GHB Addiction and Abuse: Understanding the Risks and Realities of Gamma-Hydroxybutyrate
Introduction:
What was Puff Daddy, aka P Diddy, aka Sean Combs doing with all of those bottles of baby oil laced with gamma-hydroxybutyrate (GHB)? Well, the first time I cared for a patient who was exposed to GHB was back in 1998. At the time, I was a medical student. The young woman was a victim of a sexual assault and could not remember the details of her night. During that night, multiple young College of Charleston students presented to the hospital with signs and symptoms of GHB exposure or overdose. Of course, I couldn't wait to get to the library to learn about the drug and what I saw that evening.
By the way, have you ever heard of GHB? It's a substance that's often misunderstood, surrounded by myths and misconceptions. It is commonly known as the "date rape drug" or "club drug" or "liquid ecstasy" because it can cause amnesia and blackouts. Not to be confused with another date rape drug called Rohypnol, gamma hydroxybutyrate makes the headlines and then vanishes from public discussion. Recently, it was news reported after the FBI seizing 1000 bottles of baby oil laced with GHB from Sean Combs's homes. Although, there is speculation that "baby oil" may be code word for GHB.
Despite the notoriety, you might be surprised to learn that GHB isn't just some scary street drug - it's actually produced naturally in small amounts by our own brains! But recreational GHB can quickly become dangerous.
My Goal For This Blog
In this blog post, we'll look at GHB addiction and abuse. I'll explain what this substance really is, how it affects the body, and why it's become a concern in certain communities. I'll also discuss the risks of GHB use, including the potential for overdose and the challenges of withdrawal. Together, we will thoroughly dissect the relevant information and the key takeaways.
Whether you're worried about a loved one, curious about substance use trends, or just interested in learning more about brain chemistry, this post has something for you. I hope to make the complex scientific concepts easy-to-understand with explanations, information from recent research, and my expert insight.
Understanding GHB: What It Is and How It Works
Let's start with the basics: what exactly is GHB? GHB stands for gamma-hydroxybutyrate, a chemical compound that's naturally present in our brains. In small amounts, it helps regulate things like sleep, body temperature, and even learning. Interestingly, it is also a treatment for narcolepsy in a form of a salt called Sodium Oxybate (Xyrem). The Food and Drug Administration regulates Xrem as a Schedule III substance while GHB is regulated as a Schedule I substance.
There are 2 other related drugs called gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) that are precursors to GHB. When taken, GBL is rapidly converted to GHB. It is also more potent than GHB meaning that users get more effects with less. On the other hand, 1,4-BD has a slower onset due to its slower metabolic conversion. The delayed onset can lead to users taking more, thinking it hasn't worked, thus increasing the risk of overdose. Since these 2 lead to GHB in the body, I will refer to GHB for this discussion.
When people take GHB as a recreational drug, they're using much larger amounts than what our bodies make naturally. GHB is a central nervous system depressant, a sedative, which means it slows down brain activity. It is similar to benzodiazepines.
Here's how it works: GHB interacts with specific receptors in our brains. Small amounts of GHB mostly affects GHB receptors. But as the dose increases, it starts to interact with GABA receptors too. Specifically the GABAB receptor. GABA is the brain's main "chill out" signal, reducing anxiety and arousal. Binding to the brain's reward center, GHB can lead to increased dopamine release, euphoria, and reinforcing effects. The effects of GHB are intense feelings of relaxation and euphoria.
The tricky part is that GHB is processed by our bodies very quickly. It can cause effects within minutes of taking it, but it's also out of your system fast. This rapid processing makes GHB hard to detect and can lead to unpredictable effects, especially at higher doses.
Common Street Names For GHB, 1,4-BD And GBL
Common street names for GHB (gamma-hydroxybutyrate) include:
“G” or “Liquid G”
“Georgia Home Boy”
“Grievous Bodily Harm”
“Liquid Ecstasy”
“Fantasy”
“Cherry Meth”
“Juice”
“Mils” (referring to milliliters, as GHB is often dosed in liquid form)
“Soap”
Some common street names for 1,4-BD (1,4-butanediol) include:
“One Four”
“BD”
“Butanediol”
“Liquid Fantasy”
Common street names for GBL ( gamma-butyrolactone) include:
“G” or “Liquid G”
“Gamma G”
“Georgia Home Boy”
“Blue Nitro”
“Firewater”
“Liquid Ecstasy”
The Reality of GHB Use: Who's Using It and Why
You might think GHB is everywhere, given how much it's talked about. But here's a surprise: GHB use is actually pretty uncommon compared to other substances like alcohol or marijuana.
So who's using GHB? Research shows that men are much more likely to use GHB recreationally. They also make up most of the GHB-related emergency room visits.
One group where GHB use is more common is among men who have sex with men, particularly in the context of "chemsex." Chemsex refers to using drugs to enhance sexual experiences. GHB's effects, like lowering inhibitions and creating euphoria, make it popular in these situations. It is a common drug in the club scene and among sex workers.
But why do people use GHB? Some are after the euphoric high. Others use it as a party drug for its alcohol-like effects. In the chemsex scene, it's used to increase pleasure and lower inhibitions.
It's important to understand that while GHB use isn't widespread, the risks for those who do use it are serious. The unpredictable nature of GHB, especially when mixed with other substances, can lead to dangerous situations involving health risks and consent issues.
The Dangers of GHB: Overdose and Addiction
GHB might not be widely used, but it carries serious risks and needs immediate medical attention. One of the biggest dangers is how easy it is to overdose. The first symptom may be nausea and vomiting. However, the line between a dose that causes euphoria and one that causes dangerous side effects is very thin.
Symptoms of GHB overdose can central nervous system (CNS) effects include:
• Confusion
• Dizziness
• Seizures
• Loss of consciousness
• Slowed heart rate and breathing
• Coma
In severe cases, GHB overdose can even be fatal. What makes it extra risky is that GHB is often used with other substances, like alcohol, which can make the effects much worse. People with signs of overdose should seek immediate medical attention.
GHB can also be addictive. People who use it regularly might develop a tolerance, needing more to get the same effects. This can lead to physical dependence and addiction.
Signs Of GHB Addiction
Signs of GHB addiction can include:
• Needing to use GHB more often
• Having trouble cutting down on use
• Spending a lot of time getting, using, or recovering from GHB
• Continuing to use despite negative consequences
If you or someone you care about shows these signs, it's important to seek help. GHB addiction is serious, but treatment options are available.
GHB Withdrawal: Symptoms and Treatment
When someone who's been using GHB regularly stops, they might experience withdrawal. GHB withdrawal can be intense and potentially dangerous, often starting within a few hours after the last dose.
Withdrawal symptoms can include:
• Anxiety
• Shaking
• Trouble sleeping
• Sweating
• Increased heart rate
• In severe cases, hallucinations or seizures
GHB withdrawal is often compared to alcohol withdrawal, but it can hit faster and harder. This is because GHB leaves the body so quickly.
There's no one-size-fits-all treatment for GHB withdrawal. Doctors usually focus on keeping the person safe and comfortable while managing specific symptoms. This might involve:
• Careful monitoring
• Medications to help with anxiety or sleep problems
• In severe cases, hospital care
Often, doctors turn to benzodiazepines to treat GHB withdrawal and the unpleasant symptoms. However, heavy users can be benzodiazepine resistant such that massive doses of benzodizepines, such as diazepam doses of greater than 100mg, has no effect. Doctors need to be prepared for such a scenario.
One medication that's being studied for GHB withdrawal and detox is baclofen. It works on some of the same brain pathways as GHB and might help ease withdrawal symptoms. The case studies are very convincing that very high doses of baclofen should be considered very early when considering treatment. I will write a separate article on managing withdrawal and detox because it is FAR from easy.
Remember, trying to quit GHB on your own can be dangerous. If you or someone you know wants to stop using GHB, it's important to talk to a doctor or addiction specialist. They can help create a safe plan for quitting and provide support through the withdrawal process.
Conclusion:
We've covered a lot of ground in our exploration of GHB. From its surprising role in our brains to its potential for addiction, GHB is a complex substance that demands our attention and understanding.
Key takeaways:
• GHB occurs naturally in our bodies but can be dangerous when used recreationally
• While not widely used, GHB carries serious risks including overdose and addiction
• GHB withdrawal can be intense and potentially dangerous
If you or someone you care about is struggling with GHB abuse, remember that help is available. Substance abuse treatment centers offer specialized care for GHB addiction. Treatment often includes a combination of medical support and behavioral therapies to address both the physical and psychological aspects of addiction.
It's crucial to seek professional help rather than trying to quit alone. A doctor or addiction specialist can create a personalized treatment plan to ensure safety and increase the chances of long-term recovery.
By understanding the facts about GHB, we can better protect ourselves and our loved ones. Whether it's recognizing the signs of GHB use, knowing the risks, or understanding how to get addiction treatment.
Remember, recovery is possible. With the right support and resources, people can and do overcome GHB addiction every day.
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Gupta, R., Moon, G., Bonomo, Y., & Pastor, A. (2024). A case of severe and prolonged γ-hydroxybutyrate (GHB) withdrawal syndrome successfully managed with a slow benzodiazepine and baclofen taper. Drug and Alcohol Review. Advance online publication. https://doi.org/10.1111/dar.13911
Joyce, S., Lea, S., Woolner, M., & Leddy, A. (2024). Treatment of gamma hydroxybutyrate withdrawal in a pregnant female: A case report. Journal of Addiction Medicine, 18(3), 342-344. https://doi.org/10.1097/ADM.0000000000001280
Skryabin, V. Y., Shevtsova, Y. B., & Novoselova, E. A. (2023). Consequences of 1,4-butanediol misuse: A review. Psychopharmacology Bulletin, 53(4), 48-53. PMCID: PMC10698855.
Moitroux, A., & Kestens, C. (2023). [Withdrawal syndrome following chronic use of gamma-hydroxybutyric acid (GHB)]. Revue Médicale de Liège, 78(7-8), 451-455.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 25 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes.
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