Many people are dependent on drugs, mostly legal, but just because it's available at a health store or pharmacy doesn't necessarily mean that it's good for you. This is the case with gamma hydroxybutyrate (GHB). In certain cases, as in the treatment of narcolepsy and cataplexy, GHB helps people to live healthy lives, but in other instances GHB claims lives for its own. A look at the research neurobiologists have recently done may give us a better understanding as to the cause.

What Is GHB?

GHB is a four-carbon metabolite that occurs naturally in the human body, where it is mostly found in the brain's basal ganglia, cortex, midbrain, substantia nigra, and hippocampus. In the hippocampus, the GHB receptor sites seem to mediate intrinsic neurons. GHB is structurally similar to gamma amino butyric acid (GABA) and is a dopamine enhancer (increasing dopamine levels in the brain). The function of GHB is currently uncertain. Since it can easily permeate blood brain barriers (unlike most neurotransmitters), excess GHB will modify normal brain function.

GHB is also found in peripheral blood and readily crosses placental membranes. GHB is known to act as a depressant on the body's central nervous system, reducing the amount of oxygen that reaches the brain. When synthetically produced, GHB is a hypnotic sedative, either in liquid or solid (powder) state. It is highly soluble, colourless, odourless, and nearly tasteless.

Aside from GHB itself, there are a few common analogues of GHB that are still on the market, that once ingested, turn into GHB. The two most common of these are gamma butyl lactone (GBL) and 1-4 butane diol (BD). GBL is most commonly found in nail polish, super-glue removers, and industrial floor cleaners. BD is often used as a substitute for GBL. Once these compounds form GHB, it is rapidly metabolized, taking between 20 to 30 minutes to reach maximal plasma concentration, and is excreted in the form of CO₂ and H₂O, making it very difficult to trace. As of yet, there is no process for a coroner to determine whether or not the cause of death was an overdose of GHB.

The Uses of GHB

Until 1990, GHB was sold in the USA as a dietary supplement (it is found in animal flesh foods), but due to unwanted side effects it was banned. Presently, GHB is illegal in most States and Canada, excluding investigational research regarding its use as a possibly treatment for narcolepsy and related disorders.

In Europe, GHB is used during treatment for:

• Insomnia, narcolepsy, anxiety, stress, and depression
• As a withdrawal suppressant for alcoholism and opiate addiction
• As a general anaesthetic
• As an aid during childbirth

Many places in Europe are considering discontinuing the use of GHB, as it is being used more and more for recreational purposes.

Although banned, GHB is still used in North America for a variety of purposes. On the rave scene it is used to enhance sex, or as a date rape drug, since it is highly soluble, colourless, and almost tasteless, leaving the victim defenseless and often with anterograde amnesia. GHB is also advertised as a synthetic steroid, assisting in the increase of muscle mass (this has not yet been clinically proven), athletic stamina, and a growth hormone stimulate. Other people consume GHB:

• As a health supplement to fight depression, stress and anxiety
• As a sleeping aid
• To combat ageing
• To increase libido
• To decrease body fat
• To improve memory capacity
• To build self-confidence
• To relieve the symptoms of Parkinson's disease, nactumal myocionus, schizophrenia, Huntington's chlorea, dystonia musculorum deformans, tardive dyskinesia, and hyperactivity

Legally, GHB is used in the intermediate synthesis of polyvinylpyrrolidone, DL-methionine, piperdine, phenylbuteric acid, and thiobutyric acids. It is also used as a solvent for resins, a constituent of paint remover, a textile aid, and in drilling oil.

The Effects of GHB

GHB has an extremely wide range of effects, including:

• Nothing
• Euphoria
• Electrolyte imbalance
• Increased heart rate
• Lack of co-ordination
• Respiratory depression
• Addiction
• Speech difficulty
• Bradycardia
• Pulmonary edema
• Enlarged heart
• Inebriation
• Hypotonia
• Hypertension
• Unconsciousness
• Seizures
• Vomiting and nausea
• Withdrawal
• Anterograde amnesia
• Confusion
• Vertigo
• Stomach pain
• Liver failure
• Brain damage
• Coma
• Death

Withdrawal from GHB may be life-threatening and may cause insomnia, anxiety, tremors, and sweating. Treatment for GHB withdrawal is non-specific and may take up to two weeks in an intensive care unit.

Conclusion

Although it appears that there are many areas where GHB may be useful, there is too much risk in making it freely available. It is estimated that there is at least seven years before a marketable, GHB-based drug will become available to narcoleptics, but with its continuing recreational use it may be longer. Despite the saying 'You can never have too much of a good thing', too much - indeed any - of anything can kill you.

Please Note: h2g2 is not a definitive medical resource. If you have any health concerns you must always seek advice from your local GP. You can also visit NHS Direct or BBC Health Conditions.