Incidence of craving for and abuse of gamma-hydroxybutyric acid (GHB) in different populations of treated alcoholics: an open comparative study

Abstract

Gamma-hydroxybutyric acid (GHB) is a drug currently used for the treatment of alcohol dependence. The aim of our study was to investigate the incidence of craving for and abuse of GHB in 47 patients enrolled and divided into four groups: group A (pure alcoholics), group B (alcoholics with a sustained full remission from cocaine dependence), group C (alcoholics with a sustained full remission from heroin dependence) and group D (alcoholics in a methadone maintenance treatment [MMT] programme). All patients were treated with an oral dose of GHB (50 mg/kg of body weight t.i.d.) for three months. Craving for GHB was statistically significant higher in group B than in group A (P < 0.001), C (P = 0.01) and D (P < 0.001), and in group C than in group D (P < 0.05). Abuse of GHB proved to be statistically significant higher in group B than in group A (P < 0.001) and D (P < 0.01), and in group C than in group A (P = 0.01) and D (P < 0.05). Thus, the administration of GHB in alcoholics with a sustained full remission from heroin or cocaine dependence is not recommended; however, this should not discourage physicians from using GHB for the treatment of pure alcoholics or alcohol dependents following a MMT.

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

“…The likelihood of craving is highly elevated for such patients who also have a psychiatric condition (Caputo et al, 2011). Those with a previous history of opioid or cocaine dependence are also at such risk (Caputo et al, 2009).…”

“…The general advice is not to use it in combination with sedative hypnotics, other CNS depressants or antiepileptics; or by those suffering from epilepsy or epileptiform seizures. Use of sodium oxybate is also contraindicated for those with previous or current addiction to opioids and other CNS depressants, those with a previous cocaine addiction (Caputo et al, 2009), or those with mental health issues/disorders (Gerot Lannach Pharma, 2007;Laboratorio Farmaceutico C.T.Srl., 2007;Murali and Kotagal, 2006). The UK cases examined here included individuals contraindicated for such combinations.…”

Suppression by γ-Hydroxybutyric Acid of “Alcohol Deprivation Effect” in Rats: Preclinical Evidence of its anti-Relapse Properties

“…In terms of mechanism of action, the similarity of the pharmacological profile of GHB and alcohol has led to hypothesize that the suppressing effects exerted by GHB on alcohol withdrawal syndrome, alcohol consumption, and craving for alcohol may be due to the “substitution” of alcohol actions, similar to methadone in heroin addiction (see Agabio and Gessa, 2002; Addolorato et al, 2009). As predictable on the basis of a number of clinical and preclinical observations (see Nicholson and Balster, 2001; Drasbek et al, 2006), the major limitation of the therapeutic use of GHB appears to be its abuse potential: a portion of patients undergoing GHB treatment voluntarily increased their daily GHB dosage (although some of these self-administered increases were made in an attempt to achieve more effective therapeutic doses) (Addolorato et al, 1996; Gallimberti et al, 2000; Glisson and Norton, 2002; Caputo et al, 2011) and some patients even developed dependence on GHB (Addolorato et al, 1999b; see also Caputo et al, 2009). …”

Acide gamma-hydroxy-butyrique (GHB) : plus qu’un agent de soumission chimique, une véritable source d’addiction

“…La dépendance au GHB est également une modalité de consommation décrite [63,101]. Des cas d'usage régulier de GHB suggèrent le développement sur plus de 12 mois d'une envie irrésistible de consommer (craving) [102], d'une tolé-rance, d'un syndrome de sevrage à l'arrêt de la consommation de la drogue quel que soit son dosage [53]. Cependant, plus la dose est élevée, plus le risque addictif serait important [56].…”