The assessment and management of gamma hydroxybutyrate use in general practice

Phan, Vicky; Arunogiri, Shalini; Lubman, Dan I.

doi:10.31128/ajgp-05-19-4953

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…Co-ingestant use and other health problems should also be clarified, which can further assist with clinical risk stratifications. 45 Tolerance can lead to dose escalation requirements, often by increasing dosing frequency due to its rapid absorption and elimination processes. It is common that those with GHB dependence require multiple, frequent doses throughout the day to avoid symptoms of withdrawal.…”

Section: Chronic Use and Dependencementioning

confidence: 99%

“…GHB withdrawal features resemble that of alcohol withdrawal, but with more rapid onset of symptoms, often within hours of the last dose, given its short half-life, and can become severe rapidly. 45 It is therefore imperative that treatment is commenced promptly and early to manage and prevent rapid deterioration of the withdrawal syndrome. GHB withdrawal features can include tremor, anxiety, agitation, sleep disruption, diaphoresis, and autonomic instability.…”

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

“…Acute delirium, visual or auditory hallucinations and seizures have been reported in severe GHB withdrawal, and in some cases require intensive care management to avoid potentially fatal outcome. 23,45,48 The more severe GHB withdrawal symptoms resolve within 2 weeks, but as with other sedative hypnotics, symptoms of insomnia, mood disruption and anxiety may persist for some time after the acute episode is complete. 45,49 Factors proposed to predict development of withdrawal on cessation of use include amount and frequency of daily use (more than 4 mL daily, using more than 6 times per day), prior withdrawal, and using multiple substances.…”

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

“…23,45,48 The more severe GHB withdrawal symptoms resolve within 2 weeks, but as with other sedative hypnotics, symptoms of insomnia, mood disruption and anxiety may persist for some time after the acute episode is complete. 45,49 Factors proposed to predict development of withdrawal on cessation of use include amount and frequency of daily use (more than 4 mL daily, using more than 6 times per day), prior withdrawal, and using multiple substances. 49 High level use of greater than 30 mL daily may be associated with risk of severe withdrawal.…”

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

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Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

Tay¹,

WKW²,

Murnion³

2022

SAR

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Recreational gamma-hydroxybutyrate (GHB) use, although less common than other substance use, is increasingly recognised and is over-represented in emergency toxicology presentations. This narrative review summarizes GHB pharmacology, current patterns of use, potential harms and management of GHB toxicity and withdrawal. There is a complex interplay between GHB and GABA as GHB is both a prodrug and metabolite of GABA and GHB activates both GHB and GABA receptors. GHB is rapidly absorbed, with effects seen within minutes of ingestion. Metabolism is non-linear at higher doses. While GHB is listed as a controlled substance, its precursor's gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are easily available as both have industrial applications. National surveys indicate low rates of GHB use, with identification of high-risk populations in men who have sex with men and polysubstance users. GHB is one of the three drugs most commonly used in chemsex. GHB is often co-ingested with other interacting psychoactive substances. Acute toxicity is dose-dependent, and management is supportive care. Withdrawal management is generally with benzodiazepines with addition of baclofen for more severe withdrawal. Barbiturates may have a role. Titration and tapering of pharmaceutical GHB is commonly used in the Netherlands. Complicated withdrawal with delirium may require intensive care and treatment with intravenous sedation. There are high rates of relapse after withdrawal and medications for longerterm management are currently being investigated. Chronic use is associated with poorer mental, physical and sexual health, social dysfunction and poor work performance. Laboratory detection is complicated as GHB is an endogenous substance with a short halflife, and therefore not often routinely assayed in the clinical setting. Future research should focus on improving GHB detection and management of GHB withdrawal and dependence. Interventions specific for high-risk groups should be developed and assessed.

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Section: Chronic Use and Dependencementioning

confidence: 99%

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

Section: Withdrawal and Withdrawal Managementmentioning

confidence: 99%

See 2 more Smart Citations

Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

Tay¹,

WKW²,

Murnion³

2022

SAR

View full text Add to dashboard Cite

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Pharmacological Treatment of GHB Withdrawal Syndrome

Karila,

Angerville,

Benyamina

et al. 2024

Curr Addict Rep

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Purpose of Review Gamma-hydroxybutyrate (GHB) is an illicit drug used for many reasons: during music festivals or parties, for self-management of sleep and anxiety, or in combination with other drugs to facilitate chemsex. Most people who use GHB do so occasionally, without harm. However, a minority of users experience dependence or withdrawal symptoms. GHB withdrawal syndrome often has a specific course, with rapid onset and swift progression of severe complications. In this narrative review, we aimed to summarize recent evidence related to the pharmacological treatment of GHB withdrawal syndrome. Recent Findings The management of GHB withdrawal syndrome is challenging due to the lack of specific evaluation tools and pharmacological treatment guidelines. From current findings, two pharmacological regimens could be considered for inpatients and outpatients with GHB dependence during detoxification: benzodiazepines and pharmaceutical GHB. Summary Few detoxification protocols for GHB or its analogs have been reported in the literature. The main available evidence is based on case studies and uncontrolled open-label studies, which support the efficacy of pharmacological interventions, notably high-dose benzodiazepines and titration and tapering with pharmaceutical GHB, for the management of GHB withdrawal. Barbiturates such as phenobarbital and baclofen might also represent new therapeutic options. Future research should examine these pharmacological interventions with large-scale randomized trials, withdrawal scales, or validated treatment protocols.

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