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03/10/2009 - GHB
While some things change, some things stay the same in the field of Addiction Medicine. I was recently reminded of the recurrent popularity and use of GHB by a patient who presented for detoxification. This drug was very popular in the late 1980’s when it was purportedly used as a fat burner and growth hormone promoter. Prohibition of GHB by the FDA took place in 1990. Precursor drugs, such as GBL and BD, have been available for purchase to circumvent the FDA ruling, however these drugs have either been prohibited or placed in a Class I Health Hazard( potentially life-threatening ).
The drug initially causes a euphoric effect followed by CNS depression. Observed clinical presentations in GHB intoxication include seizure-activity, coma, nausea and emesis, memory loss, and respiratory depression, particularly in the presence of other CNS depressant drugs. The drug is odorless and tasteless which has facilitated usage as a “date-rape drug”.
Onset of withdrawal symptoms typically appear one to six hours after the last dose and consist of tremor, insomnia, restlessness, and anxiety, but may progress to delirium or psychosis. Symptoms of withdrawal may last up to two weeks. In addition, a post-acute withdrawal syndrome lasting three to six months may occur. The syndrome is manifested by dysphoria, insomnia, memory problems and drug cravings. As the drug is highly addictive, relapse is not uncommon.
There are no published protocols for the treatment of withdrawal, however there are a number of potentially effective pharmaceutical interventions. Hospitalization is usually recommended, followed by intensive outpatient treatment and clinical management.