Pharmacokinetically, GHB is rapidly absorbed with peak plasma levels 20-60 minutes after ingestion. The primary route of elimination is the lungs.
Clinically, GHB alters mood and may cause disinhibition, euphoria, dissociation, sexual arousal, incontinence, diarrhea and vomiting. Overdose of the drug causes a rapid progression to coma. There are no distinctive clinical markers of GHB-induced coma. What is distinctive is the rapid awakening that occurs 2 -4 hours following ingestion. Myoclonic jerks occur which may be mistaken for seizure. Physostigmine has been reported to reverse the effects of GHB. However, the effects of GHB are short lived. Cholinergic crises from too much physostigmine may be more dangerous than an overdose of GHB.
GHB withdrawal consists of anxiety, insomnia, tremors, disorientation and paranoia. Auditory and visual hallucinations, tachycardia and hypertension may occur. Initial treatment is with benzodiazepines.
As GHB becomes less available, GBL (gamma-butyrolactone), an industrial solvent is used to make GHB. Here’s the recipe:
1 qt GBL-heat to 192˚F until 1 lb or more NaOH (caustic soda) dissolves and solution reaches a pH of 6-7. If done correctly, one should have a 50% solution of GHB. 1 tsp of liquid equals 1 gm dry GHB. In order to achieve a good sleep, average dose of 3 gms required.
Let’s not dance around the side effects issue, though. You could get in trouble with GHB. Since it forces you to fall asleep you certainly wouldn’t want to drive a car or operate machinery. Oh, by the way, during this long sleep, you may loose control of your bowels or bladder if you have taken too much GHB.
The Underground Steroid Handbook
As always, if there any questions, call the MTPC.
I am interested in any questions that you would like answered in "Question of the Week". Please e-mail me with any suggestions.
donna.seger@vanderbilt.edu
Donna Seger, M.D.
Medical Director, Middle Tennessee Poison Center