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  • The clinical picture of an abrupt onset of coma followed by rapid recovery within a few hours should arouse suspicion for GHB intoxication.
  • GHB levels are rarely available in a timely fashion.
  • Coingestions with alcohol and ecstasy are commonly associated with the recreational use of GHB.
  • Exposures to solvents or other products containing GHB precursors may lead to delayed GHB intoxication.
  • From a legal perspective, GHB levels are problematic

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Gamma-hydroxybutyrate (GHB) was originally investigated in the 1960s as a general anesthetic. Adverse effects such as seizure-like activity and an unpredictable duration of anesthesia precluded its widespread acceptance in the United States. During the 1980s, GHB became popular with bodybuilders as a purported anabolic steroid alternative, and was available in gymnasiums and health food stores. After several reports of GHB toxicity were released, nonprescription sales of GHB in nutritional supplements were banned by the FDA. Despite this ban, however, in the 1990s, recreational use of GHB by adolescents and young adults at rave parties became an increasingly common problem, particularly in Europe. GHB gained notoriety in recent years as a drug used to facilitate sexual assault, because of its ability to cause rapid intoxication and amnesia. In addition, it is nearly colorless and odorless. In 2002, GHB was approved for the treatment of cataplexy in patients with narcolepsy, which remains its main clinical use today. It has dual status as a Schedule I and Schedule III drug of the Controlled Substances Act. Recently, some toys were found to have a coating containing 1,4-butanediol (1–4 BD), a GHB precursor which, after conversion to GHB, accidental intoxication in some children.1

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GHB is sold illicitly under various street names (Table 125–1). Intentionally obscure synonyms for the chemical names of GHB and its precursors help to conceal the identity of illicit GHB products. Two common precursors of GHB include gamma-butyrolactone (GBL) and 1–4 BD, which can be found in industrial solvents such as paint thinners, floor strippers, and consumer nail care products. Sales of “chemistry kits” containing GHB precursors were an attempt to circumvent the GHB restriction. Currently, both GBL and 1–4 BD are listed as controlled substance analogues.

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Table Graphic Jump Location
Table 125-1. “Street” and Chemical Names for Gamma-Hydroxybutyrate 
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GHB is available as a clear liquid, white powder, tablet, or capsule. Oral ingestion is the route most commonly used. For oral ingestions, peak concentrations occur within 25 to 45 minutes. The presence of gastric contents may decrease bioavailability. Duration of effect is approximately 1 to 2.5 hours after anesthetic doses of 50 to 60 mg/kg and 2.5 hours after accidental overdoses. ...

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