Gamma-Hydroxybutyric acid (GHB) is a metabolite of the neurotransmitter GABA (gamma-aminobutyric acid), the major inhibitory neurotransmitter in the central nervous system. A metabolite is a substance that is formed during the normal process of metabolism. As GABA is broken down, one of the byproducts is GHB.
GHB is classified as a central nervous system depressant, meaning that when one uses the drug, it results in a reduction in the functions of the neurons in the brain and spinal cord.
According to an article published in 2009 in the journal Drug and Alcohol Dependence, GHB and the drug Xyrem (sodium oxybate) refer to essentially the same chemical substance; however, GHB refers to illicit forms of the substance that are used for nonmedicinal purposes, and sodium oxybate refers to the medicinal formulations of generally the same chemical substance. GHB or sodium oxybate was primarily used in research studies as an anesthetic, but its use resulted in some particularly troubling side effects, such as abnormal readouts on EEGs. As a result, the drug never found significant clinical use.
Today, it is sometimes used as a treatment for the sleep disorder narcolepsy and can be an adjunctive medication for individuals undergoing withdrawal from alcohol use disorders (as sodium oxybate). However, the drug GHB is listed by the United States Drug Enforcement Administration as a Schedule I controlled substance, which means that the DEA considers it to be without significant medicinal uses and a high candidate for the development of physical dependence and abuse. Xyrem is listed as a Schedule III controlled substance.
GHB appears to be readily manufactured by individuals who can find instructions for making it via a number of different sources. Street names for GHB include liquid ecstasy and Georgia Home Boy.
The drug appears to result in the release of neurotransmitters, particularly serotonin and dopamine. Massive releases of serotonin trigger the release of oxytocin, a hormone that is triggered when individuals bond. The release of dopamine and serotonin also results in feelings of euphoria and a desire to continue using the drug. The primary users of GHB appear to be:
- Younger people who frequent nightclubs: GHB is often used in the same way that ecstasy and other drugs are used. This is because the drug facilitates feelings of sociability and empathy. People who are typically shy or wish to become more sociable use the drug for these effects.
- Bodybuilders and athletes: These people believe that the drug acts like a steroid and increases muscle; many even believe that the drug is a steroid; however, it is not. GHB also has a reputation for reducing fatigue, and athletes who use it believe that it gives them more energy.
- Sexual predators: GHB can be used as a date rape drug due to its ability to produce sedation and interfere with learning and memory.
All three of these groups largely consist of younger males who are 14-25 years old.
As GHB is classified as a Schedule I controlled substance, its possession is technically illegal and its use in any context suggests abuse. Sodium oxybate can be obtained with a prescription by certain individuals; however, is a drug that can also be abused.
The signs and symptoms of GHB use/abuse reported by nearly 70 percent of individuals using the drug include:
- Increased sociability
- Feelings of tranquility
- Potential unconsciousness or comatose state
The drug appears to have peaked in its popularity in the early 2000s, but one can still find numerous online sources regarding its use, manufacture, and effects. There are several signs that may be indicative that an individual is abusing GHB that include:
- Periods of memory loss: These that typically last 1-3 hours. Chronic use may result in permanent issues with learning and memory.
- Sedation and appearing as if one is intoxicated while not smelling of alcohol: Because GHB is often used with alcohol, this particular sign may not always hold true. The sedation may be extreme, and an individual may be very relaxed or even become comatose.
- Incoherence or markedly slurred speech: As a central nervous system depressant, GHB has significant effects on the motor centers in the human brain and will affect speaking abilities. Individuals under the influence of GHB speak with very slurred, thick tones, and this may result in incoherent ramblings.
- Excitability or irritability: The person may begin talking quite rapidly, and their language may be incoherent. Sometimes, people under the influence of GHB will display body movements that do not appear to be consistent or appropriate for the situation.
- Seizures without a history of epilepsy or some seizure disorder: This symptom applies to the abuse of a number of drugs, including alcohol, benzodiazepines, cocaine, and certain combinations of drugs. There is a significant probability that any person who displays seizures without a history of brain injury, epilepsy, or a seizure disorder is displaying the effects of a drug or medication.
Physical dependence on any drug consists of the development of tolerance and withdrawal. Tolerance occurs when the specific dose of the drug the individual has been taking no longer produces the same effects it once produced, and the person must use more of the drug to get those effects. Withdrawal occurs when the person’s physical system has adjusted itself to function efficiently only when the drug is present. When the individual stops using the drug and normal metabolism reduces the levels of the drug in the person’s tissues, the system is thrown out of balance, and the person begins experiencing withdrawal symptoms.
Withdrawal from GHB appears to be similar to the withdrawal process that occurs from benzodiazepines and alcohol. An article in the Annals of Emergency Medicine described the withdrawal process in eight individuals who were abusing GHB. The individuals produced withdrawal symptoms that included the following pattern:
- A rapid onset of withdrawal symptoms occurred 1-6 hours following discontinuation of the drug. Acute symptoms of withdrawal included severe feelings of anxiety and insomnia; moderate nausea and vomiting; and mild sweating, hypertension, and tachycardia.
- From days 1-6 following discontinuation, individuals experienced progressively worsening symptoms that included severe anxiety and insomnia; moderate tremors, especially in the arms and legs; moderate tachycardia, hypertension, and sweating; and severe issues with confusion, delirium, and hallucinations.
- From days 7-14, the symptoms became episodic. They waxed and waned with anxiety, insomnia, confusion, and hallucinations still being moderate at times, and mild issues with sweating, hypertension, and tremors still occurring.
In these eight individuals, the withdrawal syndrome appeared to last about 15 days. One individual in the study died on the 13th day during withdrawal after experiencing tremors and a heart attack. The symptoms responded to treatment with benzodiazepines, which is a common treatment protocol for withdrawal from alcohol and other benzodiazepines.
Whenever an individual is abusing a drug that has a potential to develop physical dependence, especially a severe type of physical dependence that can be quite complicated and potentially fatal, it is extremely important to consult with a psychiatrist or addiction medicine physician before discontinuing the drug. GHB appears to have a relatively short half-life, and an individual who has chronically abused the drug may begin experiencing withdrawal symptoms very quickly, become confused, and be prone to self-harm or to the deleterious effects of the withdrawal process.
The first step in getting assistance with recovery from GHB abuse and addiction is to get a physician involved in the early stages of the process. This most likely will mean that the person should get involved in an inpatient withdrawal management program where medications, such as benzodiazepines, can be administered. The use of benzodiazepines will also significantly reduce issues with insomnia and anxiety. Other types of medications can also be used, such as antihypertensive medications to control blood pressure, antipsychotic medications to control hallucinations, and other medications for specific issues that can occur with fever, nausea, potential dehydration, tremors, etc.
Because there is a potential for severe withdrawal symptoms to occur rather rapidly in individuals who chronically abuse GHB, there is also a high potential that these individuals will relapse to reverse the symptoms if they do not become involved in a formal withdrawal management program. The revolving issue with attempting to quit using GHB, experiencing severe withdrawal symptoms, using the drug to control the withdrawal symptoms, and continuing to abuse the drug is a common occurrence when an individual with a substance use disorder attempts to negotiate the withdrawal process without professional help.
During the medical detox phase, the individual should also begin therapy. There are a number of different options that one can choose depending on particular needs and preferences. It is highly recommended that individuals in recovery get involved in some form of formal substance use disorder therapy in order to better understand the reasons that drove their substance use disorder and to develop coping skills to avoid relapse in the future.
Social support is an extremely important aspect of recovery. Those in recovery should become involved in peer support groups, such as a 12-Step group, community mental health group, family therapy, sober living home, etc.
Treatment for recovery from GHB abuse should be long-term and should not just include detox. Individuals who go through detox without additional treatment, such as therapy, relapse nearly 100 percent of the time.