Overload

GHB

Category: Medicines

Type

Involuntary and voluntary

Introduction and description

all the following pictures are tarot cards

Gamma-Hydroxybutyric acid (GHB), also known as 4-hydroxybutanoic acid is a naturally occurring substance found in the central nervous system, beef, small citrus fruits, and almost all animals in small amounts. 

It is produced as a result of fermentation, and so is found in small quantities in some beers and wines.  I have had to include it in a section on its own because it is used by doctors in numerous ways.  

  • Insomnia treatment - GHB was widely used in France, Italy, and other European countries for several decades as a sleeping agent
  • Anaesthetic – GHB has been used as an  anaesthetic in childbirth
  • Narcolepsy treatment -  GHB as the sodium salt, known as sodium oxybate, is sold under the name Xyrem and used to treat ‘excessive daytime sleepiness’ in patients with narcolepsy.  
  • Alcoholism treatment - It has also been used to treat alcoholism.

GHB is highly addictive and its withdrawal symptoms are truly horrendous.  Problems with its addictive nature and its side effects have led to a decrease in legitimate medical use, although I still found numerous papers on PubMed from academics promoting it as a treatment for alcoholism. 

Chronic use of GHB may produce dependence and a withdrawal syndrome that includes anxiety, insomnia, tremor, and in severe cases, treatment-resistant psychoses”.

 
GHB Related Death  by Mia EROWID. Nov 21, 2002. erowid.org/exp/13889

As I write this, I am still reeling from the death of my friend. Last Thursday my life was changed when my roommate came home, shaking and crying. It took a minute for her to say it, that Brian was dead. Later, we discovered that he took a few doses of GHB and drank alcohol as well. Since his death was only a week ago, we are still unsure of the exact dosage, or exactly what happened. We do know, however, that Wednesday night Brian went to bed and never woke up.
None of us thought that something like this could happen to one of our friends. But, now, we are all affected by this experience. Not a single one of us will ever be the same, and though we will never forget Brian and are better having known him, we wish he was still with us today.
In memory of Brian G., 1982 - 2002

GHB Abuse

GHB has a far more infamous reputation, as a so called ‘recreational drug’ and one used to improve athletic performance. 

In this context it is given a vast number of alternative names, for example, G, liquid ecstasy, Grievous Bodily Harm, gib, soap, scoop, nitro, "Georgia Home Boy",  Mils, Liquid X, Liquid G, and Fantasy.  It also has the very unpleasant reputation of being a date rape drug.  In this context, it is classified as an illegal drug in many countries including Australia and New Zealand, Canada, most of Europe and in the US. 

We again have the somewhat peculiar situation that it is illegal when used by athletes and clubbers, but legal when used by doctors. 

In 2000, with 60 deaths reported from overdose in the USA this year and concern over its use as a “date rape” drug, GHB was reclassified as a schedule I controlled substance.  In 2002, sodium oxybate, a formulation of GHB, was approved for the treatment of narcolepsy and classified as schedule III. Recently, sodium oxybate has been studied as a treatment for alcohol withdrawal

Needless to say this legal route for manufacture has resulted in a continued supply for ‘illegal’ use.

I have provided a much more detailed section which included some scientific papers in the science section under the heading GHB.

 
GHB Death Dec 2001 by vintage angel EROWID Nov 21, 2002. erowid.org/exp/12936

Brennan B,18, was a classmate of mine since freshman year. on december 28, 2001, Brennan went to Jimmy's, a bar uptown. He was partying, getting drunk, enjoying the end of the year. Soon he was outside purchasing GHB. The GHB was inegested.
As the evening progressed, Brennan became 'overly intoxicated', and was escorted outside. Outside Jimmy's, Brennan collapsed. He sat there not breathing for 30 MINUTES. He was taken to Charity Hospital, comatose. When they tested his brain for activity, there was none. Brennan was brain dead. Nothing could be done to save him. On January 8, 2002, they turned off the machine that breathed for him. I attended his wake on January 10. I never would have thought as a freshman, that I would be attending this kid's wake, and that this kid would die from the mixture of GHB and alcohol, months shy of his 19th birthday, and his graduation.

Side-effects

Over the years GHB in its various incarnations has produced a lot of deaths – a lot.  It has also produced hallucinations, out of body and near death exxperiences.  Furthermore on withdrawal from GHB you can suffer from hallucinations as terrifying as any you get from alcohol withdrawal.  So this is why it is on this site.

According to the eHealthme web site, which uses only doctor submitted Adverse Drug reports  to the FDA and SEDA and is thus US only, the most common Xyrem side effects are:

  • Fall  (388 reports)
  • Nausea  (379 reports)
  • Dizziness  (322 reports)
  • Insomnia  (316 reports)
  • Death  (314 reports)
  • Drowsiness  (309 reports)
  • Headache  (277 reports)
  • Fatigue  (271 reports)
  • Nausea And Vomiting  (250 reports)
  • Stress And Anxiety  (248 reports)

Most common side effects over time  :

< 1 month 1 - 6 months 6 - 12 months 1 - 2 years 2 - 5 years 5 - 10 years 10+ years not specified
Nausea Fall Nausea Death Death Convulsion Urinary Incontinence Fall
Insomnia Death Death Insomnia Fall Fall Irritable Bowel Syndrome Nausea
Somnolence Nausea Condition Aggravated Fall Insomnia Death Serotonin Syndrome Condition Aggravated
Headache Dizziness Fall Headache Nausea Myocardial Infarction   Insomnia
Dizziness Headache Headache Nausea Hyperhidrosis Staphylococcal Infection   Dizziness
Vomiting Vomiting Depression Condition Aggravated Confusional State Condition Aggravated   Convulsion
Condition Aggravated Somnolence Somnolence Vomiting Disorientation Weight Decreased   Weight Decreased
Depression Fatigue Fatigue Confusional State Fatigue Hypertension   Fatigue
Anxiety Insomnia Hypoaesthesia Somnambulism Weight Decreased Delayed Recovery From Anaesthesia   Somnolence
Fatigue Condition Aggravated Muscle Spasms Enuresis Contusion Dementia   Death

The addictive nature of this drug is indicated by the time people are on it. 

 

Leigh. "OD, Hospitalization: An Experience with GHB (ID 13560)". EROWID Nov 9, 2005. erowid.org/exp/13560
Due to my ignorance and lack of information about GHB I ended up OD'ing. I was at a friend of mine's house and her brother (an avid drug user) brought us a bottle of GHB. ... I started feeling the effects not long after I had taken it. A feeling of being drunk is what I can relate it to. I remember being dragged from one room to another by my friends, unable to walk on my own. The very last thing I remember is lying on a mattress, talking about how much I love tool's music, while my friends were throwing a soccer ball at me. The next thing I remember is waking up in a hospital.
This is what my friends told me happen during the time I passed out and woke up in the hospital. First off I stopped talking. My friends thought I was faking it so they didn't mind me much. One of my friends heard me starting to breathe strangely - sort of like wheezing. She came over to me and at that point I stopped breathing all together. I am very lucky because she knows CPR and administered it to me which made me start to breathe again. During this time my other friend called 911 and woke up my friend's parents. The ambulance came and I once again stopped breathing. At one point my heart stopped as well.
I sat straight up when I finally woke up a day later. I tried to scream but there was a respirator down my throat. My family was there all crying. My brother later told me that on the way to the hospital my mom looked at him and said 'you know your sister's probably dead'. I was lucky that I made it. I had friends there that acted instead of saying 'oh she'll sleep it off'.


 Taking a snapshot view using ehealthme figures , on Aug, 28, 2015: 3,782 people reported to have side effects when taking Xyrem. Among them, 314 people (8.30%) have Death.  The trend is fascinating, it leads one to suspect that either it is being prescribed for new as yet unreported ailments, or there has been a lack of reporting up to and including 2010.

Trend of Death in Xyrem reports

Time on Xyrem when people have Death :

  < 1 month 1 - 6 months 6 - 12 months 1 - 2 years 2 - 5 years 5 - 10 years 10+ years
Death 25.15% 32.16% 12.28% 15.20% 12.28% 2.92% 0.00%
 

Elise. "An Experience with GHB (ID 2299)". EROWID Sep 24, 2001.  erowid.org/exp/2299
Sunday morning, someone came up to me at the Party Smart booth and asked me to help out their friend who had been passed out for about a half hour. I went over there and it was my Zack. He was just passed out at first so I sat there with him for about twenty minutes or so. Then he got really bad. He fell unconscious. Then he started puking up blood and stomach lining. He started to convulse and stuff. It was so horrible. He stopped breathing. For a while, we couldn't find a heartbeat. We tried to keep him alive at the party for about two hours. It was horrible. .....
I spent six hours at the hospital. The doctors told me to not be surprised if he died. When they finally got him stable, I went to go see him. He still wasn't conscious. They didn't think he would live. They said if he did, he could have serious brain damage, maybe even be a vegetable because of the lack of oxygen to his brain and asphyxiation. But anyway, twelve hours later, he finally became conscious. The doctors couldn't believe it. But he would stop breathing a lot and go into arrest. He finally began to breathe on his own, so they took the tube out of his throat. Then the cops came. The doctors said they would need to keep him there because he wasn't fully recovered and he was developing pneumonia but the cops persuaded them to release him into their custody. He could barely walk or stand up and they cuffed him and took him away.

 Addiction and withdrawal

In order to understand the following it helps to know that GBL is rapidly converted into GHB by paraoxonase (lactonase) enzymes, found in the blood.

"Severe Addiction : An Experience with GBL (ID 91760)". EROWID Aug 24, 2011. erowid.org/exp/91760

 

I had had a very troublesome year with severe depression and was not responding to various SSRI's and SNRI's. I ended up with some GBL and took a dose of around 2ml. My depression instantly lifted, as well as all of my anxiety and I was able to function normally. Once it's effects had worn away, I re-dosed.
I found myself in a pattern of frequent dosing, at the worst point I was re-dosing every 2 hours or less. I had developed a massive tolerance for the substance. After several months I was collapsing more and injuring myself after taking it. I was unable to hold down more than 2 hours sleep at a time as my body would wake me up to re-dose. Also I have read about a possible 'dopamine rebound,' that being that when you take GHB/GBL dopamine levels are supressed and rebound after a few hours...making you more alert and anxious. I can say that I most certainly would feel these effects.

I was literally a mess, I couldn't function properly anymore, nobody wanted to be around me and I couldn't go anywhere without taking GBL with me.

I decided to cut down my use in an attempt to stop, taking a lesser dose less often. I went to bed and woke up a few hours later not knowing where I was, who I was or what was going on. I was in such a state of confusion and my whole body was shaking violently. I began vomiting everywhere. After a few moments I some how instinctively had a shot of GBL and all of these withdrawal symptoms evaporated.

I knew then that I needed medical help to stop my GBL intake. I sought help and found it nearly impossible and none of the doctors seemed to know what it was. I spent two days educating different groups of doctors and being passed from one place to the next.

They eventually put him on benzodiaxepines................

May all the children [and adults] who died as a result of this drug rest in peace.

References and further reading

EROWID's information page on GHB

 

Related observations