GHB is a depressant drug, meaning that it leads to diminished activity within the central nervous system. GHB is an acronym for the drug’s full chemical name – Gamma-Hydroxybutyrate.
Gamma-Hydroxybutyrate is a fatty acid that is produced naturally in the human central nervous system, and elsewhere in nature, though in much lower quantities than are found in the drug known as GHB. It is closely chemically related to, and is required in the production of, the inhibitory neurotransmitter GABA (Gamma Amino Butyric Acid), which is responsible for regulating brain activity, sleep and other functions.
The effects of Gamma-Hydroxybutyrate are therefore similar in nature to Benzodiazepines and other depressant drugs which interact with the body’s natural GABA receptors to reduce central nervous system activity.
As a drug, GHB first came to prominence in the 1960s in France, when it was synthesised by a doctor named Henri Laborit, who was conducting research into the neurotransmitter GABA. He found that while GABA is not generally transported from the blood to the brain, GHB does, and this is then transformed into GABA by natural chemical processes.
GHB has a number of legitimate purposes, and was once used for anaesthetic purposes in hospitals. It has also been used as a treatment for alcohol and drug abuse, and to treat the sleep disorder narcolepsy.
It is perhaps most well known though as an illicit drug- as a ‘club drug’ that is recreationally abused, and as a ‘date rape’ drug which is used to incapacitate and intoxicate unwitting victims.The main effects of GHB when abused in large doses are euphoria, sedation and reduction of social inhibitions (similar to alcohol). Particularly high doses can result in unconsciousness, as is the case in incidents of date rape.
GHB is usually sold on the street in small vials of transparent and odourless liquid, and is taken orally, sometimes in a drink. When used as a date rape drug it is used to ‘spike’ the victims drink, and although it has a slightly salty taste it often goes unnoticed.
GHB has been widely abused as a clubbing drug in Europe, the US and Australasia since the 1990s, and is often used in conjunction with other drugs such as Ecstasy and cocaine. It can be highly dangerous when mixed with alcohol and other central nervous system depressants.
It has also been used by bodybuilders, due to the unsubstantiated claim that it can be a substitute for Anabolic Steroids.
Following this widespread drug abuse, it has become illegal to possess without prescription in many countries, and is a Class C drug in the UK.
GHB is an acronym of the drug’s chemical name – Gamma Hydroxybutyrate.
In medical use it is also sometimes known by the generic drug name, Sodium Oxybate. The most common trade name for the drug in its legitimate pharmaceutical form as a treatment for Narcolepsy is Xyrem.
GHB is known on the street by a variety of slang names, including Liquid Ecstasy, Liquid X, GBH, Grievous Bodily Harm, G, Liquid G, Goop and Easy Lay.
A related substance is GBL (Gammabutyrolactone), which is metabolised into GHB in the body when it enters the bloodstream following ingestion. The effects of the drug are therefore virtually identical. GBL has legitimate industrial and commercial uses, and is an ingredient in some nail polish removers, paint strippers and cleaning products.
Another similar chemical precursor which is metabolised into GHB after ingestion is 1, 4BD (1, 4-butanediol). This chemical is also used in a range of solvents and industrial manufacturing processes.
When GHB is ingested orally it has a range of physiological and resultant psychological effects. Subjective experiences reported by recreational users include feelings of euphoria, talkativeness, relaxation, heightened libido, loss of inhibitions and drowsiness.
Overdose is a particular risk of GHB, because the ‘window’ of dosage in which it goes from being active to toxic is quite narrow. Generally, GHB bought on the street is of uncertain purity, making it even harder to judge the ‘correct’ dose strength.
A GHB overdose is potentially fatal, as it depresses the functions of the central nervous system. The effects of this depression in can be respiratory failure, coma and seizures. Significant symptoms of a possible overdose are difficulty seeing, loss of balance and dizziness, profuse sweating, breathing difficulties, tremors and confusion.
The risk of overdose and respiratory failure is greatly increased when GHB is taken with alcohol or other depressant drugs.
A further risk of GHB abuse is that it can expose the individual to a greater risk of suffering an accident or being taken advantage of by others.
GHB can also be addictive to some individuals, and carries a risk of both physical and psychological dependencies. Frequent use can lead to tolerance, in which greater doses are required to generate the sought after recreational effects. Combined with unknown purities of the street drug, the narrow ‘safe’ usage range of the drug, and the fact that users often combine GHB with other drugs, this can further increase the risk of overdose.
Frequent users may suffer withdrawal effects when not taking the drug, including irritability, paranoia, nausea, anxiety, mental confusion, and hallucinations in some cases.
The legitimate pharmaceutical drug which contains GHB for treatment of Narcolepsy and other conditions, Xyrem (Sodium Oxybate), is made by Jazz Pharmaceuticals in the United States. Its use and distribution is tightly controlled and it is only available on prescription in the US and some other countries.
Some of these supplies may be diverted to the black market through theft, forgery and diversion. However this is not a significant source of the drug that is known on the street as GHB.
The vast majority of GHB that is recreationally abused is manufactured illegally in secret laboratories. In some cases it is produced by organised criminals in well-equipped yet entirely illegal and unregulated laboratories. However due to the relative ease of synthesis and availability of chemical precursors, it is also made by independent individuals and small-scale producers in makeshift home laboratories.
GHB is synthetically produced via a series of chemical equations and its synthesis can be achieved by anyone with sound knowledge and skills in chemistry. There are a variety of routes that can be taken to reach the same end product, leading to variation in the purities and potency of the street product.
This illegally produced GHB, usually a clear odourless liquid though powdered forms have also been found, is usually bottled in small vials and then sold on the street, in clubs and elsewhere.
Users and dealers may also acquire supplies of GBL, which is converted into GHB inside the body. This chemical is usually only available for industrial purposes, and possessing it for any other purpose has recently been criminalised in many countries. In the UK for example, it was made a Class C drug to possess or sell, at the end of 2009.
GHB is both physically and psychologically addictive. Though addiction should not generally occur with prescription use, it is possible if the drug is misused, and if the individual has a prior history of addiction and drug abuse. However addiction is more commonly witnessed among recreational users, due to the uncontrolled and unmonitored dosages.
A person who is addicted to GHB may display a range of common symptoms. While under the immediate influence of the drug, they may appear intoxicated in the same way as they might if they had been drinking. They may seem unusually happy, even euphoric, be very talkative and relaxed. In other cases they may find it hard to talk coherently, and might appear to be suffering from cognitive difficulties.
In the cases of large doses they may exhibit signs of heavy sedation, and may fall asleep to the point that they are un-wakeable for a time. In such cases it is essential that the emergency services be called, as it may be an overdose and should not be ‘slept off’ but treated medically.
The effects of intoxication with GHB are contrasted by the symptoms of withdrawal from the drug. Frequent and heavy users who have not taken the drug for some time may suffer from these withdrawal effects to varying degrees. They may exhibit signs of insomnia, appear very anxious, sweat significantly and seem very unsettled and irritated. Often, drug addicts will act out of character, and may seem concerned about little else other than their addiction.
Other signs of GHB use include small vials of clear odourless liquid, or suspicious powders. Pills and other substance relating to concurrent drug habits may also be found.
GHB can be a highly addictive substance in its own right, and it can also form part of a poly-drug habit with other ‘club drugs’ such as MDMA.
The drug is both physically and psychologically addictive so any treatment solution needs to focus on both aspects of the problem, separately and as a whole.
From a physical addiction perspective it may be difficult to cease GHB use, despite intentions to the contrary. This is because of the wide range of withdrawal symptoms that may be experienced, due to the body coming to depend on intake of the substance. GHB withdrawal symptoms can vary in intensity depending on the strength and duration of the habit, and the individual, but can include intense anxiety, aching muscles and other uncomfortable sensations, restlessness and sleep disruption.
These physical withdrawals feed into the cravings of the habit, causing the user to seek more GHB simply to end the negative and unpleasant feelings.
From a psychological standpoint, the individual may have become attached to the euphoric feelings and other positive effects they get while on the drug, and feel ‘lost’ without it. In many cases GHB is part of a larger drug habit and lifestyle, so the psychological part of the addiction may be near to impossible to deal with without proper support and help.
Within the context of such a strong addiction, admission as an inpatient to a specialist drug rehabilitation centre may be the best option for treatment. In such an environment the patient can be closely monitored, and treated with suitable medications to ease the withdrawal symptoms.Because of the tolerance effect that can build up in frequent GHB users, they may be taking a particularly large dose when they enter rehabilitation. For this reason it is seldom recommended for an addict to go ‘cold turkey’ and cease taking the drug immediately. Instead, a ‘tapered’ approach is favoured, in which the dose is gradually reduced over a period of up to two weeks (though this can be tailored to the individual). This helps to lessen the unpleasantness of the initial detox period, thus making successful treatment more likely.
In addition to the process of detoxing to remove the addictive chemical from the body, other methods are used to deal with the psychological nature of the addiction. Counselling sessions with a professional therapist who is experienced in dealing with drug addictions may be very useful, and help the individual to understand the nature and underlying reasons of their drug addiction.
Other therapies, such as cognitive behavioural therapy (CBT) can help the patient to resist the old triggers that would lead to their drug abuse, and assist them in developing new healthy behaviours to prevent future relapse.
Because GHB is often used in conjunction with club drugs like Ecstasy, or to moderate the ‘comedown’ of drugs like Cocaine, it may be necessary to also treat these separate yet co-existing addictions. In such cases, a comprehensive treatment programme that deals with each aspect of the drug habit is usually discussed and agreed between the patient and a rehabilitation professional prior to treatment.