations [43]
  • Increased intensity of emotions [43]

A study (randomized controlled trial) in 16 healthy volunteers found that approximately 1.1 – 1.3 grams of liquid GHB produced euphoric, disinhibiting, and energetic effects [45].

However, a different study with 8 healthy volunteers who had never taken GHB before failed to find euphoria or any other positive recreational effects at an even larger dose (approximately 1.5 grams) [50].

Findings such as these demonstrate just how difficult it can be to accurately estimate the size of a “recreational” GHB dose, as this can vary considerably from person to person – and this fact alone is probably a good enough reason to avoid ever abusing this drug!

Negative Effects

GHB comes with a large number of potential negative effects – some of which can even be life-threatening! In fact, the majority of recreational users consistently experience negative effects, though this unfortunately doesn’t always prevent people from continuing to abuse GHB [30].

Some of GHB’s many potential adverse effects include:

  • Seizures [3, 4, 7]
  • Respiratory arrest [17]
  • Bradycardia (slowed heart rate) and potential cardiac arrest [21, 17]
  • Confusion and disorientation [30, 50]
  • Memory loss and amnesia (“blackouts”) [51, 52]
  • Partial or total loss of consciousness [18, 4, 12]
  • Loss of motor coordination [30, 53]
  • Uncontrollable muscle contraction/twitching (“myoclonus”) [21]
  • Dizziness [50, 43]
  • Hypothermia [21]
  • Convulsions [17]
  • Coma [17, 7]

Amnesia, blackouts, and memory loss are extremely common side effects of GHB use and occur in nearly all GHB users [51, 54, 52].

Additionally, GHB’s disorienting and consciousness-impairing effects can also lead to situational dangers, such as robbery or sexual assault [55, 52, 56, 57].

The adverse effects of GHB are possible at any dosage and become more likely as the dose increases [11, 12].

Dosing

Note: The information in this section describes what scientists currently know about the relative effects of different doses of GHB on the brain: it is not a guide to recreational or other non-medical use.

Researchers have estimated that blood levels of about 100mg/L are enough to produce some of the “euphoric” and other “pleasurable” effects, while death from respiratory arrest and other adverse effects become significant risks at levels of about 500mg/L [22, 19].

In general, however, it is not possible to say exactly how much of the drug must be taken to reach a given blood concentration, for several major reasons:

  • GHB has a non-linear dose-response relationship, with blood levels rising disproportionately as dose size increases. In other words, a dose that is twice as large may have effects that are more than twice as strong – and a dose that even a little bit too large can quickly cause major negative effects, and may even result in life-threatening overdose [58, 11, 12].
  • Different people metabolize this drug at different rates – so a dose that is safe for one person may be quite dangerous for another [59]. In other words, its effects are highly unpredictable, and can vary a lot from person to person.

What Happens If You Ingest GHB?

GHB is quickly absorbed into the bloodstream and readily crosses the blood-brain barrier. Its effects generally begin within about 30 minutes and reach their peak after approximately 60 minutes [21, 15].

GHB highs usually last between 4 and 6 hours [15].

Men metabolize (break down) the drug more efficiently than women [59].

Caucasian people may also metabolize it more quickly [59].

The majority of the drug is eliminated from the body within 4-8 hours by the liver [21].

Speculative Medical Uses

Because of the history of how it was discovered, as well as because of some of its subtle chemical properties, GHB has occasionally been proposed as a means for treating a handful of medical conditions.

However, keep in mind that these proposals were made by licensed medical doctors and other professional health scientists, and that they only apply to certain very specific medical contexts! In other words, none of these medical uses should be interpreted as “health benefits” of taking this drug.

It’s also important to note that many of these proposals either haven’t fully panned out, or at the very least have only mixed or conflicting evidence to back them up. Furthermore, even if GHB were an effective treatment for some health conditions, it is extremely unlikely to ever be approved by the FDA due to its high potential for abuse.

With that in mind, here is a brief overview of some of the speculative medical uses of GHB that have been proposed since its discovery nearly 50 years ago.

GHB has been used for inducing “absence” (petit mal) seizures and as an anesthetic [7].

It has also been used to treat:

  • Alcoholism / Alcohol Withdrawal Syndrome (AWS) [8]
  • Opioid dependence [7, 8]
  • Sleep disorders, particularly narcolepsy [8]

Some researchers have proposed that this drug may have medical potential to help treat:

However, several of these uses have only weak or mixed evidence to support them, and GHB has not been widely adopted by medical professionals as a primary treatment for any of these conditions. On the contrary, most of the conditions have much better treatments available that come with much fewer side-effects and other risks.

These medical applications are also highly unlikely to be widely adopted by clinicians or approved by the FDA because of GHB’s high abuse potential [60].

1) Sleep Disorders

GHB’s possible effectiveness for treating narcolepsy was suggested by two double-blind randomized controlled trials with a total of 248 subjects [32, 62].

GHB was also reported to alleviate cataplexy, a specific symptom of narcolepsy involving the sudden loss of muscle control in response to intense emotions [62, 63, 42, 64].

The effects increase with the dose. However, the relatively short half-life of the drug means that patients usually have to wake up during the night to re-administer a second dose, which makes it considerably less useful than other sleep-disorder treatments [33, 60].

Sodium oxybate (SO), the sodium salt version of GHB, increases slow-wave sleep duration and reduces the number of night-time awakenings in patients with narcolepsy. By improving sleep quality, SO helps narcolepsy patients function better throughout the day [33, 65].

In addition, by helping to stabilize their sleep cycle, SO also alleviates depression symptoms in narcoleptic patients [66]. However, this is most likely just a side-effect of getting better sleep – it doesn’t necessarily mean that GHB actually has “antidepressant” effects in the classical sense.

2) Alcoholism

Chemically speaking, GHB’s effects on the brain are biologically similar to those of alcohol. For this reason, it is occasionally used to treat alcohol withdrawal syndrome (AWS), which can be life-threatening in severe cases of alcoholism [67, 24, 68, 69].

Medical use of GHB in this way may also help reduce alcohol cravings and decrease relapse rates in alcohol-dependent patients (as reported by a review of 13 clinical trials) [69, 70].

GHB reduced the amount of alcohol consumed by alcohol-dependent rats after 14 days of forced abstinence, suggesting that GHB may have reduced their overall motivation to consume alcohol [71].

Despite some of this evidence for this specific medical use, GHB’s high potential for abuse makes it very much less than ideal as an alcoholism treatment. In fact, many researchers have argued that it should be categorically avoided in favor of other, safer drugs (such as benzodiazepines) [69, 72].

3) Fibromyalgia

GHB has occasionally been reported to aid in treating fibromyalgia [9]. However, the experimental support for this use is mixed.

On one hand, medical GHB (sodium oxybarate) has been reported to improve symptoms of insomnia, fatigue, and chronic pain in patients with fibromyalgia in a few clinical trials [60].

On the other hand, a more recent follow-up study (randomized controlled trial) did not find any significant effect of GHB on pain, mood, or sleep in 25 female fibromyalgia patients [73].

Additionally, concerns about the drug’s high abuse potential mean that it is unlikely to meet the FDA’s strict safety requirements [60].

4) Depression

Because GHB can have euphoric and other mood-altering effects, some researchers have suggested that it may have potential in helping treat the symptoms of depression [43, 9, 61].

Some early evidence for this came primarily from a few studies which reported that GHB may alleviate depression in patients suffering from sleep disturbances, which often worsen depression symptoms [66].

However, this evidence is rather weak, as it’s likely that any improvements in these patients were just a side-effect of sleeping better, rather than a direct “antidepressant” effect of GHB itself. Therefore, apart from this indirect effect, it is not clear whether GHB would be suitable for treating depression in general. In theory, its ability to modulate the GABAergic system could make it a promising candidate, although much more research would be needed to confirm this – and once again, its high potential for abuse would probably prevent the FDA from ever approving this use [61].

GHB Side Effects (In Medical Use)

When used under the direct supervision of clinicians, GHB does not appear to lead to addiction or withdrawal syndromes due to its tightly controlled dosage [74].

As a result, the risks of abusing sodium oxybarate (the “medical” form of GHB) during medical treatment are considerably lower than for illegal (recreational) GHB abuse [32, 75, 76].

Nonetheless, the majority of patients (61%) still report significant adverse side-effects over the course of medical treatment with GHB [64].

Reported side effects include:

Just as when the drug is abused recreationally, negative side-effects also become more likely as the dose increases [33].

GHB Use Among Bodybuilders

Interestingly, this drug became popular among bodybuilders in the 80s-90s, due to its supposed anabolic (muscle-building) effects – and some athletes even continue to use it in this way [77, 2].

However, the evidence for GHB’s usefulness as a bodybuilding supplement is not particularly strong or convincing.

On one hand, some early evidence initially supported the idea that GHB increases the production of growth hormone (GH), a hormone that stimulates growth and regeneration. For example, 14 patients given continuous intravenous GHB injections showed faster healing of burn wounds, possibly due to increased GH levels [78].

Relatedly, relatively small doses of GHB were reported to increase GH levels in 11 out of 12 volunteers. However, this effect was short-lasting (90 – 120 minutes), and it’s not clear that this would actually translate to building muscle [79].

On the other hand, many other studies have failed to find any significant influence of GHB on the levels of GH in humans [73].

GHB also does not appear to increase GH levels in mice. However, it did shift their energy metabolism from using sugars to using fats, which the authors interpreted as a potential fat-burning effect [77]. However, since has only been reported in mice, it definitely cannot be assumed that it would have similar effects in any human users.

In light of the weak scientific findings, the short effect duration, and the many potential downsides of GHB use, it would be very ill-advised to use this drug for anabolic purposes [79].

GHB and Sex

This drug has both “positive” and negative effects on sexuality and arousal in humans (but again, keep in mind that when we say “positive” effects, we’re just talking about the effects that lead people to abuse this drug recreationally – we’re not talking about any health or other benefits).

Recreational users of GHB sometimes report increased libido, sexual arousal, and sexual openness [37, 52].

GHB also intensified the brain’s response to erotic stimuli when 32 healthy volunteers viewed erotic pictures [37].

Interestingly, GHB also tends to make the brain regions involved in sexual arousal activate in response to non-erotic pictures of people. This suggests that GHB impairs people’s ability to discriminate between erotic and non-erotic stimuli [37].

This finding is consistent with the fact that recreational GHB users frequently report a variety of negative sexual side-effects or consequences. For example, users are significantly more likely to engage in risky sexual activity when under the influence [80, 52].

GHB users also report a significant “lowering of standards” when seeking or selecting sexual partners, which often leads them into situations they later regret [37, 30].

GHB’s ability to impair sexual decision-making also contributes to the spread of sexually transmitted diseases. This is not only because it lowers people’s inhibitions, but also because GHB’s ability to “energize” sexual performance also increases the likelihood of physical injury during prolonged sexual activity, which makes the transmission of diseases much more likely [30, 29].

Therefore, while GHB is sometimes claimed to “enhance” sexual activity and desire, it also significantly impairs decision-making, and very often leads to dangerous or unwanted sexual encounters as well as the spread of sexually transmitted diseases [37].

GHB and Date Rape

GHB is notorious for its role in “date rape” – also known as Drug-Facilitated Sexual Assault (DFSA) – where drugs are unknowingly given to potential victims to make them less capable of avoiding or resisting a sexual assault [56, 57, 59, 1, 81, 10].

However, some public health researchers have argued that GHB’s reputation as a “date-rape” drug may be unwarranted [82].

One argument is that many studies on date rape do not account for voluntary drug consumption, therefore biasing the crime statistics. For example, several large-scale studies have found that the majority of reported date rapes occur as a result of voluntary intoxication with alcohol and other drugs [83, 84, 85].

In fact, only 0.2 – 4.4% of reported sexual assaults have involved the use of GHB [82].

In contrast, most sexual assaults are committed using drugs that are not commonly considered “date rape drugs” such as cannabinoids, cocaine, and amphetamines [85, 82].

In light of findings such as these, some researchers have argued that GHB’s reputation as a “date-rape drug” may be greatly exaggerated due to sensationalism in the media [82].

Nonetheless, at the end of the day, the fact that there is some controversy about the exact extent of GHB’s role in date rape does not make it any less dangerous – nor should it be taken as a reason to be any less careful or vigilant about what you’re drinking or ingesting when you’re out.

GHB and Crime

While GHB has become widely associated with sexual assault, it may actually be more commonly used to incapacitate or impair potential victims of “acquisitive crimes” such as theft, burglary, and robbery [55].

For example, one study found that out of 408 cases of unintentional GHB intake, only 6.5% of victims suffered from sexual assault while 21.7% endured an acquisitive crime [55].

Similarly, a related study of 60 GHB users found that people who used GHB voluntarily were also two and a half times more likely to be the victim of an acquisitive crime than they were to be the victim of a sexual assault [52].

Adverse Health Effects of GHB

Many people abuse GHB for its supposed “positive” effects, often while ignoring the many dangers that come with GHB abuse. In addition to the harms and dangers we’ve already discussed above, there are also many other, less-immediately-noticeable adverse effects that can come from abusing GHB.

1) GHB Causes Oxidative Stress

One study reported that GHB had antioxidant effects, leading the authors to suggest that GHB could have potential as a neuroprotective agent. However, these effects were only observed in cells [86].

As it turns out, this is actually a great example of the limitations of cell studies when it comes to trying to predict the effects of substances in actual living creatures, because a number of follow-up studies in living animals reported that GHB actually causes significant oxidative stress throughout the brain.

For example, a rat study found that GHB caused oxidative stress and decreased antioxidant levels in several key brain areas including the hippocampus, a brain structure critically involved in memory [87].

Another study reported that the cognitive deficits caused by GHB in rats could be partially counteracted by pretreating the rats with antioxidants, such as melatonin [88, 87]. We should stress the “partially” part: this study doesn’t mean that these negative effects are actually preventable – it just adds evidence that oxidative stress is probably at least one of the mechanisms involved in GHB’s harmful effects on the brain.

Together, these studies suggest that oxidative stress is one of the primary ways that GHB causes damage to the brain.

2) GHB Causes Cognitive Impairments

GHB works in a similar way to ketamine, which is known to be neurotoxic in humans. For this reason, it is likely that it causes impairments to cognition and memory in human users that are similar to those caused by ketamine, and that these impairments become stronger with repeated use of the drug [20, 16].

Several studies have found that GHB use leads to cognitive impairments in rats [88, 89].

These include impaired spatial memory and learning, which may be caused by changes to the number of receptors in important brain areas such as the hippocampus [51, 90, 91].

GHB also reduces glutamate activity throughout the frontal cortex. Glutamate receptors are critical in forming new memories, and GHB may cause learning impairments by interfering with these processes [91].

In rats, long-term GHB use also reduces the production of important proteins involved in maintaining healthy cognitive function [92].

In fact, a follow-up study in rats found that even a single use of GHB can lead to long-term genetic changes that result in general cognitive impairments [93].

3) GHB Impairs Emotional Regulation and Social Behavior

GHB causes long-term deficits in social behavior in animals, possibly by interfering with the brain’s oxytocin system, which is critical in emotional bonding [44].

GHB also impairs fear-related learning and memory in rats, making them less able to remember which environmental cues signal potential danger [89].

GHB also impairs the startle reflex in rats, further suggestive of impaired emotional processing [94].

Taken together, these studies suggest that GHB may make users less sensitive to social signals of danger in their environment, and would also explain why GHB use is associated with an increased likelihood of being the victim of a sexual assault or other crime [55].

GHB Addiction

Like most illegal drugs, GHB has very high addictive potential in both humans and animals [10, 95].

Several countries have reported that GHB addiction rates are rising [16, 18, 21].

GHB has reward-reinforcing properties in humans, which probably contribute to the development of addiction and dependence [13].

Baboons given free access to GBL and BD developed compulsive patterns of drug use, suggesting an addictive (reinforcing) effect [96].

Interestingly, baboons that chronically took GHB also showed a reduced motivation to work for non-drug rewards (such as food), suggesting that GHB addiction may cause depression-like impairments in general motivation [96, 11].

GHB addiction is associated with abnormalities in many neurotransmitter systems including GABA, glutamate, dopamine, serotonin, norepinephrine, choline, and oxytocin systems, although how each of these contributes to the different symptoms of GHB addiction is still being discovered [97, 77].

The complexity of GHB addiction means that it cannot be treated with any one specific type of drug or therapy, making medical treatment difficult [97].

GHB Causes Dependence

GHB and its precursor drugs all cause dependence in habitual users, meaning that people who use it end up “needing” the drug just to feel “normal” [8]. This kind of dependence (on any drug) has significant negative consequences on users’ daily life and long-term health

The fact that GHB causes dependence has also been shown by animal studies. For example, chronic use of GHB analogs (such as GBL and BD) causes drug dependence in baboons, and dependence can occur in as little as 3-4 weeks of use [11, 98].

GHB Causes Tolerance

Repeated use of GHB can also lead to a tolerance for its effects, meaning that frequent users have to increase their dose over time in order to get high [36, 99, 7].

Interestingly, however, only some of GHB’s effects are subject to tolerance.

While chronic GHB users develop tolerance to the pleasurable sedative and hypnotic effects of GHB, the negative effects of GHB do not appear to decrease over time [41, 12].

This means that as GHB users escalate their doses to keep getting high, they become more and more likely to suffer from its negative effects, which can result in life-threatening medical emergencies.

GHB Withdrawal

Repeated use of GHB can lead to severe withdrawal syndromes when drug use is stopped [14, 21].

For example, drug cessation causes withdrawal syndromes in baboons chronically administered with GBL, a “prodrug” (chemical precursor) of GHB [11].

Withdrawal symptoms can begin as quickly as 4 hours after the last dose has worn off, and may last anywhere between 3 and 21 days [14, 21, 7].

GHB withdrawal syndrome is similar to that of alcohol and other sedative-hypnotic drugs, such as benzodiazepines [6, 8].

It is severe enough to be considered a medical emergency, and can even result in death [95, 99, 100, 36, 21].

A German study found that one-third of GHB users had to seek help at a hospital concerning withdrawal symptoms [31].

The symptoms of GHB withdrawal include:

  • Extreme drug craving [100]
  • Agitation [100, 21]
  • Anxiety and restlessness [100, 7, 21]
  • Delusions and hallucinations [14, 8, 21]
  • Paranoia [21]
  • Confusion and disorientation [21]
  • Aggressive/violent outbursts [21]
  • Slowed movements and reflexes (psychomotor retardation) [100]
  • Motor tremors [7, 14, 21]
  • Dangerously elevated heart rate (tachycardia) [14, 21]
  • Insomnia [7, 21]
  • Seizures [101]
  • Psychosis-like syndromes [8]
  • Elevated blood pressure (hypertension) [14, 21]
  • Excessive sweating (diaphoresis) [14]

Importantly, the symptoms of GHB withdrawal are even more severe in users who abuse multiple drugs [100].

Managing GHB Addiction

Because habitual GHB use and addiction come with so many risks and dangerous side-effects, anyone who is struggling with a chronic GHB use problem should absolutely consult with a medical professional to ensure that they get adequate treatment.

With that in mind, there are several general strategies that medical professionals use to help people beat GHB addiction problems.

GHB addiction and withdrawal can sometimes be managed by gradually tapering off drug use under medical supervision [102].

Occasionally, medical treatment of GHB addiction may also involve the use of other drugs to help minimize the risks of the withdrawal process, which can be highly dangerous – or even fatal – if not done properly.

The most popular medications for treating GHB withdrawal are benzodiazepines, with baclofen and propofol as common “second-line” (backup) treatments. These drugs are GABA receptor activators and therefore mimic some GHB’s effects without re-exposing users to the full effects of GHB itself [21, 8, 36].

Patients seeking help for GHB addiction are also sometimes put on antipsychotic and anticonvulsant medications to control the side-effects of withdrawal [36].

GHB Overdose

GHB overdose can be fatal, and GHB abuse is implicated in a rising number of deaths from an overdose [21, 19].

GHB overdose causes significant impairments of consciousness and carries a critical risk of respiratory arrest (cessation of breathing) – the most common cause of overdose-related deaths [6, 103, 21].

In theory, one way to “reduce” the risk of overdose is for anyone taking it to make sure they are being watched and monitored by friends [104]. However, this doesn’t actually prevent any of the dangers associated with overdosing – it only means that a person who does overdose is more likely to get medical care, since others are around to call for help if the drug user suddenly loses consciousness. Therefore, this should not be counted on as a means to reduce the real dangers of GHB use, which can still occur whether or not anyone else happens to be around.

Another major factor that contributes to overdose is that the purity and potency of “street” GHB is almost never predictable. This means that a dose that was “safe” one time is not guaranteed to be safe the next time – and this lack of predictability is one of the main contributors to accidental overdose and other drug-related harms [105].

GHB Interactions

While GHB is already highly dangerous on its own, negative effects are even more likely when GHB is combined with other drugs [27, 106].

GHB addiction and physical dependence also become much more severe when it is consumed with other drugs, such as alcohol and cocaine [26, 100].

Most users of GHB who end up at the hospital (76%) have combined it with other drugs (alcohol, amphetamines, and cocaine being the most common) [27].

Among cases of death from GHB overdose, only 37% involved GHB alone. Most GHB deaths are due to mixing GHB with other drugs, with alcohol being the most common [19].

Note that this does not mean that GHB is any “safer” if taken on its own – if anything, these data say more about the carefree attitudes that many drug-users have about taking multiple drugs at a time than anything. A person’s risk will increase the more drugs they take – but taking one is still dangerous enough on its own.

Benzodiazepines have a similar mechanism of action to GHB, and people who use one of these drugs often develop cross-tolerance for the other [8].

GHB Overdose Treatment

Currently, there are no known antidotes that can be administered to counteract GHB’s immediate effects, making medical treatment difficult [22].

Some emergency care physicians give benzodiazepines to overdosing patients, which can sometimes partially and temporarily counteract some of GHB’s neurological effects [22].

Activated charcoal is sometimes administered in an attempt to absorb some of the circulating GHB from the patient’s system. However, because of GHB’s rapid uptake in the body, it only works if the patient is treated very quickly after initial drug ingestion [107, 21].

Oftentimes, the only practical option is to monitor the patient’s vital signs and make sure that their airways are kept clear to prevent death from the cessation of breathing or emesis (choking from vomit) [21, 22].

Clearly, what all this means is that if you ever think someone around you might be overdosing, it’s best to immediately seek expert medical care as quickly as possible.

Drug Testing for GHB

Because GHB overdoses are so dangerous – and because GHB is sometimes deliberately given to other people in order to commit crimes against them – medical and law-enforcement professionals alike have developed a variety of tests that they can use to try to determine if a person has been “dosed” with GHB.

GHB levels are relatively easy to assess in drink samples. However, the fact that many common drinks – such as wine and tonic water – naturally contain some amount of GHB can make it difficult to determine for sure whether a drink was intentionally spiked by someone [108, 34].

Furthermore, the rapid metabolism of GHB in the body presents several additional challenges for forensic testing [109].

For example, because GHB is naturally present in very small amounts in the brain, it can sometimes be hard for biological tests to tell the difference between GHB made in the body and externally-administered GHB – especially if the person didn’t get tested right away [23, 110, 109].

Forensic investigation of GHB use is also made difficult by the fact that it often causes memory loss and unconsciousness. This means that victims may not become aware that they have been dosed until after the drug has already completely passed out of their body [23].

Together, all of these complicating factors can sometimes make it difficult for medical and forensic specialists to detect GHB consumption [22].

Because of these limitations, many researchers urge anyone who suspects that they have been secretly dosed with GHB to seek medical care as soon as possible [111, 57, 50, 109].

Detecting GHB Use

In theory, GHB use can be detected in saliva, urine, and hair [50, 22, 57, 112, 113, 56].

However, many of these methods are only reliable for a short time before the drug becomes undetectable [59, 114].

Another major problem is that most of these tests aren’t sensitive enough to detect a single GHB exposure, such as in cases of date rape [56].

Because of the many limitations of current screening techniques, researchers are actively developing alternative methods for detecting GHB exposure.

However, many of these new methods are still in the early stages of development and are not yet efficient or reliable enough for widespread use [114, 112, 115].

GHB “Alternatives”: Xyrem, GBL, and BD

Xyrem (sodium oxybarate) is an alternative form of GHB, which has occasionally been used by medical doctors to treat narcolepsy and cataplexy [22].

Because it is essentially identical to GHB, the prescription and use of Xyrem is very tightly controlled in order to prevent abuse [75, 116].

GHB also has a number of precursor drugs, such as gamma-butyrolactone (GBL) and 1,4-butanediol (BD). GBL and BD are “prodrugs” of GHB, meaning that they are converted to active GHB in the body after ingestion [117, 22, 118, 9].

Once ingested, GBL and BD are converted into GHB within minutes [22].

After GHB was banned in 1990, GBL and BD became widely used as substitute drugs, in large part because they were less tightly-regulated [8, 117, 22, 5, 105].

Because of the prevalence of these precursor drugs, recreational users often don’t know what they are taking. A 2006 analysis of drugs seized by the police found that only 38% of the drugs being sold as GHB on the street were genuine; the other 62% were actually GBL. This suggests that these drugs are commonly misidentified or misrepresented by sellers or users [105].

Differences Between GHB, GBL, and BD

By and large, the effects of GBL and BD are essentially identical to those of regular GHB [117, 5].

For this reason, they are also believed to be equally as dangerous, addictive, and toxic. However, some evidence suggests that GBL and BD may even be slightly more dangerous than regular GHB [6, 119].

A study in baboons found that GBL and BD are absorbed more quickly than regular GHB. This causes blood levels to spike higher and faster compared to when regular GHB is taken on its own [119]. This means that it may be more difficult to predict the effects of these drugs and that they might also be more likely to cause accidental overdoses.

GBL and BD also appear to cause behavioral impairments at relatively smaller doses than regular GHB, suggesting a higher likelihood of negative effects when taken “recreationally” [119].

On the other hand, mice develop tolerance more slowly for GBL or BD than for regular GHB, which may slightly decrease the likelihood of developing a dependence on these versions of the drug [120]. Nonetheless, again we should stress that this does not in any way make these drugs “safe” – the differences are relatively minor, and the dangers and long-term risks of abusing them are essentially the same.

About the Author

Matt Carland

Matt Carland

PhD (Neuroscience)
Matt received his PhD at the Université de Montréal in Neuroscience.
Matt holds multiple degrees in psychology, cognitive science, and neuroscience. He has over a decade of experience in academic research and has published a number of articles in scholarly journals. He currently works as a neuropsychologist in Montreal, where he performs research on the links between personality traits and the development of clinical disorders such as addiction, compulsive gambling, and disordered eating.

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