The drug GHB (gamma-hydroxybutyrate) occurs in two forms:
- Sodium oxybate or gamma-hydroxybutyrate sodium goes by the trade name Xyrem and is approved for the treatment of the sleep disorder narcolepsy. Xyrem is classified as a Schedule III controlled substance.
- GHB also refers to a synthetic and illicit version of the drug that is classified as a Schedule I controlled substance by the DEA. This article focuses on the issues associated with the illicit version of GHB.
What Is GHB?
GHB is a metabolite for the neurotransmitter GABA (gamma-aminobutyric acid), the most prevalent inhibitory neurotransmitter that occurs in the central nervous system. Inhibitory neurotransmitters have numerous functions, but they basically modulate the central nervous system by slowing down the firing of other neurons in the brain and spinal cord. This has a number of useful effects.
GHB was also used as an anesthetic at one time, but its use resulted in a number of serious side effects, and this use was discontinued. GHB became a popular drug in the 1980s, used to improve athletic performance and reduce body fat. Its popularity with bodybuilders for this capacity remains, although the drug is not an anabolic steroid as it is often portrayed to be. GHB also developed a reputation as an aphrodisiac and was one of the major date rape drugs used by predators in the early part of the century (and still may be used for this purpose).
Its use was banned by the DEA in 2000; however, two years later, it was found to be useful in treating narcolepsy. As a result, it was given special permissions by the FDA to be used for that purpose.
GHB can be produced artificially by using some very common ingredients.
Its abuse still occurs in three major groups of individuals.
- GHB is used as a rave or club drug. It still has a reputation with younger people as being a safer alternative to ecstasy. It produces feelings of euphoria and sociability, and it is still considered to be an aphrodisiac.
- Predators still use GHB as a date rape drug. It can produce unconsciousness and memory loss when given to individuals who take it unsuspectingly.
- Athletes and bodybuilders still use GHB as a fat burning aid and to increase energy and athletic performance.
Nearly 60 percent of individuals using GHB are between the ages of 18 and 25.
Despite its use by the three groups listed above, many of the reputed properties of GHB, such as its ability to increase muscle mass, as an aphrodisiac, and as an athletic performance enhancer, are mostly fictitious.
Its effect on memory and consciousness when used as a date rape drug is valid.
The Effects of Taking GHB
Despite the drug’s reputation as a safe alternative to other drugs like ecstasy and diet aids, GHB is potentially dangerous to use.
- Extremely small amounts of GHB can be toxic. The “safe” range of the dose is very small.
- Chronic use of the drug can produce hallucinations, confusion, violent outbursts, and issues with depression. It can result in seizures.
- Using GHB results in large increases in serotonin and dopamine in the central nervous system. The release of these neurotransmitters accounts for the euphoric effects and increased sociability that occur in users. However, when an individual has stopped using the drug, the levels of these neurotransmitters drop, leading to issues with apathy, depression, hopelessness, lethargy, etc.
- Small amounts of the drug affect memory while a person is under the influence of the drug. Individuals basically cannot recall events that took place while under the drug’s influence. This is the reason sexual predators use GHB as a date rape drug.
- GHB acts on the hypothalamus, which is involved in maintaining a number of regulatory functions in the body. One of the consequences of GHB is that the regulatory functions of the hypothalamus regarding body temperature can be disrupted, and individuals can become overheated extremely quickly.
- As the drug wears off, individuals become lethargic and confused.
Chronic use of GHB is also associated with the development of physical dependence. Tolerance to GHB appears to develop very rapidly. The withdrawal syndrome occurs in three phases that often begin within 24 hours after the individual has stopped taking the drug and continue for 10 days to several weeks. Withdrawal from GHB is similar to the withdrawal syndrome that occurs in individuals with an alcohol use disorder or who have abused benzodiazepines.
Withdrawal symptoms from GHB are often classified as either mild, moderate, or severe. Documented symptoms include stomach cramps, nausea, vomiting, chills, fever, mood swings, anxiety, depression, the potential to develop psychotic-like behaviors (hallucinations and delusions), and, in some cases, seizures. Seizures can be potentially fatal. Individuals who have severe withdrawal reactions as a result of discontinuing GHB may experience hallucinations, delusions, and/or seizures. Mild or moderate withdrawal syndromes consist of other symptoms listed above in varying intensities.
Individuals who chronically abuse GHB are also at risk to develop a formal substance use disorder (the clinical designation that is used to diagnose both substance abuse and a formal addiction or substance dependence).
An individual who has developed a substance use disorder as a result of abusing GHB would present with:
- Significant problems controlling their use of GHB: Issues with controlling use of the drug occur over several potential situations. These include difficulty controlling the amount of the drug one uses, continuing to use it despite experiencing negative effects because of use, giving up important activities in favor of using the drug, spending significant amounts of time using or recovering from the drug, and using the drug in situations where it is obviously dangerous to do so, such as while operating machinery or mixing it with other dangerous drugs.
- Experiencing frequent urges or cravings to use GHB
- Continuing to use GHB even though one experiences significant distress or dysfunction because of use
- The development of tolerance to GHB
- The development of withdrawal symptoms when one stops using GHB
- Taking GHB to avoid withdrawal symptoms or other stressors
Other potential indicators that someone may be abusing GHB include:
- Becoming very active and sociable at parties or clubs, but then lethargic or withdrawn in other instances
- Overheating very easily in crowded environment, such as parties, clubs, etc.
- Becoming very friendly and outgoing as social gatherings but appearing lethargic, depressed, and even irritable or anxious the next day
Treatment for GHB Abuse
Individuals with substance use disorders are typically unable to change their behavior without professional help. Treatment for an individual who has abused GHB and developed a substance use disorder follows a set of specific guidelines and uses a standard approach that is adjusted to fit the specific needs of the individual. This approach includes:
- An initial assessment: Before any treatment can be delivered, the individual needs to be assessed to determine their needs, strengths, and weaknesses. The assessment should be complete and cover a full physical appraisal, assessment of their psychological and emotional functioning, a cognitive evaluation, and full assessment of their social situation. The results of the assessment determine the specific areas of concentration that the treatment protocol should address.
- Withdrawal management: Because there is the potential that individuals who have chronically abused GHB have developed physical dependence on the drug, the initial step is to enroll in a physician-assisted withdrawal management program. The program includes the administration of medications that can address the specific symptoms that occur during withdrawal. Benzodiazepines and other medicationsare commonly used for withdrawal from GHB. Benzodiazepines are administered on a tapering schedule, such that the dose is slowly tapered down as the individual’s system adjusts. This allows the individual to be weaned off the benzodiazepine while they are undergoing the withdrawal process without experiencing significant withdrawal symptoms. Some other medications may be used, such as the muscle relaxant baclofen (which may address cravings and irritability), anticonvulsant medications, antihypertensive medications, and other medications to treat specific symptoms.
- Therapy: Despite the utility of using medications for individuals in recovery, there are no medications that can address the emotional and behavioral issues that are present in those who have developed an addiction. Substance use disorder therapy helps the individual learn about their personal reasons for abusing substances, develop coping strategies, cultivate functional approaches to issues in life, learn relapse prevention, and prepare themselves to live without use of drugs. No medication can do that. Cognitive Behavioral Therapy is the preferred method of intervention, and therapy can be delivered in individual sessions, group sessions, or a combination of both.
- Social support: This can come from an individual’s family, friends, or peers in recovery. One of the most productive ways to add to one’s social support network is to become involved in social support groups, such as 12-Step groups. These groups provide many functions. While they are not formal therapy groups, they offer a focused plan for recovery, peer support, and long-term participation in a positive recovery activity.
- Management of any co-occurring conditions: Individuals who have other issues, such as co-occurring psychological disorders, medical conditions, dysfunctional relationships, etc., should also have these managed. Those who have co-occurring psychological conditions, such as depression, bipolar disorder, anxiety, etc., must have these issues treated along with their substance use disorder for recovery to be successful. The management of these conditions should be delivered by means appropriate to the condition.