GHB: Gamma Hydroxy Butyrate

Last updated: 30 April 2006

GHB: Gamma Hydroxy Butyrate

To inform the NSW public and health professionals of emerging trends in illicit drug use pertaining to GHB, and its precursors GBL and 1, 4-butanediol.

The information is for the benefit of the general public and all NSW Health staff involved in drug and alcohol treatment roles, particularly those staff working in Emergency Departments.

Chemical structure and composition of the substance

Gamma-hydroxy butyrate (GHB) is a water soluble, naturally occurring tetra carbon molecule. GHB is a catabolite of gamma-amino butyrate (GABA).

It is a central nervous depressant with sedative hypnotic effects, originally developed as pre-surgery anaesthetic.

Street names include Grievous Bodily Harm (GBH), liquid ecstasy, liquid E, fantasy, blue nitro and liquid. Recent reports indicate a possible new street name 'beauty'.

GBL and 1, 4-butanediol

Two precursors to GHB are more commonly available. These are: Gamma butyrolactone (GBL, an industrial solvent) and 1,4-butanediol and both can be substituted for GHB because once they are ingested they are converted to GHB. The effects are experienced more slowly than after ingestion of GHB.

GHB is an illicit substance.

GHB exists in the form of a white or pale coloured powder or crystals but is often sold in a liquid form. Colorants are commonly used in production to distinguish the substance from water.

GHB and GBL may have a bitter or salty taste but when mixed in a beverage they are difficult to detect. GBL, being a solvent has a distinct smell.

Prevalence in the community and target groups

23% of the 2004 national sample of Regular Ecstasy Users reported lifetime use of GHB and 10% of the sample reported use in the previous 6 months. Average reported use was 5.5mls.

Anecdotally, GHB has been increasingly involved in poisonings, overdoses, drug-facilitated sexual assaults (such as "date rapes"), and fatalities.

Prevalence of GHB in fatalities is difficult to determine, as the substance is virtually undetectable after six or seven hours.

Recent Emergency Department data for the month of February (2006) compared to 2004 and 2005 from one metropolitan hospital shows a 53% increase in the prevalence of GHB in poisoning-related ED presentations.

Effects of the substance

The effects of GHB and its precursors (GBL and 1, 4-butanediol) vary greatly from person to person and the effects are not predictable. GHB has amnesic and anaesthetic effects. A small increase in amount can result in a dramatic increase in effect.

Immediate effects experienced include:

• sense of well-being,
• relaxation,
• drowsiness,
• increased confidence,
• reduced inhibitions,
• dizziness,
• heightened sense of touch,
• nausea and
• headaches.

There is a narrow therapeutic window and toxicity can rapidly develop with small increases in dose.

The central nervous system (CNS) depressant effects are increased markedly when it is ingested with other CNS depressants such as alcohol or benzodiazepines. Ingestion with any other psychotropic substance is likely to increase risk of toxicity. As with other illicit drugs, purity of the substance cannot be guaranteed. Improperly made GHB may contain an extremely toxic mixture of GHB and the chemical sodium hydroxide.

Long term effects of GHB use are unclear. As GHB is similar to the effects of sedative drugs, it is possible that one may become physically or psychologically dependent. There is also the potential for tolerance to develop over a period of time to achieve the same (or any) effects as first experienced.

• GHB use with other drugs - combining GHB with other depressant drugs like prescription medications or alcohol can slow down the body's central nervous system and be dangerous. The adverse effects of one drug may be greatly increased by the other.

It is increasingly common for GHB to be mixed with alcohol both inadvertently and by choice. Alcohol is particularly dangerous in combination with GHB as it can be difficult to control the dose. Overdose is a significant risk in such situations.

• GHB use in pregnancy - as is the case with many prescription drugs and illicit drugs (as well as alcohol and tobacco), it is not recommended that GHB be use during pregnancy.
• GHB and the law - the law in Australia states that it is illegal to supply, manufacture, import, possess, sell or use the drug fantasy (gamma-hydroxy butyrate). A person who does any of the above can be fined anywhere between $2000 and $500,000 and imprisoned for anywhere between 2 years and a life sentence.

Evidence of toxicity

• Evidence of overdose includes respiratory depression and/or collapse, rapid onset of drowsiness, muscle spasms, movement and speech impairments, disorientation, slurred speech, memory loss, vomiting,
• Fluctuating vital signs (when using Glasgow Coma Scale (GCS) - measures level of consciousness).
• Other side effects from higher doses include: hallucinations, tremors, episodes of tachycardia, hypotension.
• Coma can result within 15-30 minutes after ingestion

Typical clinical presentation (information for ED or police)

• Patients will often present with a provisional diagnosis of poisoning.
• Patients will usually present with decreased levels of consciousness.
• Some may present with signs of agitation, confusion, slurred speech and with delirium.
• Respiration is commonly depressed and cardiovascular signs may include hypotension, bradycardia or tachycardia.
• Coma may precede respiratory arrest.

Appropriate treatments

• Exclude other causes of altered levels of consciousness, confusion and respiratory depression.
• Support vital functions while waiting for the drug to be metabolised.
• If presentation due to ingestion of GHB or GBL, patients should recover within 3-4 hours. If recovery is delayed, consider other complicating factors.

For help and support

Alcohol and Drug Information Service (ADIS) is a 24 hour confidential telephone counselling service. Call (02) 9361 8000 or toll free 1800 422 599.