Drug Guide

GHB (Hydroxybutyric Acid)

By Anthony McDaniel, M.D.

Hydroxybutyric acid (GHB), also known as 4-hydroxybutanoic acid and sodium oxybate (INN) when used for medicinal purposes, is a naturally occurring substance found in the central nervous system, wine, beef, small citrus fruits, and almost all animals in small amounts. It is also categorized as an illegal drug in many countries. It is currently regulated in Australia and New Zealand, Canada, most of Europe and in the US. GHB as the sodium salt, known as sodium oxybate, is sold by Jazz Pharmaceuticals under the name Xyremto treat cataplexy and excessive daytime sleepiness in patients with narcolepsy.

GHB has been used in a medical setting as a general anesthetic, to treat conditions such as insomnia, clinical depression, narcolepsy, and alcoholism, and to improve athletic performance. It is also used as an intoxicant (illegally in many jurisdictions) or as a date rape drug. GHB is naturally produced in the human body's cells and is structurally related to the ketone body beta-hydroxybutyrate. As a supplement/drug, it is used most commonly in the form of a salt, for example sodium gamma-hydroxybutyrate (Na.GHB, sodium oxybate) or potassium gamma-hydroxybutyrate (K.GHB). GHB is also produced as a result of fermentation, and so is found in small quantities in some beers and wines. Succinic semialdehyde dehydrogenase deficiency is a disease that causes GHB to accumulate in the blood.

Since the 1970s club scene, club-goers have used a range of drugs to enhance their experience on the dance floor such as amyl nitrite "poppers" and cocaine. In the 1990s, newer "club drugs" became popular, such as ketamine and "designer" phenethylamines designed to circumvent contemporary drug laws, "ecstasy" (chemically MDMA, 3,4-methylenedioxy methamphetamine, or 3,4-methylenedioxy methyl alpha-methyl phenethylamine) and 2C-I (chemically 2,5-dimethoxy-4-iodophenethylamine) being prominent examples. When the laws "catch up" to certain drugs, clandestine chemists manufacture another drug, designed to affect the user in the same way as the now-banned drug. Since most of these drugs are congeners of the banned drugs, the Federal Analogue Act was introduced in the US to ban these substances proactively, based on the proclivity of a said chemical to mimic either the structure or the effects of the banned drug.

Like these other "club drugs," GHB is taken because users feel that it enhances the experience of being in a club or at a party; small doses of GHB are thought to act as a stimulant and aphrodisiac. GHB is sometimes referred to as liquid ecstasy, liquid X, or liquid E due to its tendency to produce euphoria and sociability and its use in the dance party scene. Despite this nickname, GHB has entirely separate chemical and pharmacological modes of action compared to ecstasy. The drug has been identified as a date rape drug, much the same way as alcohol and potent benzodiazepines, often known colloquially as "Rohypnol", the trade name of a potent hypnotic benzodiazepine, flunitrazepam. It has a salty taste but, as it is colorless and odorless, it has been described as "very easy to add to drinks" that mask the flavor. GHB has been used in cases of drug-related sexual assault, usually when the victim is vulnerable due to intoxication with a sedative, generally alcohol. However it is difficult to establish how often GHB is used to facilitate rape as it is difficult to detect in a urine sample after a day, and many victims may not recall the rape until sometime after this. However cases of GHB being used as a date rape drug are quite rare.

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