GHB is also known as a party and a rape drug. Despite its growing popularity, many of the users remain unaware of its dangers, such as risky sexual behavior, cognitive impairment, and addiction. GHB overdose can also be fatal. However, this drug also has a variety of surprising medical uses. Read on to learn more about the effects and health impacts of GHB.
Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature.
What is GHB?
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 [R, R, R].
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 [R, R, R, R, R].
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 [R, R].
As a result, GHB has become a major cause of overdose-related emergency room visits worldwide [R].
Legality of GHB
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 [R, R, R, R, R, R].
Nonetheless, it is still widely sold illegally by drug dealers across the world.
Who Uses GHB?
Natural Sources of GHB
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 [R, R].
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 [R].
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 [R R].
GHB Mechanisms of Action
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 [R, R].
GHB also affects other neurotransmitters, although these mechanisms are still being researched [R]:
- Its positive effects, including 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 [R].
- Its mood-enhancing and pro-social effects may involve increased levels of oxytocin, commonly involved in social bonding in humans [R].
- Elevated levels of progesterone, a hormone involved in sexual development and behavior, may also be involved in GHB’s pro-social effects [R].
- It 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 [R, R, R, R].
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 [R, R, R, R, R].
Positive Effects of GHB
The positive effects of GHB include:
- Relaxation [R]
- Euphoria and mood-enhancing effects [R, R, R, R]
- Pro-social (empathogenic) effects [R, R]
- Increased sexual desire [R, R]
- Decreased inhibitions [R, R]
- Decreased anxiety [R]
- Heightened awareness of one’s body and sensations [R]
- Increased intensity of emotions [R]
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 [R].
However, a different study with 8 healthy volunteers who had never taken GHB before failed to find euphoria or other positive recreational effects at an even larger dose (approximately 1.5 grams) [R].
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.
Negative Effects of GHB
GHB comes with a large number of potential negative effects which can be life-threatening. In fact, the majority of recreational users consistently experience negative effects, though this often doesn’t prevent them from continuing to abuse GHB [R].
These potential adverse effects include:
- Seizures [R, R, R]
- Respiratory arrest [R]
- Bradycardia (slowed heart rate) and potential cardiac arrest [R, R]
- Confusion and disorientation [R, R]
- Memory loss and amnesia (“blackouts”) [R, R]
- Partial or total loss of consciousness [R, R, R, R, R, R]
- Loss of motor coordination [R, R]
- Uncontrollable muscle contraction/twitching (myoclonus) [R]
- Dizziness [R, R]
- Hypothermia [R]
- Convulsions [R]
- Coma [R, R]
Dosing of GHB
Researchers have estimated that blood levels of about 100mg/L are enough to produce euphoric and other recreational effects, while death from respiratory arrest and other adverse effects become a major risk at levels of about 500mg/L [R, R].
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 a couple 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 [R, R, R].
- Different people metabolize this drug at different rates, so a dose that is safe for one person may be quite dangerous for another [R, R].
What Happens After Taking 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 [R, R].
GHB highs usually last between 4 and 6 hours [R].
Men metabolize (break down) the drug more efficiently than women [R].
Whites may also metabolize it more quickly [R].
Potential Medical Uses of GHB
GHB has been used for inducing “absence” (petit mal) seizures and as an anesthetic [R].
It has also been used to treat:
- Alcoholism/Alcohol Withdrawal Syndrome [R]
- Opioid dependence [R, R]
- Sleep disorders, particularly narcolepsy [R]
Some researchers have also identified this drug as a potential treatment in:
However, several of these uses have mixed evidence.
They are also unlikely to be widely adopted by clinicians because of GHB’s high abuse potential [R].
1) GHB and Sleep Disorders
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 [R, R].
In addition, by helping to stabilize their sleep cycle, SO also alleviates depression symptoms in narcoleptic patients [R].
2) GHB and Alcoholism
However, GHB’s high potential for abuse makes it less than ideal as alcoholism treatment, and some researchers have argued that it should be avoided in favor of other, safer drugs such as benzodiazepines [R, R].
3) GHB and Fibromyalgia
GHB has occasionally been used to treat fibromyalgia [R]. However, the experimental support for this use is mixed.
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 [R].
Additionally, concerns about the drug’s high abuse potential mean that it is unlikely to meet the FDA’s strict safety requirements [R].
4) GHB and Depression
Direct evidence for this comes primarily from studies showing that GHB can alleviate depression in patients suffering from sleep disturbances, which often worsen depression symptoms [R].
However, apart from this indirect effect, it is not clear whether GHB would be suitable for treating depression in general. Its ability to modulate the GABAergic system makes it a promising candidate, although much more research would be needed to confirm this [R].
Side Effects of GHB
When used under the supervision of clinicians, GHB does not appear to lead to addiction or withdrawal syndromes due to its tightly controlled dosage [R].
Nonetheless, the majority of patients (61%) still report adverse side-effects over the course of medical treatment with GHB [R].
Potential side effects:
- Gastrointestinal problems [R]
- Dizziness [R, R, R]
- Headaches [R, R, R]
- Confusion [R]
- Nausea [R, R]
- Vomiting [R]
- Excessive sleepiness [R, R]
- Pain [R]
Negative side-effects also become more likely as the dose increases [R].
GHB and Bodybuilding
However, the evidence for GHB’s usefulness as a bodybuilding supplement is mixed.
Some evidence does support 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 [R].
Relatedly, relatively small doses of GHB significantly increased GH levels in 11 out of 12 volunteers. However, this effect was short-lasting (90 – 120 minutes) [R].
Nonetheless, other studies have failed to find any significant influence of GHB on the levels of GH in humans [R].
GHB also does not appear to increase GH levels in mice. However, it did shift their energy metabolism from using sugars to using fats, suggesting a potential fat-burning effect [R].
In light of the ambiguous scientific findings, the short effect duration, and the many potential downsides of GHB use, it would be ill-advised to use this drug for anabolic purposes [R].
GHB and Sex
This drug has both positive and negative effects on sexuality and arousal in humans.
GHB also intensified the brain’s response to erotic stimuli when 32 healthy volunteers viewed erotic pictures [R].
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 [R].
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 [R, R].
GHB’s ability to impair sexual decision-making contributes to the spread of sexually transmitted diseases, and GHB’s ability to energize sexual performance also increases the likelihood of physical injury during prolonged sexual activity [R, R].
Therefore, while GHB seems to enhance sexual reactivity and desire, it also impairs decision-making and often leads to dangerous or unwanted sexual encounters [R].
GHB and Date Rape
GHB is notorious for its supposed 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 [R, R, R, R, R, R].
However, some public health researchers have argued that GHB’s reputation as a “date-rape” drug is unwarranted [R].
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 [R, R, R].
In fact, only 0.2 – 4.4% of reported sexual assaults have involved the use of GHB [R].
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 [R].
GHB and Crime
While GHB has become widely associated with sexual assault, it is actually more commonly used to incapacitate or impair potential victims of “acquisitive crimes” such as theft, burglary, and robbery [R].
For example, one study found that among 408 cases of unintentional GHB intake, only 6.5% of victims suffered from sexual assault while 21.7% endured an acquisitive crime [R].
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 [R].
Adverse Effects of GHB
1) Causes Oxidative Stress
In contrast, a number of studies in living animals suggest that GHB causes significant oxidative stress in 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 [R].
Together, these studies suggest that oxidative stress is one of the primary ways that GHB causes damage to the brain.
2) 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 [R, R].
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 [R].
In rats, long-term GHB use also reduces the production of important proteins involved in maintaining healthy cognitive function [R].
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 [R].
3) 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 [R].
GHB also impairs fear-related learning and memory in rats, making them less able to remember which environmental cues signal potential danger [R].
GHB also impairs the startle reflex in rats, further suggestive of impaired emotional processing [R].
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 increased likelihood of being the victim of a sexual assault or other crime [R].
GHB has reward-reinforcing properties in humans, which probably contribute to the development of addiction and dependence [R].
Baboons given free access to GBL and BD developed compulsive patterns of drug use, suggesting an addictive (reinforcing) effect [R].
Interestingly, baboons that chronically took GHB also showed reduced motivation to work for non-drug rewards (such as food), suggesting that GHB addiction may cause depression-like impairments in general motivation [R, R].
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 [R, R].
The complexity of GHB addiction means that it cannot be treated with any one specific type of drug or therapy, making medical treatment difficult [R].
GHB Causes Dependence
GHB and its precursor drugs all cause dependence in habitual users [R].
GHB Causes Tolerance
Interestingly, however, only some of GHB’s effects are subject to tolerance.
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.
For example, drug cessation causes withdrawal syndromes in baboons chronically administered with GBL, a “prodrug” of GHB [R].
A German study found that one-third of GHB users had to seek help at a hospital concerning withdrawal symptoms [R].
The symptoms of GHB withdrawal include:
- Drug craving [R]
- Agitation [R, R]
- Anxiety and restlessness [R, R, R]
- Delusions and hallucinations [R, R, R]
- Paranoia [R]
- Confusion and disorientation [R]
- Aggressive/violent outbursts [R]
- Slowed movements and reflexes (psychomotor retardation) [R]
- Motor tremors [R, R, R]
- Dangerously elevated heart rate (tachycardia) [R, R]
- Insomnia [R, R]
- Seizures [R]
- Psychosis-like syndromes [R]
- Elevated blood pressure (hypertension) [R, R]
- Excessive sweating (diaphoresis) [R]
Importantly, the symptoms of GHB withdrawal are even more severe in users who abuse multiple drugs [R].
Managing GHB Addiction
GHB addiction and withdrawal can sometimes be managed by gradually tapering off drug use [R].
Withdrawal can also occasionally be managed with other drugs.
The most popular drugs 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 [R, R, R, R].
Patients seeking help for GHB addiction are also sometimes put on antipsychotic and anticonvulsant medications to control the side-effects of withdrawal [R].
Using GHB in the watchful company of friends may partially reduce the risk of overdosing on GHB [R].
However, uncertainties about the purity and potency of street GHB still leaves significant risk for accidental overdose and other dangers [R].
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) [R].
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 [R].
Benzodiazepines have a similar mechanism of action to GHB, and people who use one of these drugs often develop cross-tolerance for the other [R].
GHB Overdose Treatment
Currently, there are no known antidotes that can be administered to counteract GHB’s immediate effects, making medical treatment difficult [R].
Some emergency care physicians give benzodiazepines to overdosing patients, which can partially counteract some of GHB’s neurological effects [R].
Activated charcoal can sometimes be 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 [R, R].
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) [R, R].
GHB and Drug Testing
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 know for sure if a drink was intentionally spiked by someone [R, R].
The rapid metabolism of GHB in the body also presents several additional challenges for forensic testing [R].
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 [R].
Together, all of these complicating factors can make it very difficult for medical and forensic specialists to detect GHB use [R].
Detecting GHB Use
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 [R].
Because of the many limitations of current screening techniques, researchers are actively developing alternative methods for detecting GHB exposure.
GHB Alternatives: Xyrem, GBL, and BD
Xyrem (sodium oxybarate) is an alternative form of GHB, which is used medically to treat narcolepsy and cataplexy [R].
Once ingested, GBL and BD are converted into GHB within minutes [R].
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 were genuine; the other 62% were actually GBL. This suggests that these drugs are commonly misidentified or misrepresented by sellers or users [R].
Differences Between GHB, GBL, and BD
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 [R].
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 [R].
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 [R].
“I like how GHB can open things up [emotionally]; it occurs to me that it has the slightly fake quality of the similar opening-up that I get from MDMA, but I decide that’s OK, this feels good anyway.”
“I have had a number of positive ‘experiments’ with this drug. For example one night I decided to introduce it to a friend. […] we both agreed that it had been a joyful and nice experiment when we talked about the day after. And we both came a lot closer to each other, because of the lack of [emotional] barriers.”
“So one night we were out at my friend’s house and his girl says hey want a shot of juice? I was like, what’s juice? She says ya know GHB. It’s like drinkin’ a bunch of beers in one shot. I said sure why not. Well a cap-full later I was in lala land! WOW I felt great it was pretty amazing stuff, but another girl there was being carried around and almost passed out and it kinda freaked me out. Nonetheless, I felt incredible like I could kick anyone’s ass and bang any chick I wanted to. But I definitely saw the potential for trouble with this stuff. Not knowing much about it only ever tried it once more and haven’t since. But it sure was fun!”
“I had heard of a few GHB trips that resulted in complete freak-outs, although I had never seen any myself. […] a trip I recently witnessed was no exception. The only way I can accurately describe what I saw, is to relate it to something I have seen in a documentary on voodoo where the individual possessed by a spirit behaved in a similar fashion. It is really something you have to see to believe.”
“Within 15 min my breathing had become extremely labored […] I awoke to the interior of an ambulance with its medics asking me the typical what’s your name type questions… That was about the only memory I had from the whole hospital experience. […] The weirdest side effect I remember having was hallucinations of scorpions and other bugs, small but very real to me.”
“I was fine for a while, but after about 30 mins, I was sitting on a couch and I started getting crazy visuals … and was finding them very enjoyable. Then I tried to stand up and I couldn’t keep balance, so I sat back down. Then a couple of my sober friends saw that I was in trouble and started to carry me out. I was vomiting violently by this point and later found out most of what came up was blood, not vomit. […] I will never touch GHB again.”