GHB, or gamma-hydroxybutyrate, is a short-chained fatty acid metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It is a naturally occurring substance found in various mammalian tissues but is also produced as a pharmaceutical known as sodium oxybate (trade name Xyrem)—an FDA approved medication used to treat narcolepsy, a sleep disorder. In this form, the drug is designated as a Schedule III controlled substance by the DEA.
GHB is also a synthetic drug that is classified as a Schedule I controlled substance by the DEA. GHB has sedative, disinhibiting, and amnestic effects and is a popular drug of abuse. GHB has been used for several illicit or otherwise questionable purposes, including:
- As a “date rape drug” sought after by sexual predators due to its sedative properties and effects on memory.
- As a club drug (sometimes referred to as “liquid ecstasy”) that was once believed to be a safe alternative to MDMA for its euphoria, increased sociability, and purported aphrodisiac properties.
- As a growth hormone promoting, muscle-building supplement for bodybuilders
Its reputation as a potential bodybuilding aid and as an aphrodisiac is not supported by research studies into the drug’s effects. The use of GHB as a date rape drug led to it being totally banned for legal use by the DEA, but in 2002, researchers found that the drug was useful in treating various aspects of narcolepsy, for which the FDA has now approved its use in treating. Despite the medical utility of the pharmaceutical version, the majority of GHB use takes place illicitly.
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Dangers of Using GHB
As a metabolite of GABA, it has been widely posited that GHB likely functions similarly to that inhibitory neurotransmitter. Though the precise mechanism of action hasn’t been fully elucidated, GHB may interact with certain GABA receptors to function as a sedating central nervous system depressant. The ability of a drug to decrease the firing rates of the neurons in the brain and spinal cord can result in significant medicinal purposes for the drug; however, when these drugs are abused, they can have significant long-term effects.
Even though sources on the Internet claim that GHB is a safer alternative to some drugs—including club drugs such as ecstasy—there are significant risks associated with its use. Several of the most salient dangers of abusing GHB include:
Toxic effects: GHB is a potentially toxic substance, with a very real overdose potential. The use of illicit GHB often involves wildly imprecise dosing, which can easily result in dangerous, if not lethal amounts of the drug being inadvertently ingested. The amount of drug that can be used safely is quite small, which increases GHB overdose risks. Though some reports indicate that flumazenil (a benzodiazepine receptor antagonist) may be of some benefit, currently there is no definitive antidote for GHB toxicity.
Mood swings: It is postulated that taking GHB can temporarily disrupt certain neurotransmitter systems (e.g., serotonin) and these changes may be associated with significant feelings of euphoria and friendliness. As the drug is cleared from the system and the effects wear off, people may experience quite the opposite, with increased feelings of depression and amotivation.
Hyperthermia: Using GHB, especially in the context of some other drugs, can impair thermoregulation, which is our body’s ability to control temperature. When people are in crowded conditions, such as a club, and using drugs like alcohol (a diuretic), this can lead to an increased potential for dehydration and/or overheating, which can result in permanent organ damage.
Short-term memory and disinhibition: Memory functions are severely compromised when an individual is under the influence of GHB. Use of GHB may also result in a person performing behaviors they would not normally engage in that can lead to long-term consequences.
The development of physical dependence: Chronic abuse of GHB has been linked to the development of physical dependence. Tolerance to the drug develops rapidly, and the withdrawal syndrome associated with GHB is similar to the withdrawal syndrome from alcohol or benzodiazepines.
Immediate effects that can have long-term consequences: Research studies have indicated that using GHB can lead to the following immediate effects that can result in accidents, injury, and other long-term issues:
- Loss of inhibitions
- Extreme lethargy or drowsiness
- Respiratory suppression, which can lead to chronic lung problems or organ damage
- Unconsciousness or a comatose state
When individuals combine GHB with alcohol, the effects listed above may be intensified. Research studies published in the Journal of Psychoactive Drugs and Neuroscience and Biobehavioral Review have indicated that chronic abuse of GHB can also lead to the following long-term difficulties:
Psychiatric issues: There have been reports of psychotic symptoms manifesting with chronic abuse of GHB and its associated withdrawal syndrome. In addition, chronic problems with depression, apathy, a lack of motivation, and even potential suicidal behaviors may be associated with chronic use of GHB.
Cognitive issues: Chronic GHB abuse has been associated with the development of problems with the ability to concentrate or pay attention, the ability to form new memories, and complex problem-solving and reasoning problems.
Respiratory issues: Because GHB is a central nervous system depressant, it may cause respiratory depression, which can result in a person becoming more susceptible to anoxic brain injury, respiratory infections, and chronic lung disease.
Cardiovascular problems: GHB abuse and its repeated accompanying episodes of GHB withdrawal may be associated with the development of cardiovascular issues, including hypertension and tachycardia (increased heart rate) and a subsequent higher risk for heart attack and stroke.
Neurological issues: The development of anxiety, agitation, delirium, and seizures has been associated with withdrawal from GHB and long-term abuse of the drug. Left unmanaged (with medications such as benzodiazepines), withdrawal seizures can be potentially fatal.
Other potential long-term problems associated with abusing a drug like GHB include:
Relationship issues: People who struggle with compulsive drug use may suffer damage to their important personal and professional relationships. In many, cases the damage that occurs to a person’s relationships as a result of drug abuse may not be repairable.
Lower levels of achievement: People who abuse drugs like GHB may experience setbacks in terms of their personal and professional goals, including issues with their occupational, educational, and other goals. Chronic drug abuse is associated with significantly lower levels of achievement and productivity, and significantly higher levels of personal and professional strife.
Long-term health issues: As mentioned above, chronic abuse of GHB can lead to serious, sometimes lasting issues with physical health.
Chronic abuse of GHB may be part of a diagnosed substance use disorder, which could require long-term professional treatment in order to recover. Treatment for a substance use disorder can help people recover from compulsive drug use to prevent many of the aforementioned long-term issues before they arise.