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Gamma hydroxybutyrate (GHB) intoxication

Authors
Deborah L Zvosec, PhD
Stephen W Smith, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

GHB is a central nervous system (CNS) depressant that is abused recreationally as a "party drug" or "club drug" with a wide array of formulations, use patterns, and health risks.

GHB was first synthesized in France as an analog of gamma aminobutyric acid (GABA) capable of crossing the blood brain barrier. Initially used as an anesthetic in Europe, GHB was found to have inadequate analgesic effects and significant side effects, including myoclonus and emergence delirium, and did not receive approval in the United States [1]. In the 1980s GHB was marketed as a bodybuilding and weight loss drug and sold in health food stores. Recreational use of GHB subsequently became more widespread as GHB was abused at clubs, raves, and dance venues for euphoric, sexual, stimulant, and relaxant effects.

Following reports of adverse effects from and the enactment of government restrictions on GHB, gamma butyrolactone (GBL) and 1,4 butanediol (BD), two common industrial solvents, became popular as "dietary supplements", and were promoted for bodybuilding, weight loss, sleep, and in the treatment of depression, anxiety, and alcohol and drug dependence. Both GBL and BD are rapidly metabolized to GHB, with the same clinical effects. (See 'Pharmacology and cellular toxicology' below.)

Adverse events from and subsequent regulation of GBL and BD "supplements" led to spurious sale of both compounds as "non-toxic" and "organic" solvents, "cleaning products," and "chemical samples" to avoid detection and prosecution [2]. These products were then replaced by industrial GBL and BD sold on the internet through unregulated companies in Asia and Europe [3]. Analog supplements, such as "Potion 9," have also been spuriously marketed on the internet in recent years as "mood enhancers," promoted primarily for prosexual effects, but with no disclosure of BD on product labels or websites [4].

The toxicology and management of acute GHB intoxication are reviewed here. GHB withdrawal, GHB in the treatment of narcolepsy, the toxicology of other drugs of abuse that may be coingested, and general management of the poisoned patient are all discussed separately. (See "Gamma hydroxybutyrate (GHB) withdrawal and dependence" and "Treatment of narcolepsy in adults", section on 'Sodium oxybate' and "MDMA (ecstasy) intoxication" and "General approach to drug poisoning in adults" and "Initial management of the critically ill adult with an unknown overdose".)

                                      
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Literature review current through: Nov 2017. | This topic last updated: Mar 08, 2017.
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