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All about Gamma-Hydroxybutyric Acid (GHB)

Last updated on 20th December 2023

In April 2022, Gamma-Hydroxybutyric Acid (GHB) was reclassified as a Class B drug, a change from its original Class C rating in the Misuse of Drugs Act 1971. This reclassification was predicated on an assessment of the drug’s harm by the Advisory Council on the Misuse of Drugs (ACMD)’s recommendations.

The ACMD reported that in the UK in recent years, drugs like GHB (collectively known as GHBRS) “have been used to facilitate serious crimes, including murder, rape, sexual assault and robbery.” It went on to describe criminal cases demonstrating this extreme criminal harm as well as health harm with “a marked increase in deaths between 2008 and 2018.”

Data from the Office for National Statistics reports that, in the decade preceding 2018, GHB was mentioned on the death certificate of 219 people whose cause of death was drug poisoning. In 92 cases, it was the only drug mentioned on the death certificate. Experts believe that this is very likely to be an underestimate as GHB is not one of the drugs that are routinely tested for after a person’s death, as well as the fact that it is no longer in the body after around 24 hours.

The statistics show that GHB use is a growing public health concern in the UK, highlighting the need for increased awareness as well as access to treatment and support services.

GHB being put into a drink

What is gamma-hydroxybutyric acid?

Gamma-hydroxybutyric acid (GHB) is a chemical that occurs naturally in small amounts in the human body. It is a neurotransmitter that is produced in the brain and is involved in the regulation of various brain functions including sleep, anxiety and motor control. Its medical uses include treating narcolepsy (a sleep disorder) and alcohol withdrawal.

However, GHB is also synthesised in laboratories for its use as a drug and it is now classified as a Class B drug in the UK due to its potential for abuse, addiction and harm. It is used illicitly as a recreational drug due to its ability to produce euphoria, relaxation and sedation. It is sometimes nicknamed “liquid ecstasy” as a result.

Other street names include:

  • Scoop.
  • Grievous Bodily Harm.
  • Gina.
  • Liquid X.
  • Fantasy.
  • Georgia Home Boy.
  • Easy Law.
  • Great Hormones at Bedtime.
  • Soap.
  • Cherry Meth.
  • Blue Nitro.

GHB is a central nervous system depressant and its effects can be unpredictable and dangerous, especially when used in combination with other substances such as alcohol or other recreational drugs. Overdose of GHB can lead to coma, respiratory depression and even death.

GHB is almost identical to gamma-butyrolactone (GBL). This substance is sold in stores as an industrial solvent. Once it enters the body, it becomes GHB. Both GHB and GBL are odourless and come in the form of an oily liquid. Users dilute the drug into soft drinks before consuming.

What is gamma-hydroxybutyric acid used for?

GHB was originally developed in the USA as a pre-medication to help patients sleep before surgery. It is also used on prescription to treat narcolepsy – a sleep disorder characterised by excessive daytime sleepiness and sudden episodes of muscle weakness or paralysis. It has also been used as a treatment for drug and alcohol addiction and as an anaesthetic agent during surgery.

It works to treat narcolepsy because it suppresses the central nervous system and helps to regulate sleep patterns by increasing slow-wave sleep and reducing rapid-eye movement (REM) sleep. It is thought to work by binding to GABA-B receptors in the brain, which helps to calm neuronal activity and promote relaxation.

However, due to its potential for abuse and misuse, GHB is illegal to possess and its medical uses are also tightly regulated. It can only be prescribed by a qualified healthcare professional. It is classified as a controlled substance in the UK, meaning it is subject to strict regulations regarding its manufacture, distribution and use. Any use of GHB should only be under the supervision and guidance of a medical professional.

Is GHB addictive?

GHB is addictive. It has a high potential for abuse and dependence, particularly when used recreationally or in larger amounts than prescribed. GHB produces feelings of euphoria, relaxation and disinhibition which can lead to repeated use and ultimately addiction.

New evidence is emerging that shows how the body can become physically dependent on GHB. This is reportedly rare, but when someone becomes physically dependent on GHB it can be severe and withdrawal symptoms come on rapidly. This dependence can develop rather quickly, including after a single weekend’s binge on the drug or it could result from repeated use over time.

Withdrawal symptoms can occur when someone stops using GHB after developing a dependence.

These symptoms can include:

These withdrawal symptoms can be severe and even life-threatening. As a result, it’s important to seek medical help when discontinuing use. Doctors often treat GHB withdrawal with other drugs such as benzodiazepines, which themselves are also often addictive. Further research is needed into successful treatment options for GHB addiction and withdrawal.

How is GHB taken?

GHB is a colourless, odourless liquid with a slightly salty taste. It is often mixed with water or soft drinks. It can also be taken as a capsule or in powder form, but this is less common. The powder form is usually mixed in a drink before it is consumed.

GHB can be injected into a vein or a muscle for a more immediate and intense effect. If done like this recreationally, it is more dangerous and carries a higher risk of overdose and other complications.

Additionally, GHB can be administered rectally as a suppository for a faster and more potent effect.

The dosage and effects of GHB vary widely depending on the individual, how pure the drug is, and factors such as metabolism, body weight and tolerance. Its effects range from feelings of mild relaxation to profound sedation and loss of consciousness. Recreational use of GHB is illegal in the UK and is extremely dangerous, particularly when taken in combination with other drugs or alcohol.

Taking GHB through needle

What is gamma-hydroxybutyric acid known for?

GHB is not really known for its medicinal properties. Rather, it’s known for its sedative and euphoric effects and has gained notoriety as a drug that is sometimes used as a “date rape” drug as a result. In addition to its sedation effects, it also causes memory loss.

“Date rape” is a term used to describe a type of sexual assault that occurs when a person is forced or coerced into sexual activity by someone they know, usually on a date or in a social situation. It is often used to refer to situations where drugs or alcohol are used to incapacitate the victim and make them unable to resist or fight back.

When GHB is used in this context it’s often mixed with alcohol or other drugs to increase its effects. Given that it is odourless and almost tasteless, it is difficult to detect when it has been added to a drink, which is what makes it a popular choice for perpetrators of sexual assault.

In many cases, the perpetrator will slip GHB into the victim’s drink, often without their knowledge, to incapacitate them and take advantage of them sexually. As well as GHB, Rohypnol (also known as “roofies”) and ketamine are used.

Date rape is a serious crime and can have long-lasting physical and psychological effects on the victim. People need to be aware of the risks and take steps to protect themselves such as never leaving their drink unattended and avoiding situations where they may be vulnerable to this type of assault.

The BBC stresses that GHB has become a “rapist’s weapon of choice” stating that a recent survey estimated that over a quarter of those polled were sexually assaulted whilst unconscious. Notorious sexual predator Reynhard Sinaga used to take victims back to his flat where he would use the drug before assaulting them. It was his conviction for at least 136 rapes which helped lead to the reclassification of GHB.

Aside from this reputation, GHB is also used consensually by some and it is allegedly fairly common for gay men to use it during chemsex – when drugs are used to enhance the sexual experience between partners. Of course, aside from the risks associated with using GHB, chemsex also brings the added risks of sexually transmitted infections.

How does it affect the body?

Gamma-hydroxybutyric acid affects the body by depressing the central nervous system. Its effects are sedative, hypnotic and euphoric, causing relaxation, drowsiness and loss of inhibitions.

As mentioned, the drug acts on the gamma-aminobutyric acid (GABA) receptors in the brain, increasing the activity of this inhibitory neurotransmitter. This leads to a decrease in neuronal activity which is how the sedative and hypnotic effects arise.

GHB can also cause several physiological effects, including a decrease in heart rate, breathing rate and blood pressure. In higher doses, it can cause profound sedation, loss of consciousness and respiratory depression, which can be life-threatening.

Some more significant effects can occur as a result of its use, particularly when it comes to accidental overdose. These side effects include coma, respiratory depression, seizures and even death. This is one of the reasons why the drug has been reclassified and why its production and use are strictly regulated.

Treatments for GHB abuse

The treatment for GHB abuse usually involves a combination of medication-assisted treatment, behavioural therapy and support groups. As the withdrawal symptoms of GHB abuse can be severe and life-threatening, addiction treatment should be supervised by medical professionals. Indeed, competitive bodybuilder, former Mr America and Mr USA Mike Scarcella died during GHB withdrawal.

Medication

Medication-assisted treatment usually involves the use of other medications to manage unpleasant withdrawal symptoms and associated cravings for the drug. These medications may include benzodiazepines, barbiturates or other sedatives.

Behavioural therapy

Behavioural therapy is an essential component of GHB addiction treatment. Cognitive behavioural therapy (CBT) and contingency management are two common forms of therapy used in treating GHB addiction. CBT helps individuals to identify and modify the negative thought patterns and behaviours that contribute to their addiction.

Contingency management involves offering rewards or incentives for positive behaviours, such as attending therapy sessions or remaining drug-free.

Other psychotherapy treatments

Aside from CBT, there are other models that clinics use to treat addiction to substances such as GHB. Not all of those addicted to GHB will respond in the same way and sometimes people need to try different methodologies before they find something that works for them.

Methodologies include:

  • Acceptance and commitment therapy.
  • Art therapy.
  • Counselling.
  • Experiential therapy.
  • Dialectical behavioural therapy.
  • Group therapy.
  • Family therapy.
  • Music therapy.
  • Meditation.
  • Holistic therapy.
  • Fitness therapy.
  • Psychodynamic therapy.

Support groups

Support groups, such as Narcotics Anonymous (NA) or SMART Recovery, can also be helpful in GHB addiction treatment. Groups such as these offer a supportive and understanding environment for those in recovery. They can also offer more resources and tools for staying clean.

Preventing relapse

People must seek professional help when they are dealing with GHB addiction. Treatment options can vary based on individual needs and circumstances, so it is crucial to work with a medical professional or addiction specialist to develop a personalised treatment plan.

Relapse is a common challenge in addiction recovery and GHB addiction is no exception.

If someone has relapsed with their addiction recovery, here are some steps they should follow:

1. Seek professional support from a healthcare worker, addiction counsellor or support group. They can provide guidance on the next steps such as detoxification, rehabilitation or ongoing support.

2. Identify triggers: Understanding the triggers that led to the relapse can prevent future relapses. Triggers may include stress, social situations or exposure to GHB or other substances. Once identified, steps can be taken to avoid or manage these triggers.

3. Develop a relapse prevention plan.

Counselling for drug addiction.

Final thoughts on Gamma-hydroxybutyric acid

It is important to remember that recovery from GHB addiction is a lifelong process. Treatment may involve multiple rounds of therapy and ongoing support from healthcare professionals, family and friends.

If you or someone you know needs support for GHB addiction, the following organisations may help:

Substance Misuse Awareness

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About the author

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Laura Allan

Laura is a former Modern Foreign Languages teacher who now works as a writer and translator. She is also acting Chair of Governors at her children’s primary school. Outside of work, Laura enjoys running and performing in amateur productions.



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