Gamma hydroxybutyrate (GHB)

Jake Frederick, PharmD student Fall 2022

Background/History

GHB is a depressant that was developed in 1960 as an anesthetic for surgery due to its ability to cause patients to sleep and induce a medical coma. However, it failed due to its inability to mask pain and seizurelike symptoms. In the late 80s, it saw overthe-counter use as a sedative and a growth hormone stimulator for bodybuilders, but was banned by the FDA in 1991 due to adverse reactions. Today, it is used frequently at parties as a euphoriant and aphrodisiac. Due to these effects on the body, it is a substance that has been identified as a “date rape” drug.

Slang Terms

• G

• Grievous bodily harm

• Liquid ecstasy

• Liquid E

• Liquid X

• Georgia Home Boy

• Soap

• Cherry meth

• Blue nitro

• Fantasy

Pharmacology/Drug Effects

GHB is an agonist of the GABA-B receptors in the central nervous system and acts as a depressant, similar to ethanol. However, ethanol acts on the GABA-A receptor complex to act. When these GABA-B complexes are activated, they reduce the rate that nerve transmissions occur, causing sedation.

Drug Interactions/Toxicology

• GHB taken with alcohol and other sedative medications (such as benzodiazepines) can increase the sedative effect of the drug.

• Taking GHB with amphetamines and other stimulants can lead to an increased incidence of side effects due to opposing mechanisms of action.

Laws

https://www.google.com/imgres?imgurl=https%3 A%2F%2Fwww.aidedrogue.ca%2Fwpcontent%2Fuploads%2F2022%2F01%2Fdar-ghbscaled.jpg&imgrefurl=https%3A%2F%2Fwww.aide drogue.ca%2Fen%2Fthe-differentsubstances%2Fghb%2F&tbnid=b5feqsU-xpznM&vet=12ahUK

Up until 2000, there were no restrictions on the use of GHB. However, President Bill Clinton signed H.R. 2130 (the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000) into law, and now GHB is a schedule-I drug.

• GHB increases the risk of seizures, so using it with an anticonvulsant would decrease these medications’ effectiveness in preventing seizures

• Naloxone (Narcan) can decrease GHB action on the brain

• Overdose can cause blackouts, memory loss, confusion, loss of consciousness, and death.

Monitoring/Drug Screens

GHB is primarily used in the teenager and young adult population, but screening should be utilized for everyone. The HEADSS (home life, education, activities, drugs, suicide, sex) assessment as well as a social history should be taken at medical office visits. If the patient confirms they are using GHB, the provider should inform the patient of GHB use and provide resources for rehabilitation programs

Professional Opinion

Due to its lack of studies in human subjects, side effects, overdose potential, and use as a date rape drug, GHB should remain a schedule-I drug. In the past it has been used in the medical setting, but the drawbacks far outweighed the benefits, meaning that there is no place for it in the medical field let alone the general population.

– J. Frederick

References

Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol. 2015;13(1):47-70. doi:10.2174/1570159X13666141210215423

Gamma-Hydroxybutyrate (GHB): Overview, uses, side effects, precautions, interactions, dosing and reviews. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-950/gamma-hydroxybutyrate-ghb. Accessed October 13, 2022.

GHB. GHB - Alcohol and Drug Foundation. https://adf.org.au/drug-facts/ghb/#:~:text=Other%20names,meth%2C%20blue%20nitro%2C%20fishies. Accessed October 13, 2022.

O'connell T, Kaye L, John J. Plosay I. Gamma-Hydroxybutyrate (GHB): A newer drug of abuse. American Family Physician. https://www.aafp.org/pubs/afp/issues/2000/1201/p2478.html. Published December 1, 2000. Accessed October 13, 2022.