What Is GHB, and What Are the Risks of Abuse?
GHB (gamma-Hydroxybutyric acid) is a naturally occurring substance that is found primarily in the central nervous system of humans.
GHB is a metabolite of the neurotransmitter GABA. Since the discovery of GHB, it has had many roles in research, such as in the development of clinical models of seizure disorders and as a potential drug that could protect tissues in individuals with heart attacks and strokes. GHB also has uses in the treatment of narcolepsy, withdrawal from alcohol, and may be useful in the treatment of major depressive disorder.
Even so, GHB never found significant clinical use. In the 1960s, it was used as a general anesthetic but eventually was discontinued, as its use was associated with abnormal EEG patterns.
GHB did receive some popularity with bodybuilders in the 1980s who believed the drug could improve muscle mass, and some athletes took it to improve their performance. However, it also became a drug of abuse due to its euphoria-producing effects and reputed aphrodisiac qualities. The sale of GHB over the counter was tightly controlled in many states in the 1990s, and in 2000, the United States Drug Enforcement Administration designated GHB as a Schedule I controlled substance.
GHB goes by a number of different street names, including liquid ecstasy, Georgia home boy, and lollipops. It is an extremely dangerous drug of abuse, and the range between a “safe” dose and one that is potentially toxic is very small. It is also a drug that has been used as a date rape drug since it produces sedation and amnestic effects in individuals who take significant doses.
When an individual takes GHB, it crosses the blood-brain barrier and enters the brain, resulting in a massive release of serotonin and dopamine. The release of serotonin facilitates the release of a hormone known as oxytocin, which creates feelings of euphoria and strong social connections to other people. The release of dopamine is rewarding and facilitates a desire for an individual to reuse the drug and to also focus very narrowly on specific stimuli. GHB also affects the brain area known as the hypothalamus, which has many functions, including the control of body temperature. This means that individuals that abuse GHB are at a high risk for overheating.
The euphoric effects of the drug are balanced by negative effects that include depression, amnesia, aggressiveness, hallucinations, confusion, and the potential for seizures. Individuals who are on GHB are initially very focused and euphoric, but as the drug runs its course, the individual’s euphoria and ability to focus turns to aggression and depression.
There are a number of sites online that report that GHB is safe to use; however, based on the DEA’s assessment of the drug, in addition to other professional assessments, GHB is potentially very dangerous and has a high potential for abuse and the development of physical dependence. One of the major drawbacks to restricting use of GHB is that it can be manufactured privately without a sophisticated knowledge of chemistry, and it is easily purchased online from overseas sources and then shipped to private individuals.
The primary abusers of GHB come from three specific groups:
- Bodybuilders: GHB is still believed by many bodybuilders to have muscle mass-inducing qualities and to facilitate the ability to engage in strenuous exercise, so it is sometimes available in certain fitness circles. GHB is often wrongly referred to as an anabolic steroid, but it is not a steroid. In addition, some people use GHB as an appetite suppressant for weight loss; however, there is little scientific data to support the notion that it can function in this capacity.
- Sexual predators: Certain individuals use GHB as a means to drug potential rape victims, as the drug produces sedation and amnesia in many individuals who take it.
- Clubgoers: GHB is considered to be an alternative to the drug ecstasy, and it is often used in the nightclub scene by individuals who use it for its euphoric effects, tendency to make individuals more sociable, and reported aphrodisiac effects.
Overall, GHB is primarily abused by younger individuals.
Again, it is important to note that there are number of reports online stating that GHB is safe to use; however, there is a documented pattern of the development of tolerance and withdrawal for individuals who regularly use GHB. One of the major risks of GHB abuse is as potential to develop physical dependence (the combined symptoms of the development of both tolerance and the withdrawal syndromes).
The withdrawal process for GHB appears to be very similar to the withdrawal process for alcohol and benzodiazepines. This indicates that there is a potential danger in chronic users of GHB to suffer ill effects from the withdrawal process. The development of tolerance to GHB appears to occur very rapidly, and this facilitates the abuse process such that individuals need increasing amounts to achieve results that were once achieved at lower doses. Continued use of GHB as tolerance increases results in the development of physical dependence on the drug, where the individual’s physical system adjusts its functioning to account for the presence of the drug in its tissues. The body continues to metabolize GHB, and if the individual does not maintain specific levels of the drug in the tissues by taking it on a regular basis, the individual’s system is thrown out of balance. As a result, there are number of negative physical and emotional symptoms that occur (withdrawal syndrome).
It appears that the withdrawal syndrome from GHB includes:
- An acute phase: Depending on the amount of GHB regularly being used, acute withdrawal can occur 1-24 hours after the person stops using the drug. Heavy and regular users of the drug will experience more severe withdrawal symptoms. These early acute symptoms of withdrawal from GHB often include:
- Nausea, vomiting, and stomach cramps
- Confusion, even delirium
- High blood pressure
- Irregular heartbeat
- Moderate symptoms: About 1-6 days after the individual has stopped using GHB, the symptoms will peak and can consist of:
- Mild or moderate issues with vomiting, nausea, and diarrhea
- Continued moderate sweating, high blood pressure, and shakiness or tremors
- More severe issues with insomnia, anxiety, confusion, and potential hallucinations
- Extended symptoms: Typically a week after the individual has discontinued GHB, there will be some intermittent symptoms that are not quite as severe as earlier manifestations of the symptoms. These may include issues with anxiety, insomnia, irregular heartbeat, high blood pressure, sweating, mild tremors, nausea, and the potential for hallucinations. In this phase of the withdrawal process, the symptoms may be episodic and can last as long as two weeks.
- Seizure potential: It appears that the potential for the individual to develop seizures as a result of the withdrawal process from GHB can occur anytime after discontinuation. Seizures occurring in the withdrawal process represent potentially fatal manifestations of the withdrawal process, and any individual withdrawing from GHB should only do so under close medical supervision.
Treatment for GHB Abuse
Treatment for withdrawal from GHB typically consists of the use of benzodiazepines to control the potential for hallucinations and seizures. In some cases, anticonvulsant medications, such as gabapentin, can be used. Beta blockers and other antihypertensive medications may be useful in controlling issues with blood pressure and irregular heartbeat, and in some cases, the use of antipsychotic medications may be needed to control hallucinations. Other specific issues can be controlled with specific medical interventions, such as issues with dehydration, fever, nausea, etc.
Simply undergoing the withdrawal process will not address the larger issue of GHB abuse. Many individuals who simply go through detox and do not become involved in long-term aftercare programs for substance use disorders are at extremely high risk for relapse. Relapse can be particularly problematic when GHB is involved because individuals who go through the withdrawal process may no longer have the same level of tolerance that they initially had. The potential for overdose is increased as they instinctively attempt to use amounts of the drug similar to those they had use previously.
Long-term recovery from GHB abuse requires that an individual attend therapy for substance use disorders, get strong social support to assist them in avoiding relapse, and maintain an attitude of abstinence that often includes changes in friends and places one frequents, as well as an overall readjustment in the individual’s lifestyle. Because many individuals who abuse GHB are younger, it is extremely important for these individuals to develop strong support groups of family members, friends, and other individuals in recovery who are committed to maintaining sobriety. If individuals participate in intensive and long-term aftercare programs for substance use disorders, the prognosis for the recovery is significantly more positive than for individuals who simply go through the withdrawal management process.