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GHB (gamma hydroxybutyrate) is a potent central nervous system (CNS) depressant drug. It occurs naturally in tiny quantities in the human brain as a neurotransmitter, which is a chemical that signals between brain cells. GHB is a prescription drug, but people also abuse it recreationally. It is also a well-known “date rape” drug.
In the U.S., GHB is used in one prescription drug (Xyrem) that has been approved by the FDA for the treatment of cataplexy or excessive daytime sleepiness in people with narcolepsy. However, because of its abuse potential and dangerous side effects, Xyrem is not commonly used and is only available through a restricted-use program. GHB is otherwise an illicit substance in the U.S.
Although GHB is a controlled substance, it is a widely available street drug throughout the U.S. It is also easily produced illicitly, and there are two similar drugs used as substitutes. These compounds, GBL (gamma butyrolactone) and 1,4 BD (1,4-butanediol), are found in various industrial solvents.
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GHB is abused for several reasons:
GHB is sold illicitly as a clear, colorless liquid or as a white powder that can be easily dissolved in a liquid. The effects can be felt within 15 to 30 minutes of taking the drug, and last 3 to 6 hours, depending on the dose and the individual’s physical characteristics.
GHB occurs naturally in the brain, where it plays a role in slowing things down. As such, the side effects of GHB are related to these depressant effects:
Other significant potential side effects of GHB include:
As a CNS depressant, GHB can suppress breathing, leading to loss of consciousness, coma, and death.
GHB has a high abuse and addiction potential. It is addictive because it can cause physical and mental dependence through its activation of the CNS reward system.
Because of its abuse potential and addictive properties, GHB is a Schedule I controlled substance under the Controlled Substances Act in the U.S. This means that it has a high abuse potential as well as no medical uses. However, the FDA-approved GHB-containing product (Xyrem) is considered a Schedule III substance.
GHB is a Schedule I controlled substance in the U.S.
Addiction to GHB is primarily defined as using the drug without a prescription despite obvious negative consequences. You may also be unable to stop drug use despite having a strong desire to do so. The symptoms of GHB addiction may be physical, mental, behavioral, or social in nature. Physical symptoms include:
Mental symptoms of GHB addiction may include:
Behavioral symptoms of GHB addiction include:
Social symptoms of GHB addiction include:
The most serious risk of GHB abuse is death. As a central nervous system (CNS) depressant, GHB can cause respiratory suppression to the point where the individual stops breathing and dies, even at relatively low doses.
GHB overdose can cause respiratory suppression, leading to loss of consciousness, coma, and death.
GHB use can lead to a loss of inhibition and risky behaviors, such as sexual promiscuity or other dangerous behaviors. Additionally, the drug may also cause problematic behaviors due to visual hallucinations, agitation, and aggression.
GHB abuse can also greatly increase the effects of other CNS depressants, such as alcohol or opioids, thereby lowering the dose needed to produce sedation, impairment, and overdose.
Regular abuse of GHB may produce addiction and withdrawal symptoms.
Recovery from substance addiction requires more than simply not using the drug. Addiction is, at its core, a dysfunctional coping mechanism for handling traumas or stressors from the past or present.
Overcoming physical and mental dependence on the powerful effects of the drug usually requires intensive treatment, or the relapse rate can be very high. After all, if overcoming drug addiction was a simple matter of “just stopping,” people would have already done so on their own.
Treatment for GHB addiction can involve pharmacological measures to help with the physical dependence and withdrawal symptoms, as well as behavioral treatments to help with the mental dysfunction that can be both a cause and effect of drug abuse.
More than half of people who develop substance addiction do so to “self-medicate” the symptoms of a mental health disorder.National Institute on Drug Abuse
Many of these people are not even aware that they have a treatable mental health disorder. As such, diagnosis and treatment of any underlying mental health disorder is an important part of addiction treatment.
Professional treatment programs are available to help people make the transition from active drug use to health and happiness in long-term recovery.
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Drug Enforcement Administration (DEA). “Drugs of Abuse.” (2017). https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=60
Drug Enforcement Administration (DEA). “Drug Scheduling.” (2019). https://www.dea.gov/drug-scheduling
Food and Drug Administration (FDA). “Highlights of Prescribing Information: Xyrem.” (2018). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021196s030lbl.pdf
Kamal, R.M., van Noorden, M.S., Franzek, E., Dijkstra, B.A., Loonen, A.J., and De Jong C, A.J. “The Neurobiological Mechanisms of Gamma-Hydroxybutyrate Dependence and Withdrawal and Their Clinical Relevance: A Review.” Neuropsychobiology, vol. 73 (2016): 65-80. https://www.karger.com/Article/Fulltext/443173#
National Institute on Drug Abuse (NIDA). “Comorbidity: Addiction and Other Mental Illnesses.” Research Report Series. (2010). https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf