GHB is commonly known as a party and “date-rape” drug. 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 side effects, mechanisms, and historical and current uses.
What is GHB?
Overview
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].
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].
Street names
“Street names” of GHB include “Fantasy”, “G”, “Gamma Oh”, “Georgia Home Boy”, and “liquid ecstasy” or “liquid X” [24, 1, 25].
GHB Side Effects
Short-Term Side Effects of Abuse
GHB comes with a large number of immediate side effects – some of which can even be life-threatening! The majority of recreational users consistently experience side effects, though this unfortunately doesn’t always prevent people from continuing to abuse GHB [26].
Some of GHB’s many potential side effects include:
- Seizures [3, 4, 7]
- Respiratory arrest [17]
- Bradycardia (slowed heart rate) and potential cardiac arrest [21, 17]
- Confusion and disorientation [26, 27]
- Memory loss and amnesia (“blackouts”) [28, 29]
- Partial or total loss of consciousness [18, 4, 12]
- Loss of motor coordination [26, 30]
- Uncontrollable muscle contraction/twitching (“myoclonus”) [21]
- Dizziness [27, 31]
- 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 [28, 32, 29].
Additionally, GHB’s disorienting and consciousness-impairing effects can also lead to situational dangers, such as robbery or sexual assault [33, 29, 34, 35].
The adverse effects of GHB are possible at any dosage and become more likely as the dose increases [11, 12].
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 [36].
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 [37, 38, 39].
Nonetheless, the majority of patients (61%) still report significant adverse side-effects over the course of medical treatment with GHB [40].
Reported side effects include:
- Gastrointestinal problems [40]
- Dizziness [40, 41, 42]
- Headaches [40, 41, 42]
- Confusion [40]
- Nausea [41, 42]
- Vomiting [40]
- Excessive sleepiness [41, 42]
- Pain [42]
Just as when the drug is abused recreationally, negative side-effects also become more likely as the dose increases [41].
Long-Term 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 [43].
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 [44].
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 [45, 44]. 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 [45, 46].
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 [28, 47, 48].
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 [48].
In rats, long-term GHB use also reduces the production of important proteins involved in maintaining healthy cognitive function [49].
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 [50].
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 [51].
GHB also impairs fear-related learning and memory in rats, making them less able to remember which environmental cues signal potential danger [46].
GHB also impairs the startle reflex in rats, further suggestive of impaired emotional processing [52].
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 [33].
GHB Addiction, Overdose, and Withdrawal
GHB Addiction
Like most illegal drugs, GHB has very high addictive potential in both humans and animals [10, 53].
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 [54].
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 [54, 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 [55, 56].
The complexity of GHB addiction means that it cannot be treated with any one specific type of drug or therapy, making medical treatment difficult [55].
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, 57].
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 [58, 59, 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 [60, 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 [53, 59, 61, 58, 21].
A German study found that one-third of GHB users had to seek help at a hospital concerning withdrawal symptoms [62].
The symptoms of GHB withdrawal include:
- Extreme drug craving [61]
- Agitation [61, 21]
- Anxiety and restlessness [61, 7, 21]
- Delusions and hallucinations [14, 8, 21]
- Paranoia [21]
- Confusion and disorientation [21]
- Aggressive/violent outbursts [21]
- Slowed movements and reflexes (psychomotor retardation) [61]
- Motor tremors [7, 14, 21]
- Dangerously elevated heart rate (tachycardia) [14, 21]
- Insomnia [7, 21]
- Seizures [63]
- 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 [61].
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 [64].
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, 58].
Patients seeking help for GHB addiction are also sometimes put on antipsychotic and anticonvulsant medications to control the side-effects of withdrawal [58].
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, 65, 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 [66].
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 [67].
GHB Interactions
While GHB is already highly dangerous on its own, negative effects are even more likely when GHB is combined with other drugs [68, 69].
GHB addiction and physical dependence also become much more severe when it is consumed with other drugs, such as alcohol and cocaine [70, 61].
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) [68].
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 [71, 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.
Takeaway
The illegal drug GHB is a major cause of overdose-related ER visits worldwide. It’s known under several street names, including “Fantasy”, “G”, and “liquid ecstasy” or “liquid X”.
Abuse can cause unpredictable and potentially life-threatening side effects, including confusion, blackouts and memory loss, heart problems, seizures, and even coma.
GHB can also damage the brain in the long term. It increases oxidative stress while impairing cognition, emotional processing, and social behavior.
Withdrawal can be severe and, in some cases, fatal. Mixing GHB with other drugs or alcohol increases the risk of overdose and death.
Anyone who suspects that they have been dosed with GHB should seek medical care as soon as possible.
