Gamma-hydroxybutyrate (GHB), also known as ‘fantasy’, ‘grievous bodily harm’ (‘GBH’), ‘liquid ecstasy’ and ‘liquid E’, is classed as a depressant drug that contains sedative and, at sufficient doses, anesthetic properties. Depressant drugs slow down the activity of the brain and other parts of the central nervous system. Alcohol, heroin and benzodiazepines are drugs that also have depressant effects.
GHB naturally occurs in the body as a neurochemical compound. It was first manufactured in 1960 and has been used in several countries as a general anesthetic, and for treatment of the sleep disorders insomnia and narcolepsy. More recently, GHB is being trialed as a treatment for alcohol and opiate (e.g. heroin) withdrawal.
GHB commonly comes as a colorless, odorless, bitter or salty-tasting liquid usually sold in small bottles or vials. It also comes as a crystal powder. It is mostly taken orally, however, there have been reports of people injecting the drug. Some media reports have implied that GHB also comes in a bright blue liquid form (‘blue nitro’), however it is important to note that manufacturers can change the color of GHB by adding a different color food dye.
Generally, two broad groups of people have been known to take GHB. In the 1980s bodybuilders used it to promote the kind of sleep known as ‘slow wave sleep’, during which a growth hormone is released. More recently, an increasing number of people in the dance/club scene are using GHB for its euphoric and sedative effects. GHB has also been identified as a ‘date rape drug’ due to effects of amnesia, impairing movement and speech, and because it can be added to drinks without visible trace.
The effects of any drug vary from person to person and depend on many factors including: how much of the drug is used; the strength of the drug; how it is used; how often the person uses it; how recently the person has eaten; and the physical and psychological characteristics of the person.
The effects of GHB appear to vary greatly according to the amount used ‘ a small increase in amount can result in a dramatic increase in effect. One of the most dangerous aspects of using GHB is the small difference between an amount that produces the desired effect and the amount that results in overdose. A further risk is that there is often no way to be sure that the drug is manufactured correctly. Improperly made GHB may result in an extremely toxic mixture of GHB and the chemical sodium hydroxide.
Generally, the effects of GHB are experienced within fifteen minutes after use and last for approximately three hours. Effects of lower amounts may include:
- sense of wellbeing
- induced sleep
- increased confidence, reduced inhibitions
- increased sociability
- enhanced sense of touch
An increase in the amount or strength of GHB used, may result in the initial feelings of euphoria being replaced by effects including:
- extreme drowsiness/grogginess
- difficulty focusing eyes
- stiffening of muscles
- unconsciousness/abrupt short-term coma
- respiratory collapse
- amnesia (afterwards)
- impaired movement and speech
There appears to be a very fine line between the amount of GHB required to achieve the desired affect and that which leads to coma. As there is usually no way of knowing the strength of GHB, the risk of overdosing is increased. Combining GHB with other drugs will also increase the dangers. For example, using GHB with another central nervous system depressant, such as alcohol, benzodiazepines, such as ‘Valium’, or opiates, such as heroin, will intensify the effects and increase the risk of overdosing. Deaths have been associated with the use of GHB in the United States, however there is debate over whether death can result from using GHB alone or using GHB with other drugs, particularly alcohol.
An added risk of overdose is that GHB can cause both unconsciousness and vomiting, which raises the risk of choking on vomit.
There has been little research conducted on the effects of long-term use of GHB. Apart from the potential to develop physical and psychological dependence, the health and social consequences of long-term use are largely unknown.
Although not well known, reports suggest that some people can become both physically and psychologically dependent (addicted) on GHB.
Physical dependence occurs when a person’s body becomes used to functioning with the drug present; if the person suddenly stops their drug use, withdrawal symptoms are experienced. A sign of psychological dependence is when the use of a drug becomes increasingly important in a person’s life ‘ the drug use may take priority over other activities and responsibilities.
A person who becomes dependent on a drug may find it difficult to cut down or stop using.
Although research to date has been limited, there have been reports that prolonged use of high doses of GHB may lead to withdrawal symptoms after abrupt cessation of GHB use. Symptoms may include agitation/anxiety, insomnia, muscle cramping and tremors. Withdrawal symptoms may be experienced from three to twelve days before subsiding.
Little is known about GHB use during pregnancy. As is the case with many other licit and illicit drugs, GHB use during pregnancy is not recommended. Drug use during pregnancy can increase the incidence of premature labor, resulting in low birth weight babies. If the mother continues to use GHB while breastfeeding, it is possible that the drug will be present in the mother’s milk and possibly cause adverse effects to the baby.