Demographic and Clinical Characteristics of Regular GHB-Users with and without GHB-Induced Comas

Pereira, Filipa Raposo; McMaster, Minni T. B.; Vries, YvonD. A. T. de; Brink, Wim van den; Wingen, Guido A. van

doi:10.1080/10826084.2020.1793368

Cited by 6 publications

(8 citation statements)

References 51 publications

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“…Demographic characteristics of cases in this study and patterns in ED presentation day and time are consistent with observations from ambulance data in Victoria [1] and ED presentations in NSW [10] and SA [3]. The median age of 34 years is higher than reported in other studies [30][31][32], and the proportion of female GHBconfirmed cases (n = 24, 53.3%) contrasted with the predominance of males reported in studies with GHB user-groups [14] and ED presentation [12,33,34] and coronial data [2]. Three-quarters of GHB-confirmed ED presentations in our case series occurred on a weekday (Monday to Friday; n = 35, 77.8%), and most commonly between 12:00 and 18:00 h (44.4%).…”

Section: Discussionsupporting

confidence: 88%

A multicentre case series of analytically confirmed gamma‐hydroxybutyrate intoxications in Western Australian emergency departments: Pre‐hospital circumstances, co‐detections and clinical outcomes

Smith,

Greene,

McCutcheon

et al. 2024

Drug and Alcohol Review

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IntroductionGamma‐hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre‐hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA).MethodsThis case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre‐hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB‐confirmed cases.ResultsGHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One‐third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co‐detected in 37 (82.2%) GHB‐confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, ‘unresponsive’ and ‘unconscious’ in various pre‐hospital settings (n = 28, 62.2%). ‘Agitated’ and/or ‘erratic’ mental state and behavioural observations were recorded in 20 (44.4%) cases.Discussion and ConclusionsAnalytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co‐ingestion warrants further exploration.

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Section: Discussionsupporting

confidence: 88%

A multicentre case series of analytically confirmed gamma‐hydroxybutyrate intoxications in Western Australian emergency departments: Pre‐hospital circumstances, co‐detections and clinical outcomes

Smith,

Greene,

McCutcheon

et al. 2024

Drug and Alcohol Review

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“…Whether such alterations also occur in recreational GHB-users, particularly in those experiencing multiple GHB-induced comas have been recently investigated by Pereira et al . [ 55 , 106 - 110 ]. For their investigations, they recruited 81 participants equally divided over three groups: (a) chronic users of high GHB doses (≥25 times in preceding two years) with multiple GHB-induced comas (≥4) with or without a GHB-use disorder (GHB-Coma group); (b) regular users of moderate GHB doses that never had a GHB-induced coma (GHB-NoComa group); and (c) a control group of mild polydrug users who never used GHB, since polysubstance use is a common habit among GHB users (No-GHB group).…”

Section: Resultsmentioning

confidence: 99%

“…found that heavy GHB-users who had multiple GHB-induced comas ( i.e . GHB-Coma group) perform worst on verbal memory and self-reported higher levels of anxiety, stress, depression, and impulsivity [ 55 , 106 , 108 ]. Moreover, in fMRI studies using episodic memory, working memory, and emotion processing tasks, the GHB-Coma group showed a compromised capacity to interpret and encode new memories, reduced focus, and problems in interpreting negative emotions compared to the other two groups [ 106 - 108 ].…”

Section: Resultsmentioning

confidence: 99%

“…Importantly, POCD may appear after surgery under general anaesthesia, but independently of the anaesthetic drug [ 53 ] and the type of anaesthesia (general or spinal) [ 54 ]. Remarkably, most frequent GHB-users were not concerned about potential neurocognitive impairments induced by GHB-intoxication and/or GHB-induced comas [ 33 , 55 ]. The risk of neurotoxicity, including cognitive impairment, associated with GHB use and GHB-induced coma has been previously reviewed [ 56 - 58 ].…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review

Amsterdam

Brunt

Pereira

et al. 2022

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Background: GHB (gamma-hydroxybutyric acid; sodium oxybate) is a general anaesthetic that is clinically used for the treatment of narcolepsy, cataplexy, alcohol withdrawal and alcohol relapse prevention. In addition, GHB is recreationally used. Most clinical and recreational users regard GHB as an innocent drug devoid of adverse effects, despite its high dependence potential and possible neurotoxic effects. At high doses, GHB may lead to a comatose state. This paper systematically reviews possible cognitive impairments due to clinical and recreational GHB use. Methods: PubMed and PsychINFO were searched for literature data about the acute and residual cognitive deficits following GHB use. This review is conducted using the PRISMA protocol. Results: A total of 43 reports covering human and animal data on GHB-induced cognitive impairments were eligible and reviewed. This systematic review found no indication for cognitive impairments after clinical GHB use. However, it supports the view that moderate GHB use may result in acute short-term cognitive impairments, whereas regular high-dose GHB use and/or multiple GHB-induced comas are probably neurotoxic resulting in long-term residual cognitive impairments. Conclusion: These results emphasize the need for awareness among clinicians and recreational users to minimize negative health consequences of recreational GHB use, particularly when high doses are used, and GHB-induced comas occur.

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“…Clinical effects become evident as early as 5 min after ingestion, reaching their peak after 30–60 min. GHB can induce a dose-dependent stimulant or sedative effect, adding to its recreational appeal [ 12 ]. This dual effect is associated with euphoria, disinhibition, sensory and sexual arousal at lower doses, evolving into anxiolytic, narcotic and sedative effects and altered states of consciousness at higher doses.…”

Section: Introductionmentioning

confidence: 99%

GHB: a life-threatening drug complications and outcome of GHB detoxification treatment—an observational clinical study

Neu,

Danker-Hopfe,

Fisher

et al. 2023

Addict Sci Clin Pract

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Background GHB (gammahydroxybutyrate) and its precursors are popular recreational drugs due to their sedative, anxiolytic and sexually stimulating effects. Their use has been steadily increasing in recent years. The detoxification process is complex and prone to high rates of complications while little is known about the pathophysiology. This study aims to elucidate the characteristics of GHB-addicted patients and to evaluate the risks and complications of GHB withdrawal treatment. Methods This observational study describes prospectively the socioeconomic status, clinical history and course of inpatient detoxification treatment of a group of 39 patients suffering from GHB substance use disorder. Detoxification treatment took place in a highly specialized psychiatric inpatient unit for substance use disorders. Results GHB patients were characterised by being young, well-educated and by living alone. More than 50% of the patients had no regular income. The patients were male and female in equal numbers. Detoxification treatment was complicated, with high rates of delirium (30.8%) and high need for intensive care (20.5%). Conclusions In our sample, GHB users were young, well-educated people and male and female in equal number. Detoxification proved to be dangerous for GHB-addicted patients. The presence of delirium and the need for transfer to an intensive care unit during detoxification treatment was extraordinarily high, even with appropriate clinical treatment. The reasons for this remain unknown. Therefore an intensive care unit should be available for GHB detoxification treatment. Further studies are needed to evaluate the options for prophylactic treatment of delirium during detoxification.

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Demographic and Clinical Characteristics of Regular GHB-Users with and without GHB-Induced Comas

Cited by 6 publications

References 51 publications

A multicentre case series of analytically confirmed gamma‐hydroxybutyrate intoxications in Western Australian emergency departments: Pre‐hospital circumstances, co‐detections and clinical outcomes

A multicentre case series of analytically confirmed gamma‐hydroxybutyrate intoxications in Western Australian emergency departments: Pre‐hospital circumstances, co‐detections and clinical outcomes

Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review

GHB: a life-threatening drug complications and outcome of GHB detoxification treatment—an observational clinical study

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