If you decide to use GHB, or GHB-like drugs, it’s important to understand and consider the risks, as well as the strategies that you can use to reduce harm. GHB withdrawal is similar to alcohol withdrawal, varying from mild to severe. It’s also dangerous to take GHB with stimulant drugs such as MDMA, cocaine, ice, or amphetamines. Using GHB in combination with alcohol is dangerous even in small amounts. If you choose to use GHB avoid mixing it with other alcohol and other drugs. Methamphetamine suppresses autonomic response and can cause sores and abrasions in the mouth.
Taken in strong doses or with alcohol, the effects of GHB can be physically disabling. GHB is difficult to detect in a strongly flavoured alcoholic drink. These qualities have led people to ‘spike’ alcoholic drinks with GHB, with the intention of committing a sexual assault against the ‘disabled’ victim.
Depressants
It is rapidly converted into GHB by lactonase enzymes found in the blood. A 2022 review22 compared 43 studies on GHB-induced cognitive impairment in humans and animals. The analysis suggests that moderate or clinical use may result in acute cognitive impairment. Working memory, short-term memory, and impaired performance on cognitive tasks were impaired after doses as low as 10mg/kg, but these effects appear to be temporary. Conversely, one study found that a dose of 20mg/kg improved social and non-social cognition, but did not affect base cognitive functions, such as visual or verbal memory recall. However, chronic heavy use of GHB, especially if accompanied by GHB-induced comas appear to cause long-term cognitive impairment and are likely neurotoxic.
Is Gamma Butyrolactone Illegal?
- If you or someone else needs urgent help after taking drugs or drinking, call 999 for an ambulance.
- That is to say that, over time, the concentration of GHB in the system decreases below the threshold for significant GABAB receptor activation and activates predominantly the GHB receptor, leading to wakefulness.
- GHB (Xyrem) was approved by the FDA in 2002 for use in the treatment of narcolepsy/Cataplexy 3.
- GHB, GBL and 1,4-BD can cause overdoses that make you lose consciousness or stop breathing.
- Naomi Carr is a qualified mental health nurse with several years of experience working with children and adults in the UK.
When used as a recreational drug, GHB may be found as the sodium or potassium salt, which is a white crystalline powder, or as GHB salt dissolved in water to form a clear solution. The sodium salt of GHB has a salty taste.34 Other salt forms such as calcium GHB and magnesium GHB have also been reported, but the sodium salt is by far the most common. GHB induces the accumulation of either a derivative of tryptophan or tryptophan itself in the extracellular space, possibly by increasing tryptophan transport across the blood-brain barrier. The blood content of certain neutral amino-acids, including tryptophan, is also increased by peripheral GHB administration. GHB-induced stimulation of tissue serotonin turnover may be due to an increase in tryptophan transport to the brain and in its uptake by serotonergic cells. As the serotonergic system may be involved in the regulation of sleep, mood, and anxiety, the stimulation of this system by high doses of GHB may be involved in certain neuropharmacological events induced by GHB administration.
GHB Receptor
As such, it is essential to understand the chemistry behind the synthesis of GBL to ensure that it is produced safely and efficiently. Dependence can develop fairly quickly, for example after a weekend of severe bingeing on GHB and its related compounds, or may result from regular use over a longer period. Doctors are currently treating withdrawal from GHB-type drugs with benzodiazepines, although further research is needed into other treatments.
Physical Health Risks
Butane-1,4-diol is also used as a recreational drug known by some users as “Bute”,18 “One Comma Four”, “Liquid Fantasy”, “One Four Bee” or “One Four B-D-O”. In one industrial chemical synthesis, acetylene reacts with two equivalents of formaldehyde to form butyne-1,4-diol. Hydrogenation of butyne-1,4-diol gives butane-1,4-diol.9 It is also made on an industrial scale from maleic anhydride in the Davy process, which is first converted to the methyl maleate ester, then hydrogenated. GBL is not active in its own right, its mechanism of action stems from its identity as a prodrug of gamma-hydroxybutyrate. The compound gamma-butyrolactone (GBL) was found in extracts from samples of unadulterated wines.
You may be more likely to engage in risky sexual behaviours when using these drugs. Or you may end up in situations where you are not sober enough to enthusiastically gain or give consent. It is good to think about how you might keep yourself and others safe before you use. It can also be a good idea to colour liquid GHB/GBL/1,4-BD with blue food colouring.
GHB and GBL have very strong effects, and when mixed with other drugs, they can become more dangerous. This is especially the case for alcohol and other depressant drugs as effects become more intense and the risk of overdose increases. GHB, GBL and 1,4-BD are most commonly mixed into a drink and swallowed, which releases them into your body slower than by snorting or injecting.
Cognitive Effects
Interestingly, naloxone and naltrexone has shown to reverse the effects GHB (and GBL) on dopamine release. GHB has an interesting but still greatly undiscovered pharmacology. It was created with the intention to produce an analogue of (or a related compound to) the inhibitory neurotransmitter GABA and thought to act via GABA receptors (mainly GABAB). However, we now know that it stimulates its own distinct GHB receptor, that it is endogenously (naturally) present in the brain, and that GHB actually has a low affinity (ability to bind) for the GABA receptors. Instead the salt is mixed with water to produce a clear liquid – often sold in small platic bottles.
Benzodiazepines
GHB, when sold as a solution varies in concentration, so it is very important to know how strong the solution is, although you should not rely on it being the strength you have been told. People have ended up coming round in hospital after swigging from the bottle directly. Different people will be more or less sensitive to the effects, just as with alcohol. If you buy or are given a pre-prepared solution of any of these drugs, the risks of accidentally taking too much is especially high. Taking an unmeasured dose of an unknown solution is very risky, even if it seems like a small amount. Measuring out doses millilitre by millilitre using a pipette, and starting with a small dose, reduces the risk 4.
However, potentiation of ethanol’s effects may simply be caused by competition for the alcohol dehydrogenase and aldehyde dehydrogenase enzymes with co-administered 1,4-butanediol. The shared metabolic rate-limiting steps thus leads to slowed metabolism and clearance for both compounds including ethanol’s known toxic metabolite acetaldehyde. In the 1980’s It was marketed for a short time as a fat burner and muscle developer.
Polydrug use is a term for the use of more than one drug or type of drug at the same time or one after another. Polydrug use can involve both illicit drugs and legal substances, such as alcohol and medications. Both of the metabolic breakdown pathways shown for GHB can run in either direction, depending on the concentrations of the substances involved, so the body can make its own GHB either from GABA or from succinic semialdehyde. GHB is produced in the body in very small amounts, and blood levels may climb after death to levels in the range of 30–50 mg/L.62 Levels higher than this are found in GHB deaths. GHB can be manufactured with little knowledge of chemistry by mixing another drug, GBL, with an alkali hydroxide such as sodium hydroxide, to form the GHB salt.
Risks And Side Effects
Seek medical advice immediately if symptoms include tight pressure headaches, vomiting, disorientation, delirium, amnesia, psychosis, severe agitation, paranoia, muscle numbness, seizures, convulsions, tachycardia, and auditory and visual hallucinations. In Hong Kong, GHB is regulated under Schedule 1 of Hong Kong’s Chapter 134 Dangerous Drugs Ordinance. It can only be used legally by health professionals and for university research purposes.
However, GBL is typically more potent than GHB and has a faster onset of action. Additionally, GBL is often used as an industrial solvent, while GHB is sometimes prescribed for medical purposes. Both substances can be dangerous when misused, leading to overdose, addiction, and other serious health risks. GHB was synthesised and introduced into medicine in 1960 and in 1963 discovered as a naturally occurring chemical in the human brain 22. Throughout much of the 1960’s it was a popular anaesthetic, but was abandoned by doctors following discoveries of its poor analgesic effects 23.
