Gamma‐butyrolactone (GBL) dependence and withdrawal

Abstract

GBL withdrawal can be managed in ambulatory settings, but needs to be backed up with seamless access to in-patient treatment if required.

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

“…This is similar to that of alcohol, but sometimes with particularly marked neuropsychiatric symptoms and autonomic instability that can be life-threatening. For a comprehensive review of GHB abuse, dependence and withdrawal, see Gonzalez and Nutt, (2005) (Bell and Collins, 2011;McDonough et al, 2004). There are case reports of the use of other sedative agents, mainly pentobarbital, in patients resistant to treatment with benzodiazepines (McDonough et al, 2004;Schneir et al, 2001;Sivilotti et al, 2001) (III).…”

Commentary on Bell & Collins (2011): Out‐patient management of gamma‐hydroxy butyric acid (GHB) withdrawal – an alternative strategy for the future?

“…As stated by Bell & Collins, in 82% of cases in a previous case report series detoxification commenced unplanned [1,5]. This raises the question of whether planned detoxification in an outpatient setting is superior to unplanned detoxification beginning in an emergency department (which is often the case) with respect to compliance, lapses to GHB/GBL use and successful completion of withdrawal.…”

“…However, as shown by Bell & Collins [1] out-patient management can be an alternative option, in particular when considering that a significant number of patients in the mentioned case report series refused admission to an in-patient setting (17 of 19 patients). As stated by Bell & Collins, in 82% of cases in a previous case report series detoxification commenced unplanned [1,5].…”

“…Secondly, as stated in the paper [1] there are only few data available on the use of GHB and its precursors in adolescents. Despite publication of one case report of a 16-year-old patient with acute withdrawal symptoms, and a review on clinical implications for child psychiatrists [2,3] there is limited evidence on treatment strategies for both acute intoxication and also acute withdrawal delirium in younger patients.…”

“…The paper by Bell & Collins [1] adds an important perspective on the management of detoxification with the party drug gamma-hydroxy butyric acid (GHB) and its physiological precursor gamma-butyrolactone (GBL) in an out-patient setting. A couple of points deserve careful consideration when interpreting the data of this highly interesting case report series.…”