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GHB, GBL Intoxication

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Abstract

  • History, chemical profile

    • Gamma-Hydroxybutyric acid is a general anesthetic. It was first synthetized in France by Henri Laborit. Its chemical structure is close to GABA therefore explaining both its euphoric and sedative profile by way of action on GABA receptors.

    • GHB’s medical use today is limited to narcolepsy.

    • Gamma-Butyrolatone results from dehydration of GHB. It has no action of its own. It behaves as a pro-drug of GHB. Lactonase transforms GBL back into GHB. Because of its fat solubility, GBL has a higher potency and faster onset of action.

    • 1,4-Butanediol or 1,4BD is another close parent to GHB and GBL but is less potent.

    • The main metabolism steps of GHB, GBL, and 1,4BD use alcohol deshydrogenase and aldehyde deshydrogenase. This pathway is shared with alcohol. This explains the cumulative effect of these drugs and alcohol.

  • How does the drug present, how is it consumed?

    • GHB and GBL both present as a salt. The powder is most often ingested after dissolution in water or another liquid. Some users inject dissolved GHB although this is rare.

    • GHB is often dissolved in alcoholic beverages in the party context. This also allows to mask its salty taste.

    • GBL is sometimes sold as a dietary supplement, although illegal in most developed countries.

  • Context of using and desired effect

    • At low dose, GHB provokes euphoria, disinhibition, increased empathy, interest in sex. It is sometimes labelled as “liquid ecstasy.”

    • “Chemsex” or “PNP/Party and Play” parties constitute typical contexts of using where GHB is used to increase/enhance sexual performances.

    • At higher does, GHB is sedative. Sleep inducing can be the desired effect.

    • GHB is used by athletes as a doping agent. It has been shown to increase Growth Hormone secretion in men.

    • GHB has been called the “rape drug.” Dissolved in the victim’s drink, it can allow the perpetrator to take advantage of his/her victim who will have limited to no recollection of events.

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References

  1. Hockenhull J, Murphy KG, Paterson S. An observed rise in gamma-hydroxybutyrate-associated deaths in London: evidence to suggest a possible link with concomitant rise in chemsex. Forensic Sci Int. 2017;270:93–7.

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  2. Mason PE, Kerns WP. Gamma hydroxybutyric acid intoxication. Acad Emerg Med. 2002;9(7):730–9.

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Correspondence to Julien J. Cavanagh M.D. .

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Cavanagh, J.J., Smith, T.Y. (2018). GHB, GBL Intoxication. In: Nordstrom, K., Wilson, M. (eds) Quick Guide to Psychiatric Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-58260-3_32

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  • DOI: https://doi.org/10.1007/978-3-319-58260-3_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-58258-0

  • Online ISBN: 978-3-319-58260-3

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