GHB

G, grievous bodily harm (GBH), fantasy, liquid E, liquid ecstasy, liquid x, 4-hydroxybutanoic acid

GHB stands for gamma-hydroxybutyrate, which is a depressant. Although it is sometimes called liquid ecstasy it is not chemically related to ecstasy, which is a stimulant. GHB is a naturally occurring substance found in the body.

It was first synthesised in the 1960s and developed as an anaesthetic, and has been used as a treatment for a number of medical conditions, including insomnia, depression, narcolepsy and alcoholism.

It has also been used by bodybuilders and athletes in the belief that it raises growth hormone levels; however, there is no evidence that this is the case. More recently, it has been associated with the nightclub and rave scenes.

GHB usually comes as a liquid, and is sold in vials, bottles or fish-shaped soy sauce containers. It is colourless, but may have colour added to stop it being mistaken for water or other clear liquids. It is odourless, and can have either a bitter or a salty taste.

Less often, GHB is found in the form of a white powder.

GHB, GBL and 1,4-B

Analogues such as gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-B) are converted to GHB by the body when they are ingested. GHB is reported to have a salty taste, while GBL and 1,4-B are said to have a ‘chemical’ taste. 

GHB and the law

It is prohibited to use, possess, supply or manufacture GHB in New South Wales.

How GHB is used

GHB is usually swallowed.

Short term effects

The short-term effects of GHB include:

  • feelings of euphoria and increased wellbeing
  • increased libido
  • drowsiness
  • nausea and vomiting
  • visual disturbances
  • agitation and dizziness
  • coordination
  • respiratory depression and distress.

Initial effects occur 15-20 minutes after oral administration, with peak effects occurring 30-60 minutes post-ingestion. The effects of GHB can last from one and a half hours, up to three hours, or even longer if large doses have been consumed. 

Long term effects

Little is known about the long-term effects of GHB due to the short time it has been used as a recreational drug.

How common is GHB use?

The 2016 National Drug Strategy Household Survey found that 1.0% of Australians aged 14 and over have ever tried GHB, while 0.1% used GHB in the year preceding the survey.

GHB and driving

The short-term effects which include drowsiness, visual disturbances, incoordination and dizziness, mean that it is dangerous and illegal, to drive while under the influence of GHB.

GHB and pregnancy

Little is known about the effects of GHB on the unborn child. However, it is possible that GHB crosses the placenta in pregnancy, and has some effect on the baby. It is also possible that GHB will be present in breast milk if taken during breastfeeding. 

Using GHB with other drugs

When GHB is mixed with other depressants, such as alcohol or benzodiazepines, it increases the depressant effects of both drugs, which may lead to respiratory distress and even death. Small doses of GHB are potentially very potent and when combined with alcohol or methamphetamines the risk of overdose is greatly increased. 

 

Dependence

Dependence can develop with chronic GHB use, although tolerance is not normally observed. 

Withdrawal

Binge use does not seem to be a risk for significant withdrawal symptoms — rather, long term continuous use of GHB or its analogues seem to be a pre-requisite for the development of the withdrawal syndrome. Withdrawal symptoms may include insomnia, anxiety, tremors, sweating, hallucinations, increased heart rate and blood pressure, and psychosis. Sudden withdrawal from high doses may require medical assistance, as bladder and bowel incontinence or blackouts may be experienced. 

Overdose

Overdosing is a serious danger with GHB. The difference between a dose that produces the desired effects and a dose that produces dangerous effects is very small. Serious adverse effects can include sudden sedation and respiratory distress. Analysis of different vials of GHB has shown that the concentration varies considerably, so users can never be sure of how much they are taking. 

Treatment

Evidence from better-researched drugs suggests that services providing good social support, as well as psychological interventions to help maintain motivation and improve coping skills, may be effective.