Acute toxicity and withdrawal syndromes related to gamma‐hydroxybutyrate (GHB) and its analogues gamma‐butyrolactone (GBL) and 1,4‐butanediol (1,4‐BD)

Abstract

Gamma-hydroxybutyrate (GHB) has been used as a recreational drug since the 1990s and over the last few years there has been increasing use of its analogues gamma-butyrolactone (GBL) and to a lesser extent 1,4-butanediol (1,4BD). This review will summarize the literature on the pharmacology of these compounds; the patterns and management of acute toxicity associated with their use; and the clinical patterns of presentation and management of chronic dependency associated with GHB and its analogues.

Misuse of the γ‐aminobutyric acid analogues baclofen, gabapentin and pregabalin in the UK

“…There is also concern regarding their access from online pharmacies and misuse of legitimately prescribed medication [5]. Furthermore, dependent users of recreational drugs may seek access to these medications in an attempt to prevent or treat withdrawal symptoms [3,6,7]. However, to date there have been no data reported on the prevalence of the misuse of these medications in any country.…”

Gamma-hydroxybutyrate (GHB): an emerging substance of abuse

“…First developed as an anesthetic agent in 1960, and in subsequent years the abuses have been reported in body building activities as dietary supplements and growth hormone stimulant. Starting from the eighties, it started to be used especially as a "club drug" because of its sexual desire enhancing effects, and an increasing number of case reports of GHB acute poisoning have been reported (1)(2)(3)(4).…”

A brief history of ‘new psychoactive substances’

“…When GHB was listed in Schedule IV of the United Nations Convention on Psychotropic Substances around eight years ago, rapid substitution took place, and the metabolically active precursor chemical γ -butyrolactone (GBL) became prevalent. Both GHB and GBL, as well as the related substance 1,4-butanediol, are described by Wood et al [11] By around 2006, it became clear that manufacturers of new substances were now trawling the world's scientific and patent literature in search of failed pharmaceuticals or, as they also became known, 'designer medicines'. The piperazines were soon followed in around 2008 by cathinone derivatives, the most common of which in Europe was 4-methylmethcathinone (mephedrone).…”