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GHB Overview

GHB (Xyrem) is a central nervous system (CNS) depressant that was approved by the Food and Drug Administration (FDA) in 2002 for use in the treatment of narcolepsy (a sleep disorder). This approval came with severe restrictions, including its use only for the treatment of narcolepsy, and the requirement for a patient registry monitored by the FDA. GHB is also a metabolite of the inhibitory neurotransmitter gamma-amino butyric acid (GABA). It exists naturally in the brain, but at much lower concentrations than those found when GHB is abused. GHB and Rohypnol are available in odorless, colorless, and tasteless forms that are frequently combined with alcohol and other beverages. Both drugs have been used to commit sexual assaults (also known as “date rape,” “drug rape,” “acquaintance rape,” or “drug-assisted” assault) due to their ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault. GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is typically taken orally in pill form. Recent reports, however, have shown that Rohypnol is being ground up and snorted. GHB is also abused for their intoxicating effects, similar to other CNS depressants. GHB also has anabolic effects (it stimulates protein synthesis) and has been used by bodybuilders to aid in fat reduction and muscle building.

GHB Abuse Treatment

Little information is available on treatment options for persons addicted to any club drug, including GHB. Some users of GHB are not physically dependent upon it, and can be treated and informed on an outpatient basis. Chronic use may result in severe withdrawal symptoms upon detoxification, and close medical supervision and supportive care is required for these patients. Hospitalization may range from 7 to 14 days. Withdrawal effects are reported as severe and patients may attempt to self-detoxify using benzodiazepines or alcohol. Using these additional substances may worsen withdrawal, and lead to respiratory depression, coma and death. Medications such as benzodiazepines, antihypertensive medications, and/or anticonvulsants may be needed during detoxification, but only under medical supervision. Baclofen has been noted in a case report as a possible treatment for GHB withdrawal. This is not a current FDA-approved treatment use. Baclofen is a GABAB agonist, as is GHB. Baclofen can occupy GABAB receptor sites, replacing GHB, while GHB withdrawal takes place. In the case report, the addition of baclofen allowed the rapid decreases in the GHB dose without seizure or delirium and resulted in long-term improvement of tremors.

Amnesia or memory loss is a complication of treatment that may result in relapse, with the patient returning to GHB use, unaware of the consequences of GHB addiction. Continued patient education is necessary to overcome this adverse effect.

GHB Signs of Abuse

There are ways to notice whether or not an individual is struggling with GHB/club drug abuse. There are certain effects that the drug has on the body that others can take note of. The subjective effects of gamma-hydroxybutyrate (GHB) are reported as:

  • Changes in personality or behavior
  • Feelings of relaxation
  • Increased sociability
  • Loss of inhibition
  • Sense of wellbeing
  • Heightened sexual interest
  • Restful sleep

There are also wide individual differences in response to the drug so some may experience adverse side-effects even at low dose. Central nervous system (CNS) depression is the hallmark of GHB ingestion. Deaths have occurred where individuals have been 'left to sleep it off'. Individuals tend to come to medical attention as a result of adverse effects or overdose. Diagnosis is usually based on history (typically third party or collateral information from paramedics, etc.) and on clinical examination.

Effects of GHB Abuse

GHB acts on at least two sites in the brain: the GABAB receptor and a specific GHB binding site. At high doses, GHB’s sedative effects may result in sleep, coma, or death. Coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB and two of its precursors, gamma butyrolactone (GBL) and 1, 4 butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths.

GHB Withdrawal Symptoms

Repeated use of GHB may lead to withdrawal effects, including insomnia, anxiety, tremors, and sweating. Severe withdrawal reactions have been reported among patients presenting from an overdose of GHB or related compounds, especially if other drugs or alcohol are involved.

GHB Abuse Statistics

GHB addiction is a treatable condition, but its use is increasing in recent years. According to the 2011 Survey on Drug Use and Health by the US Substance Abuse and Mental Health Administration, it is estimated that 607,000 persons per year used GHB in the years 2009-2011, compared to 374,000 during 2002-2005. Similarly, the estimated number of new GHB users increased from 109,000 per year during 2002-2005 to 169,000 per year during 2009-2011. The increase in initiation is evident among young adults aged 18 to 25 and adults aged 26 and older. There were 28,000 youth initiates per year in 2002-2005 and 27,000 in 2009-2011. Young adult initiates increased from 53,000 per year to 89,000 per year, and older adult initiates increased from 28,000 to 54,000 for these combined time periods. Past year use estimates for 2002-2005 and 2009-2011 showed the same pattern: for youths, estimates were 43,000 and 39,000; for young adults, the estimates were 124,000 and 208,000; and for older adults, the estimates were 207,000 and 361,000. Monitoring the Future (MTF) data indicates an increase for young adults aged 19 to 28 and a decrease for 10th graders in rates of past year GHB use between 2002 and 2011. MTF data did not indicate any changes among 8th and 12th graders between these 2 years. Patients with GHB addiction should seek advice from health care providers who can guide them with the most appropriate and safe treatment. Combined behavioral and medical therapies may allow the patient to integrate back into mainstream society and lead a positive and productive life.

References
http://www.drugabuse.gov
http://www.fda.gov/Drugs
http://www.usa.gov/
http://www.justice.gov/dea/druginfo/factsheets.shtml
http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp

Individualized detox protocols are carefully monitored and tailored to address detox symptoms. As part of our holistic approach, our detox incorporates traditional detox with biofeedback sessions.

Clients being treated in our residential program reside with us for the specific amount of days established in their individualized addiction treatment program.

Our treatment model is rooted in the belief that it is our utmost responsibility to do whatever we can to prepare our clients for life outside of treatment.

In addition to our traditional therapeutic treatments we offer holistic and alternative therapies such as: yoga, chiropractic care, medical massage, personal training and art therapy.