GHB

Gamma-hydroxybutyrate (GHB) is a naturally occurring substance in the human central nervous system and wine, beef, small citrus fruits, and almost all animals in small amounts. It was first synthesised in a laboratory in the 1960s and has since been used for various medical purposes, including the treatment of narcolepsy and alcohol withdrawal syndrome.^{1, 8}

GHB produces a feeling of euphoria and a sensation of increased sociability when taken recreationally. It has, however, also been associated with significant public health problems, such as misuse and addiction, and has been implicated in cases of ‘drug-facilitated’ sexual assault.^{2, 5} Furthermore, GHB has been associated with numerous fatalities, often when combined with alcohol or other drugs.³

In summary, while GHB has some therapeutic uses, it is also a substance of abuse with the potential to cause severe harm, including death. Both beneficial applications and significant challenges to public health and safety mark its history from discovery to the present day.

Appearance

GHB typically presents as a colourless and transparent liquid. However, it can also be found in other forms such as a white powder or as capsules.²

Tastе

GHB has a slightly salty taste. This taste can be masked when the drug is mixed with alcoholic or other sweet beverages, but it can sometimes make drinks taste noticeably saltier or different.⁵

Smell

GHB is generally odourless, making it difficult to detect based on smell alone.⁴

GHB is often taken orally in liquid form, typically mixed with a beverage. The drug is also found in the form of powder or capsules, which are either ingested or diluted in a liquid.² However, the use of GHB for non-medical purposes is illegal and highly dangerous due to the narrow margin between a recreational dose and a potentially lethal dose.³

The doses reported in the literature vary greatly, as they are dependent on numerous factors, including the individual’s body weight, tolerance, and the purity of the drug. Here are some approximate ranges:

• Minimum to feel something (mg): The threshold dose, or the minimum amount to feel something, is typically reported to be around 500mg to 1g.
• Low dose: A low dose is typically between 1g to 2g. This dosage may produce feelings of relaxation and euphoria.
• Common dose: A common recreational dose usually ranges from 1g to 2.5g. This can cause feelings of euphoria, increased sociability, and drowsiness.
• High dose: High doses of 2.5g to 4g can lead to confusion, dizziness, and sedation. Over 4g is often considered a dangerously high dose and may lead to unconsciousness, seizures, and even coma.⁶

Notes on what may happen when exceeding the high dose: When high doses of GHB are consumed, it can lead to dangerous and potentially lethal health effects. These can include severe respiratory depression, unconsciousness, seizures, and even coma.³ In some cases, high doses of GHB can result in death, typically due to respiratory failure.

Users of GHB often report feeling a sense of euphoria, increased sociability, and relaxation. Some people may also experience increased libido, a sense of tranquillity, and mild hallucinations.² However, these feelings are dose-dependent and can quickly give way to more dangerous effects at higher doses.

GHB can have various physical effects, including changes in heart rate, blood pressure, and respiration. At higher doses, it can cause seizures.

The effects of GHB are typically felt within 10 to 20 minutes after consumption.

Expected duration of effects of the drug after consumption: After consumption, GHB typically takes about 10 to 20 minutes to start having an effect. However, this can vary depending on individual factors such as body weight, metabolism, and whether the drug was taken on an empty or full stomach.⁶

In terms of risks, in addition to the possibility of overdose and the associated health effects, the use of GHB can lead to dependency and withdrawal symptoms. These can include insomnia, anxiety, tremors, and, in severe cases, hallucinations and delirium.⁷

Regarding its legal status in the UK, GHB is classified as a Class C drug under the Misuse of Drugs Act 1971, meaning it’s illegal to possess, supply, or produce. Penalties for possession can be up to 2 years in prison, an unlimited fine, or both, while supply and production can lead to up to 14 years in prison, an unlimited fine, or both.

Mixing GHB with other substances, particularly alcohol or other depressants, can lead to unpredictable effects and significantly increase the risk of overdose. This is because these substances can enhance the depressant effects of GHB on the central nervous system, leading to severe respiratory depression, unconsciousness, or death.

1. Mamelak, M. (2009). Treatment of narcolepsy with gamma-hydroxybutyrate. Sleep, 12(1), 77-87. https://pubmed.ncbi.nlm.nih.gov/2928622/
2. Carter, L. P., Pardi, D., Gorsline, J., & Griffiths, R. R. (2009). Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem): Differences in characteristics and misuse. Drug and Alcohol Dependence, 104(1-2), 1-10. https://www.sciencedirect.com/science/article/abs/pii/S0376871609001720
3. Zvosec, D. L., Smith, S. W., Porrata, T., Strobl, A. Q., & Dyer, J. E. (2011). Case series of 226 γ-hydroxybutyrate-associated deaths: Lethal toxicity and trauma. The American Journal of Emergency Medicine, 29(3), 319-332. https://www.sciencedirect.com/science/article/abs/pii/S0735675709004641
4. Wood, D. M., Warren-Gash, C., Ashraf, T., Greene, S. L., Shather, Z., Trivedy, C., Clarke, S., & Dargan, P. I. (2008). Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD). QJM: An International Journal of Medicine, 101(1), 23-29. https://academic.oup.com/qjmed/article/101/5/337/1530076
5. Couper, F.J., Marinetti, L.J. (2002). The Findings of Drugs in Cases of Sexual Assault. Journal of Forensic Sciences, 47(5), 1089-1093. https://pubmed.ncbi.nlm.nih.gov/12362506/
6. Busardò, F.P., Jones, A.W. (2015). GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome. Current Neuropharmacology, 13(1), 47-70. http://www.eurekaselect.com/article/65708
7. Galloway, G.P., Frederick, S.L., Staggers Jr, F.E. et al. (1997). Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence. Addiction, 92(1), 89-96. https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1997.tb03640.x
8. Gallimberti, L., Canton, G., Gentile, N., Ferri, M., Cibin, M., Ferrara, S.D., Fadda, F., Gessa, G.L. (1989). Gamma-hydroxybutyric acid for treatment of alcohol withdrawal syndrome. The Lancet, 334(8666), 787-789. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(89)90738-2/fulltext