GHB - Side Effects, Risks, & Treatments

GHB has a high abuse and addiction potential, with no medical uses. Therefore it is classified as a Schedule I controlled substance in the U.S. People develop a physical and mental dependence through its activation of the central nervous system (CNS) reward system.
Evidence Based
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What is GHB?

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.

GHB is 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:

  • Fitness – based on the mistaken belief that GHB increases muscle gain and weight loss
  • Rape drug – based on its effect on rendering a victim passive, unconscious, and with no memory of the event. GHB is clear, colorless, and easy to slip into a drink. GHB is also difficult to detect in the body unless tested within four hours of administration
  • For its “high” – because it has euphoric and calming effects
  • As a rave drug – based on its ability to increase libido and suggestibility

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.

Graphic human body showing symptoms.

Side Effects of GHB

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:

  • Euphoria
  • Drowsiness
  • Dizziness
  • Confusion
  • Sense of calm
  • Memory impairment

Other significant potential side effects of GHB include:

  • Seizures
  • Depression and suicidality
  • Sleepwalking
  • Nausea and vomiting
  • Reduced appetite
  • Blurred vision
  • Amnesia
  • Headache
  • Agitation and aggression
  • Dry mouth
  • Loss of bladder control

As a CNS depressant, GHB can suppress breathing, leading to loss of consciousness, coma, and death.

Graphic of head filled with pills

Is GHB Addictive?

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.

Pill bottle and skull

GHB Addiction Symptoms

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:

  • Tolerance – this means needing higher doses to obtain the same effect
  • Withdrawal – after the drug effects wear off, the individual experiences uncomfortable symptoms, such as insomnia, shaking, rapid heart rate and high blood pressure, and seizures

Mental symptoms of GHB addiction may include:

  • Obsessive or invasive thoughts about using the drug
  • Using the drug to deal with stress or mental illness symptoms
  • Mental illness symptoms from drug use, especially depression or anxiety

Behavioral symptoms of GHB addiction include:

  • Taking the drug when it hasn’t been prescribed, or at higher doses, than prescribed
  • Secrecy and solitude
  • Denial, lying, and concealing drug use
  • Use of other addictive substances
  • Neglecting responsibilities and usual life activities due to drug use
  • Participating in risky or dangerous behaviors

Social symptoms of GHB addiction include:

  • Legal problems due to drug use
  • Relationship/marital difficulties
  • Financial difficulties due to reduced income from employment difficulties and the expense of obtaining the drug
Icon with triangle signifying risk.

Risks of GHB Abuse

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.

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GHB Addiction Treatment

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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Resources

Busardò, Francesco P, and Alan W Jones. “GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome.” Current Neuropharmacology, vol. 13,1 (2015): 47-70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462042/

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

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Updated on: June 24, 2020
Author
Addiction Group Staff
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