GAMMA HYDROXYBUTYRIC ACID
Sodium oxybate is the sodium salt of gamma-hydroxybutyrate (GHB), an endogenous metabolite of gamma-aminobutyric acid (GABA) a major inhibitory neurotransmitter. Evidence suggests a role for GHB as a neuromodulator/neurotransmitter. Under endogenous conditions and concentrations, and depending on the cell group affected, GHB may increase or decrease neuronal activity by inhibiting the release of neurotransmitters that are co-localised with GHB. After exogenous administration, most of the observed behavioural effects appear to be mediated via the activity of GHB at GABA(B) receptors, as long as the concentration is sufficient to elicit binding, which does not happen at endogenous concentrations. Xyrem (sodium oxybate) oral solution is indicated for the treatment of cataplexy in narcolepsy and excessive daytime sleepiness (EDS) in narcolepsy.
It is used most commonly in the form of a chemical salt (Na-GHB or K-GHB) which is taken recreationally as a depressant with effects quite similar to those of alcohol. These salts are powders but are most often mixed with water for recreational use. While GHB is most notorious for a few cases where it has been given to unsuspecting individuals, it is more commonly used as a recreational intoxicant like alcohol, as a sleep-aid, or as a supplement by body-builders. One of the major concerns with GHB is that the recreational dosage range is narrow and even small overdoses can cause temporary unrousable unconsciousness (a type of coma) and large overdoses (poisonings) can be life-threatening.
It's a drug with a bizarre back story. Depending on whom you ask, it's either the perfect party drug - or pure evil. The substance, which is produced naturally in small amounts by the body, was used in 1960 as an anesthetic. In the late 1980s, the drug became popular among gym goers and club kids.Fans claim that GHB provides the euphoria of alcohol without the sloppy side effects like slurred speech or hangover. Bodybuilders say that it increases production of human growth hormone (HGH) and promotes sounder sleep. When users overdose, however, GHB can cause a coma like sleep - and mixing it with alcohol the increases the depressant effect, quickly leading to unconsciousness. This led to the substance being labeled, along with Rohypnol ("roofies"), as the drug of choice for sexual predators.
The average GHB dose is 1 to 5 grams and takes effect in 15 to 30 minutes, depending on the dosage and purity of the drug. "One gram of GHB can be like a can of beer, two grams can be like three cans, and three grams can be like a case,". Young clubbers who smuggle the liquid in water, Gatorade, or eye drop containers love the drug for the same reason as their older celeb counterparts: It's very difficult for police to detect and leaves the blood within a few hours.
"I call it the Nick Nolte effect," said former LAPD detective Trinka Porrata, who now runs ProjectGHB, a nonprofit focused on GHB addiction and recovery. Porrata was referring to the 2002 incident in which the actor was arrested while driving under the influence of GHB, which resulted in the now-infamous wild-haired mug shot. She explained that hospital emergency rooms do not have the technology to test for GHB on site, so they have to send out for additional lab work, which can be expensive and time- consuming. "They do it because no one, including judges, knows what GHB is. The system forces them into it," she says.
What is particularly unique about GHB is that onset of unconsciousness can occur quickly. A user can be dancing and talking with friends, yet a few seconds later fall on the floor unconscious and temporarily unwakeable. In fact, most users expect to "overdose" at some point and fall unconscious.
Charles says he's had some "horrible experiences" of friends who have passed out from the drug - what he calls "going under" - and thrown out of nightclubs while still unconscious. 'Going under' can last anything from 20 minutes to five hours and you don't know if that person might need an ambulance," he says.
He says the drug is used in nightclubs and at "chill-out" parties and is "very addictive". While the Class C drug increases the desire for sex and reduces inhibitions - the risks include unconsciousness, coma and death. One in five GHB users last year reported to the Global Drugs Survey that they had passed out or overdosed. Users also risk becoming dependent in a couple of weeks. The specific problem with GHB is you don't know how strong it is and a few drops of liquid are difficult to measure, especially if its odourless.
Perceived as being more commonly (but not exclusively) used by gay men, GHB has prosocial (mood elevating and disinhibiting - a bit like alcohol) and sexual promoting and enhancing effects. It's big on the chemsex scene in many cities. There is a tiny difference (less than 1ml) between the dose that gets people feeling happy and horny, and the dose that leaves them unconscious so we strongly advise to always measure dosage carefully using a syringe. Note that alcohol increases the respiratory depression that you get with GHB, massively increasing the risk of overdose. Because GHB comes on very quickly after taking it (within 15 minutes) and only last a few hours, taking another dose too soon can increase your risk of overdose so leave a minimum of 2-3 hours between doses. Because GHB can affect your memory we advise people to set a reminder on your phone. Like all illegal drugs the purity and potency of different batches vary.
The chemical gamma-hydroxybutyrate (GHB) is a naturally occurring component of human cells. It is a central nervous depressant that was initially sold and promoted in health food stores to improve physical performance, reduce stress, induce sleep, build muscle, and burn fat. GHB, also known as "G" or "liquid ecstasy," is now often found and used in social environments, such as parties, clubs, and raves, for its intoxicating, euphoric, and sedative effects. Because of these effects, GHB can be lethal when combined with alcohol or other depressants, and as a result, has been implicated in many cases of 'date rape' and also labeled as a 'club drug.' GHB was synthesized and introduced into medicine in 1960.
GHB (gamma-hydroxybutyrate) is a powerful central nervous system depressant that the human body produces in small amounts. A synthetic (man-made) version of GHB was developed in the 1920s as an anesthetic. Individuals abuse synthetic GHB because of its euphoric and sedative effects. Because of its anesthetic properties, GHB also has been used by sexual predators to incapacitate their victims. GHB analogs, which include GBL, BD, GHV, and GVL, are drugs that possess chemical structures that closely resemble GHB. These analogs produce effects similar to those associated with GHB and are often used in its place.
Gamma-Hydroxybutyric acid (GHB) is another name for the generic drug sodium oxybate. Xyrem (which is sodium oxybate) is the trade name of the FDA approved prescription medication.
Analogues that are often substituted for GHB include GBL (gamma butyrolactone) and 1,4 BD (also called just "BD"), which is 1,4-butanediol. These analogues are available legally as industrial solvents used to produce polyurethane, pesticides, elastic fibers, pharmaceuticals, coatings on metal or plastic, and other products. They are also sold illicitly as supplements for bodybuilding, fat loss, reversal of baldness, improved eyesight, and to combat aging, depression, drug addiction, and insomnia. GBL and BD are sold as "fish tank cleaner," "ink stain remover," "ink cartridge cleaner," and "nail enamel remover" for approximately $100 per bottle - much more expensive than comparable products. Attempts to identify the abuse of GHB analogues are hampered by the fact that routine toxicological screens do not detect the presence of these analogues.
At bars or "rave" parties, GHB is typically sold in liquid form by the capful or "swig" for $5 to $25 per cap. GHB has been encountered in nearly every region of the country. GHB is usually sold as a liquid or as a white powder that is dissolved in a liquid, such as water, juice, or alcohol. GHB dissolved in liquid has been packaged in small vials or small water bottles. In liquid form, GHB is clear and colorless and slightly salty in taste.
GHB and its analogues are abused for their euphoric and calming effects and because some people believe they build muscles and cause weight loss. GHB and its analogues are also misused for their ability to increase libido, suggestibility, passivity, and to cause amnesia (no memory of events while under the influence of the substance) - traits that make users vulnerable to sexual assault and other criminal acts.
GHB abuse became popular among teens and young adults at dance clubs and "raves" in the 1990s and gained notoriety as a date rape drug. GHB is taken alone or in combination with other drugs, such as alcohol (primarily), other depressants, stimulants, hallucinogens, and marijuana.
GHB takes effect in 15 to 30 minutes, and the effects last 3 to 6 hours. Low doses of GHB produce nausea. At high doses, GHB overdose can result in unconsciousness, seizures, slowed heart rate, greatly slowed breathing, lower body temperature, vomiting, nausea, coma, and death.
Currently, there is no antidote available for GHB intoxication.
- Combining G with alcohol, opiates, benzos, or any other CNS depressant is extremely dangerous and can be fatal, even if taken several hours apart.
- Never use G alone. If you pass out, your breathing passage can become blocked and you could suffocate.
- G has a moderate to high addiction potential. Daily use can lead to severe, physical withdrawal symptoms requiring medical assistance.
- Like alcohol, G impairs judgment and motor functioning. Don't drive on G. Even if you think you can drive fine, the effects of G can suddenly become stronger.
- Don't store G in a bottle that could be mistaken for water. Some people dye their G blue with food coloring in order to distinguish it from water and help prevent accidental dosing.
- GHB and GBL are illegal under federal and state laws. BD is banned under analogue laws in several states. Possession can result in long prison sentences.
- Be self aware! If you choose to use G, having an intention is the best way to maximize the benefits and reduce the risks.
GHB (gamma hydroxybutyrate) is a depressant, which means it slows down the messages traveling between the brain and the body. GHB usually comes as a colourless, odourless, bitter or salty liquid, which is usually sold in small bottles or vials. It can also come as a bright blue liquid known as 'blue nitro', and less commonly as a crystal powder. GHB is usually swallowed, but sometimes it's injected or inserted anally. There is no safe level of drug use. The chemical composition of GHB is highly variable. It's very easy to take too much GHB: the difference between the amount needed to get high and the amount that causes an overdose can be hard to judge.
Street Names: GHB, G, Liquid Ecstasy, Liquid X,Liquid G,Goop, Georgia Home Boy, Grievous Bodily Harm, Easy Lay
|Prescribers Digital Reference|
|Adults:||9 grams/night PO.|
|Geriatric:||9 grams/night PO.|
|Adolescents:||Weighing 45 kg or more: 9 grams/night PO.|
|Adolescents:||Weighing 30 to 44 kg: 7.5 grams/night PO.|
|Adolescents:||Weighing 20 to 29 kg: 6 grams/night PO.|
|Children:||7 to 12 years weighing 45 kg or more: 9 grams/night PO.|
|Children:||7 to 12 years weighing 30 to 44 kg: 7.5 grams/night PO.|
|Children:||7 to 12 years weighing 20 to 29 kg: 6 grams/night PO.|
|Children:||7 to 12 years weighing less than 20 kg: Specific information not available; a maximum nightly dosage less than 6 grams/night PO should be considered.|
|Children:||1 to 6 years: Safety and efficacy have not been established.|
|Infants:||Safety and efficacy have not been established.|
A euphoric depressant which is prescribed as a sleep aid and sometimes to help with Alcohol detox. Also used as a recreational depressant, as a non-toxic alternative to Alcohol. Despite not having Alcohol's toxicity it is risky due to among other things inconsistent concentration in commonly sold solution form, and can be very dangerous if taken with other depressants.
NOTE: Tends to induce heavy sedation from about the 3g mark.
|All ROAs:||20-60 minutes||1.5-2.5 hours||2-4 hours|
Alcohol, benzos and other depressants
Similar to alcohol, but subjectively 'cleaner'
|Black Box Warnings:|
Central nervous system (CNS)
Abuse and misuse
Risk Evaluation and Mitigation Strategy program
World Health Organization 2012:
GHB, also known as 4-hydroxybutanoic acid and sodium oxybate, is a naturally-occurring substance found in the central nervous system, wine, beef, small citrus fruits, and almost all animals in small amounts. At pharmalogical doses it acts as a central nervous system depressant. Since the 1960s GHB has undergone various preclinical and clinical trials and has been evaluated for a range of potential therapeutic uses in obstetrics, anaesthesia, alcohol/opiate withdrawal and treatment of narcolepsy and cataplexy.Furthermore, some reports have suggested antidepressant effects of GHB as well as sex enhancing effects in humans. Tolerance and withdrawal has been observed at prolonged high dosage. Reports indicate that GHB is misused for various reasons and by various sections of society. These include, its sexual enhancing effects, growth hormone promoting effects and more recently its euphoric ("high") effects. There have also been reports of GHB being used to facilitate sexual assault.
GHB can easily be manufactured in the home from inexpensive ingredients and recipes obtained from the Internet. The powder (usually GHB sodium salt) is invariably mixed with water prior to consumption. Many of the dangers associated with illicit GHB use are due to variances in the GHB concentrations of such solutions.GHB has been reported to be mainly used and misused in USA, Australia and Europe and has resulted in numerous hospital admissions and related deaths. It appears that toxic effects can be produced directly from the compound and the presence of other substances and particularly alcohol may exacerbate such effects. A range of factors such as low price, ease of availability and administration,lack of information, the need for sedation following heavy stimulant use, and careless media coverage, increase the probability of GHB diffusion and consequent harm. Other factors, such as antisocial effects, relatively short duration, and its low-status image, mitigate against widespread diffusion and so decrease the probability of harm.
Common or street names:
Circles, Date Rape Drug, Forget Pill, Forget-Me Pill, La Rocha, Lunch Money, Mexican Valium, Mind Eraser, Pingus, R2, Reynolds, Rib, Roach, Roach 2, Roaches, Roachies, Roapies, Rochas Dos, Roofies, Rope, Rophies, Row-Shay, Ruffies, Trip-and-Fall, Wolfies
GHB has been used in the medical setting as a general anesthetic and as a treatment for cataplexy, narcolepsy, and alcoholism. It is also used illegally as an intoxicant, as an athletic performance enhancer, as a date rape drug, and as a recreational drug.
Recreational doses of 1 - 2 g generally provide a feeling of euphoria, and larger doses create deleterious effects such as reduced motor function and drowsiness.
GHB has been used as a club drug, apparently starting in the 1990s, as small doses of GHB can act as a euphoriant and are believed to be aphrodisiac. By 2009 this use had diminished, possibly due to the narrow range of dosing and adverse effects of confusion, dizziness, blurred vision, hot/cold flushes, profuse sweating, vomiting, and loss of consciousness when overdosed. The downward trend was still apparent in 2012.
Usage as a date rape drug:
- A naturally occurring neurotransmitter and a psychoactive drug
- A central nervous system depressant
- The effects of GHB can last from 1.5 to 4 hours, or longer if large doses have been consumed
- First published work on it in 1874
- First extended research into GHB and its use in humans was conducted in the early 1960s
GHB became known to the general public as a date rape drug by the late 1990s. GHB is colourless and odorless and has been described as "very easy to add to drinks". When consumed, the victim will quickly feel groggy and sleepy and may become unconscious. Upon recovery they may have an impaired ability to recall events that have occurred during the period of intoxication. In these situations evidence and the identification of the perpetrator of the rape is often difficult. It is also difficult to establish how often GHB is used to facilitate rape as it is difficult to detect in a urine sample after a day, and many victims may only recall the rape some time after its occurrence.
At higher doses, GHB may induce nausea, dizziness, drowsiness, agitation, visual disturbances, depressed breathing, amnesia, unconsciousness, and death.
Consuming GHB with alcohol can cause respiratory arrest and vomiting in combination with unrousable sleep, which can contribute to a lethal outcome.
GAMMA HYDROXYBUTYRIC ACID PREPARATIONS
The prescription form of GHB has been approved by the U.S. Food and Drug Administration (FDA) for treatment of narcolepsy, a sleep disorder caused by the brain's inability to regulate sleep-wake cycles. People with narcolepsy experience irresistible bouts of daytime sleep. They can also experience muscle control problems, paralysis, and hallucinations. GHB is available under the generic name sodium oxybate and trade name Xyrem (Orphan Medical) for the treatment of paralysis associated with narcolepsy.
|Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.|
Stop using sodium oxybate and call your doctor at once if you have:
Common side effects may include:
|This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.|
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB)
- A medication used to treat two symptoms of narcolepsy: sudden muscle weakness and excessive daytime sleepiness
- Approved for use by the FDA to treat symptoms of narcolepsy in 2002
- Approved for treating symptoms of narcolepsy in the European Union in 2005
In the US, the cost (as of Q3 2015) of Xyrem is $5,468.09 per 180 mL bottle (500 mg/mL)(a 10 to 15-day supply). Jazz Pharmaceuticals raised the price of Xyrem 841%. In 2007 it cost $2.04; by 2014 it cost $19.40 per 1-milliliter dose.
γ-Hydroxybutyric Acid - Table 1. Table 1. Molecular Mechanisms and Physiological Consequences of Ingestion of GHB. Figure 1. Figure 1. Putative Metabolic Interrelationship of GHB with γ-Butyrolactone and 1,4-Butanediol.
Wednesday September 13, 2023 - nejm.org
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