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GHB: Difference between revisions
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GHB as the sodium salt, known by the trade name Xyrem,<ref>http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=JAZZ.O</ref> is a prescription sleep-aid which is used to treat various medical conditions such as cataplexy<ref>{{Citation | title=Sodium Oxybate: MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a605032.html}}</ref> and excessive daytime sleepiness in patients with narcolepsy.<ref>{{Citation | vauthors=((Kluger, R.)), ((Mamelak, M.)) | title=Pharmaceutical composition and treatment of narcolepsy | url=https://patents.google.com/patent/US4738985A/en}}</ref> It has also been used in a medical setting as a general anesthetic to treat conditions such as insomnia, clinical depression, and alcoholism,<ref>{{Citation | vauthors=((Gessa, G. L.)), ((Fadda, F.)), ((Campochiaro, C. M. di)) | title=Use of gamma-hydroxybutyric acid salts for preparing pharmaceutical compositions for use in the treatment of alcoholism, and the compositions obtained | url=https://patents.google.com/patent/US4983632A/en}}</ref> and to improve athletic performance. | GHB as the sodium salt, known by the trade name Xyrem,<ref>http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=JAZZ.O</ref> is a prescription sleep-aid which is used to treat various medical conditions such as cataplexy<ref>{{Citation | title=Sodium Oxybate: MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a605032.html}}</ref> and excessive daytime sleepiness in patients with narcolepsy.<ref>{{Citation | vauthors=((Kluger, R.)), ((Mamelak, M.)) | title=Pharmaceutical composition and treatment of narcolepsy | url=https://patents.google.com/patent/US4738985A/en}}</ref> It has also been used in a medical setting as a general anesthetic to treat conditions such as insomnia, clinical depression, and alcoholism,<ref>{{Citation | vauthors=((Gessa, G. L.)), ((Fadda, F.)), ((Campochiaro, C. M. di)) | title=Use of gamma-hydroxybutyric acid salts for preparing pharmaceutical compositions for use in the treatment of alcoholism, and the compositions obtained | url=https://patents.google.com/patent/US4983632A/en}}</ref> and to improve athletic performance. | ||
GHB is used as a recreational substance for its alcohol-like effects. While a common recreational dose is between 1.5 - 2.5 grams, a dose between 2.5 grams and 5 grams will likely result in falling asleep within 5 - 15 minutes, and a dose of 5 - 10 grams can result in convulsions, unconsciousness (a coma-like state) and vomiting. Doses above 10 grams are associated with a risk of death.<ref name="ErowidGHBVault">{{Citation | title=Erowid GHB Vault : Dosage | url=https://www.erowid.org/chemicals/ghb/ghb_dose.shtml}}</ref> Do not confuse grams with milliliters. If consuming GHB that has already been premixed into a liquid form, additional caution is required as there is no way to know for sure the concentration of the solution (e.g. how many grams of GHB is in each mL of solution). As such, users are advised to start with a low dose and work their way up slowly by increasing the dose in small increments. However, an appropriate interval between dosing is essential to avoid accidental overdose. | GHB is used as a recreational substance for its alcohol-like effects. While a common recreational dose is between 1.5 - 2.5 grams, a dose between 2.5 grams and 5 grams will likely result in falling asleep within 5 - 15 minutes, and a dose of 5 - 10 grams can result in convulsions, unconsciousness (a coma-like state) and vomiting. Doses above 10 grams are associated with a risk of death.<ref name="ErowidGHBVault">{{Citation | title=Erowid GHB Vault : Dosage | url=https://www.erowid.org/chemicals/ghb/ghb_dose.shtml}}</ref> Do not confuse grams with milliliters (the density of GHB is aproximately 1.2g/ml <ref>https://www.chemspider.com/Chemical-Structure.9984.html</ref>). If consuming GHB that has already been premixed into a liquid form, additional caution is required as there is no way to know for sure the concentration of the solution (e.g. how many grams of GHB is in each mL of solution). As such, users are advised to start with a low dose and work their way up slowly by increasing the dose in small increments. However, an appropriate interval between dosing is essential to avoid accidental overdose. | ||
GHB, along with [[GBL]], has acquired a reputation as a "date rape drug," in which it is purportedly secretly placed into alcoholic drinks.{{citation needed}} There is very limited evidence to suggest that this actually happens but care should always be taken when accepting drinks from strangers. | GHB, along with [[GBL]], has acquired a reputation as a "date rape drug," in which it is purportedly secretly placed into alcoholic drinks.{{citation needed}} There is very limited evidence to suggest that this actually happens but care should always be taken when accepting drinks from strangers. | ||
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==Pharmacology== | ==Pharmacology== | ||
GHB has at least two distinct binding sites<ref>{{cite journal | vauthors=((Mamelak, M.)) | journal=Neuroscience & Biobehavioral Reviews | title=Gammahydroxybutyrate: An endogenous regulator of energy metabolism | volume=13 | issue=4 | pages=187–198 | date=1 December 1989 | url=https://www.sciencedirect.com/science/article/pii/S0149763489800533 | issn=0149-7634 | doi=10.1016/S0149-7634(89)80053-3}}</ref> in the central nervous system. GHB is an [[agonist]] at the newly characterized GHB receptor, which is excitatory.<ref>{{cite journal | vauthors=((Wu, Y.)), ((Ali, S.)), ((Ahmadian, G.)), ((Liu, C. C.)), ((Wang, Y. T.)), ((Gibson, K. M.)), ((Calver, A. R.)), ((Francis, J.)), ((Pangalos, M. N.)), ((Carter Snead, O.)) | journal=Neuropharmacology | title=γ-Hydroxybutyric acid (GHB) and γ-aminobutyric acidB receptor (GABABR) binding sites are distinctive from one another: molecular evidence | volume=47 | issue=8 | pages=1146–1156 | date=1 December 2004 | url=https://www.sciencedirect.com/science/article/pii/S0028390804002527 | issn=0028-3908 | doi=10.1016/j.neuropharm.2004.08.019}}</ref><ref name="Maitre2005">{{cite journal | vauthors=((Maitre, M.)), ((Humbert, J.-P.)), ((Kemmel, V.)), ((Aunis, D.)), ((Andriamampandry, C.)) | journal=médecine/sciences | title=Mécanismes d’action d’un médicament détourné : le γ-hydroxybutyrate | volume=21 | issue=3 | pages=284–289 | date=1 March 2005 | url=https://www.medecinesciences.org/articles/medsci/abs/2005/03/medsci2005213p284/medsci2005213p284.html | issn=0767-0974 | doi=10.1051/medsci/2005213284}}</ref> It is also a weak [[agonist]] at the [[GABA]]<sub>B</sub> receptor, which is inhibitory.<ref name="Maitre2005"/> | GHB has at least two distinct binding sites<ref>{{cite journal | vauthors=((Mamelak, M.)) | journal=Neuroscience & Biobehavioral Reviews | title=Gammahydroxybutyrate: An endogenous regulator of energy metabolism | volume=13 | issue=4 | pages=187–198 | date=1 December 1989 | url=https://www.sciencedirect.com/science/article/pii/S0149763489800533 | issn=0149-7634 | doi=10.1016/S0149-7634(89)80053-3}}</ref> in the central nervous system. GHB is an [[agonist]] at the newly characterized GHB receptor, which is excitatory.<ref>{{cite journal | vauthors=((Wu, Y.)), ((Ali, S.)), ((Ahmadian, G.)), ((Liu, C. C.)), ((Wang, Y. T.)), ((Gibson, K. M.)), ((Calver, A. R.)), ((Francis, J.)), ((Pangalos, M. N.)), ((Carter Snead, O.)) | journal=Neuropharmacology | title=γ-Hydroxybutyric acid (GHB) and γ-aminobutyric acidB receptor (GABABR) binding sites are distinctive from one another: molecular evidence | volume=47 | issue=8 | pages=1146–1156 | date=1 December 2004 | url=https://www.sciencedirect.com/science/article/pii/S0028390804002527 | issn=0028-3908 | doi=10.1016/j.neuropharm.2004.08.019}}</ref><ref name="Maitre2005">{{cite journal | vauthors=((Maitre, M.)), ((Humbert, J.-P.)), ((Kemmel, V.)), ((Aunis, D.)), ((Andriamampandry, C.)) | journal=médecine/sciences | title=Mécanismes d’action d’un médicament détourné : le γ-hydroxybutyrate | volume=21 | issue=3 | pages=284–289 | date=1 March 2005 | url=https://www.medecinesciences.org/articles/medsci/abs/2005/03/medsci2005213p284/medsci2005213p284.html | issn=0767-0974 | doi=10.1051/medsci/2005213284}}</ref> It is also a weak [[agonist]] at the [[GABA]]<sub>B</sub> receptor, which is inhibitory.<ref name="Maitre2005" /> | ||
However, at therapeutic doses, GHB reaches much higher concentrations in the brain and activates [[GABA]]<sub>B</sub> receptors, which are primarily responsible for its sedative effects.<ref name="Dimitrijevic2005">{{cite journal | vauthors=((Dimitrijevic, N.)), ((Dzitoyeva, S.)), ((Satta, R.)), ((Imbesi, M.)), ((Yildiz, S.)), ((Manev, H.)) | journal=European Journal of Pharmacology | title=Drosophila GABAB receptors are involved in behavioral effects of γ-hydroxybutyric acid (GHB) | volume=519 | issue=3 | pages=246–252 | date=20 September 2005 | url=https://www.sciencedirect.com/science/article/pii/S0014299905007442 | issn=0014-2999 | doi=10.1016/j.ejphar.2005.07.016}}</ref> GHB's sedative effects are blocked by GABA<sub>B</sub> [[antagonists]]. As the [[GABA]] system is the most prolific inhibitory receptor set within the brain, its modulation results in the [[sedating]] (or [[anxiety suppression|calming effects]]) of GHB on the nervous system. While research into the GHB receptor is limited, there is evidence that activation of the GHB receptor in some brain areas results in the release of [[glutamate]], the principal excitatory neurotransmitter.<ref name="Castelli2003">{{cite journal | vauthors=((Castelli, M. P.)), ((Ferraro, L.)), ((Mocci, I.)), ((Carta, F.)), ((Carai, M. A. M.)), ((Antonelli, T.)), ((Tanganelli, S.)), ((Cignarella, G.)), ((Gessa, G. L.)) | journal=Journal of Neurochemistry | title=Selective γ-hydroxybutyric acid receptor ligands increase extracellular glutamate in the hippocampus, but fail to activate G protein and to produce the sedative/hypnotic effect of γ-hydroxybutyric acid: γ-Hydroxybutyric analogues on glutamate levels | volume=87 | issue=3 | pages=722–732 | date=19 September 2003 | url=http://doi.wiley.com/10.1046/j.1471-4159.2003.02037.x | issn=00223042 | doi=10.1046/j.1471-4159.2003.02037.x}}</ref> Drugs that selectively activate the GHB receptor cause absence seizures in high doses, as do GHB and [[GABA]]<sub>B</sub> agonists.<ref name="Castelli2003"/> | However, at therapeutic doses, GHB reaches much higher concentrations in the brain and activates [[GABA]]<sub>B</sub> receptors, which are primarily responsible for its sedative effects.<ref name="Dimitrijevic2005">{{cite journal | vauthors=((Dimitrijevic, N.)), ((Dzitoyeva, S.)), ((Satta, R.)), ((Imbesi, M.)), ((Yildiz, S.)), ((Manev, H.)) | journal=European Journal of Pharmacology | title=Drosophila GABAB receptors are involved in behavioral effects of γ-hydroxybutyric acid (GHB) | volume=519 | issue=3 | pages=246–252 | date=20 September 2005 | url=https://www.sciencedirect.com/science/article/pii/S0014299905007442 | issn=0014-2999 | doi=10.1016/j.ejphar.2005.07.016}}</ref> GHB's sedative effects are blocked by GABA<sub>B</sub> [[antagonists]]. As the [[GABA]] system is the most prolific inhibitory receptor set within the brain, its modulation results in the [[sedating]] (or [[anxiety suppression|calming effects]]) of GHB on the nervous system. While research into the GHB receptor is limited, there is evidence that activation of the GHB receptor in some brain areas results in the release of [[glutamate]], the principal excitatory neurotransmitter.<ref name="Castelli2003">{{cite journal | vauthors=((Castelli, M. P.)), ((Ferraro, L.)), ((Mocci, I.)), ((Carta, F.)), ((Carai, M. A. M.)), ((Antonelli, T.)), ((Tanganelli, S.)), ((Cignarella, G.)), ((Gessa, G. L.)) | journal=Journal of Neurochemistry | title=Selective γ-hydroxybutyric acid receptor ligands increase extracellular glutamate in the hippocampus, but fail to activate G protein and to produce the sedative/hypnotic effect of γ-hydroxybutyric acid: γ-Hydroxybutyric analogues on glutamate levels | volume=87 | issue=3 | pages=722–732 | date=19 September 2003 | url=http://doi.wiley.com/10.1046/j.1471-4159.2003.02037.x | issn=00223042 | doi=10.1046/j.1471-4159.2003.02037.x}}</ref> Drugs that selectively activate the GHB receptor cause absence seizures in high doses, as do GHB and [[GABA]]<sub>B</sub> agonists.<ref name="Castelli2003" /> | ||
Activation of both the GHB receptor and [[GABA]]<sub>B</sub> is responsible for the addictive profile of GHB. GHB's effect on [[dopamine]] release is biphasic.<ref name="Dimitrijevic2005"/> This means that while low concentrations stimulate [[dopamine]] release via the GHB receptor,<ref>{{cite journal | vauthors=((Maitre, M.)), ((Hechler, V.)), ((Vayer, P.)), ((Gobaille, S.)), ((Cash, C. D.)), ((Schmitt, M.)), ((Bourguignon, J. J.)) | journal=The Journal of Pharmacology and Experimental Therapeutics | title=A specific gamma-hydroxybutyrate receptor ligand possesses both antagonistic and anticonvulsant properties | volume=255 | issue=2 | pages=657–663 | date= November 1990 | issn=0022-3565}}</ref> higher concentrations inhibit [[dopamine]] release via [[GABA]]<sub>B</sub> receptors.<ref>{{cite journal | vauthors=((Smolders, I.)), ((De Klippel, N.)), ((Sarre, S.)), ((Ebinger, G.)), ((Michotte, Y.)) | journal=European Journal of Pharmacology | title=Tonic GABA-ergic modulation of striatal dopamine release studied by in vivo microdialysis in the freely moving rat | volume=284 | issue=1 | pages=83–91 | date=15 September 1995 | url=https://www.sciencedirect.com/science/article/pii/001429999500369V | issn=0014-2999 | doi=10.1016/0014-2999(95)00369-V}}</ref> After an initial phase of inhibition, [[dopamine]] release is then increased via the GHB receptor. | Activation of both the GHB receptor and [[GABA]]<sub>B</sub> is responsible for the addictive profile of GHB. GHB's effect on [[dopamine]] release is biphasic.<ref name="Dimitrijevic2005" /> This means that while low concentrations stimulate [[dopamine]] release via the GHB receptor,<ref>{{cite journal | vauthors=((Maitre, M.)), ((Hechler, V.)), ((Vayer, P.)), ((Gobaille, S.)), ((Cash, C. D.)), ((Schmitt, M.)), ((Bourguignon, J. J.)) | journal=The Journal of Pharmacology and Experimental Therapeutics | title=A specific gamma-hydroxybutyrate receptor ligand possesses both antagonistic and anticonvulsant properties | volume=255 | issue=2 | pages=657–663 | date= November 1990 | issn=0022-3565}}</ref> higher concentrations inhibit [[dopamine]] release via [[GABA]]<sub>B</sub> receptors.<ref>{{cite journal | vauthors=((Smolders, I.)), ((De Klippel, N.)), ((Sarre, S.)), ((Ebinger, G.)), ((Michotte, Y.)) | journal=European Journal of Pharmacology | title=Tonic GABA-ergic modulation of striatal dopamine release studied by in vivo microdialysis in the freely moving rat | volume=284 | issue=1 | pages=83–91 | date=15 September 1995 | url=https://www.sciencedirect.com/science/article/pii/001429999500369V | issn=0014-2999 | doi=10.1016/0014-2999(95)00369-V}}</ref> After an initial phase of inhibition, [[dopamine]] release is then increased via the GHB receptor. | ||
GHB induces the accumulation of either a derivative of tryptophan or [[tryptophan]] itself, possibly by increasing tryptophan transport across the blood–brain barrier. | GHB induces the accumulation of either a derivative of tryptophan or [[tryptophan]] itself, possibly by increasing tryptophan transport across the blood–brain barrier. GHB-induced stimulation may be due to this increase in tryptophan transport to the brain and in its uptake by serotonergic cells. As the [[Serotonin|serotonergic]] system may be involved in the regulation of sleep, mood, and anxiety, the stimulation of this system by high doses of GHB may be involved in certain neuropharmacological events induced by GHB administration. | ||
These findings may explain the paradoxical mix of sedative and stimulatory properties of GHB as well as the so-called "rebound" effect reported by individuals using GHB as a sleeping agent wherein they awake suddenly after several hours of GHB-induced deep sleep. Over time, the concentration of GHB in the system decreases below the threshold for significant [[GABA]]<sub>B</sub> receptor activation and activates predominantly the GHB receptor, leading to wakefulness. | These findings may explain the paradoxical mix of sedative and stimulatory properties of GHB as well as the so-called "rebound" effect reported by individuals using GHB as a sleeping agent wherein they awake suddenly after several hours of GHB-induced deep sleep. Over time, the concentration of GHB in the system decreases below the threshold for significant [[GABA]]<sub>B</sub> receptor activation and activates predominantly the GHB receptor, leading to wakefulness. | ||
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*'''[[Effect::Sleepiness]]''' & '''[[Effect::Wakefulness]]''' - At very low dosages, GHB can make one tired, while common doses are primarly wakefullness-promoting. High doses can lead to feelings of being extremely sleepy. | *'''[[Effect::Sleepiness]]''' & '''[[Effect::Wakefulness]]''' - At very low dosages, GHB can make one tired, while common doses are primarly wakefullness-promoting. High doses can lead to feelings of being extremely sleepy. | ||
*'''[[Effect::Analysis suppression]]''' | *'''[[Effect::Analysis suppression]]''' | ||
*'''[[Effect::Anxiety suppression]]''' | *'''[[Effect::Anxiety suppression]]''' | ||
*'''[[Effect::Cognitive euphoria]]''' - GHB produces intense states of euphoria comparable to that of [[cocaine]], [[MDMA]], and [[opiates]]. For this reason, it is sometimes called "liquid ecstasy". It is commonly described as a more euphoric and disinhibiting version of alcohol. While this may be accurate, it is also far easier to overdose on. | *'''[[Effect::Cognitive euphoria]]''' - GHB produces intense states of euphoria comparable to that of [[cocaine]], [[MDMA]], and [[opiates]]. For this reason, it is sometimes called "liquid ecstasy". It is commonly described as a more euphoric and disinhibiting version of alcohol. While this may be accurate, it is also far easier to overdose on. | ||
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==Toxicity and harm potential== | ==Toxicity and harm potential== | ||
[[File:HarmCausedByDrugsTable.svg|thumb|upright=1.35|Table from the 2010 [[DrugScience]] study ranking various drugs (legal and illegal) based on statements by drug-harm experts. GHB was found to be the ninth overall most dangerous drug.<ref name="Nutt_2010">{{cite journal | vauthors = Nutt DJ, King LA, Phillips LD | title = Drug harms in the UK: a multicriteria decision analysis | journal = Lancet | volume = 376 | issue = 9752 | pages = 1558–1565 | date = November 2010 | pmid = 21036393 | doi = 10.1016/S0140-6736(10)61462-6 | s2cid = 5667719 | citeseerx = 10.1.1.690.1283 }}</ref>]] | |||
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of GHB<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]] | [[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of GHB<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]] | ||
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Accidental ingestions of GHB have also occurred due to inadequate storage methods. If GHB is put into a clear liquid, glass, or bottle, it can be easily mistaken for water. It is recommended to clearly label your GHB in writing and dye the liquid with blue food coloring so it no longer resembles a drinkable beverage. It is also recommended to store your GHB in a container that no one would drink out of. | Accidental ingestions of GHB have also occurred due to inadequate storage methods. If GHB is put into a clear liquid, glass, or bottle, it can be easily mistaken for water. It is recommended to clearly label your GHB in writing and dye the liquid with blue food coloring so it no longer resembles a drinkable beverage. It is also recommended to store your GHB in a container that no one would drink out of. | ||
GHB is also corrosive it is recommend it to dilute it with a non-alcoholic liquid in the ratio of atleast 1:100ml if not done this can result in burns in the intestine as well as the mouth.[https://sidekicks.berlin/en/ghb-gbl/#beratung] | |||
It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this substance. | It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this substance. | ||
====Neurotoxicity==== | ====Neurotoxicity==== | ||
A 2022 review<ref>Amsterdam JV, Brunt TM, Pereira FR, Crunelle CL, Brink WVD. [https://web.archive.org/web/20230313103920/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878963/ Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review.] Curr Neuropharmacol. 2022;20(4):809-819.</ref> compared 43 studies on GHB-induced cognitive impairment in humans and animals. The analysis suggests that moderate or clinical use may result in acute cognitive impairment. Working memory, short-term memory, and impaired performance on cognitive tasks were impaired after doses as low as 10mg/kg, but these effects appear to be temporary. Conversely, one study found that a dose of 20mg/kg improved social and non-social cognition, but did not affect base cognitive functions, such as visual or verbal memory recall. However, chronic heavy use of GHB, especially if accompanied by GHB-induced comas appear to cause long-term cognitive impairment and are likely neurotoxic. | |||
In multiple studies, GHB has been found to impair spatial memory, working memory, learning and memory in rats with chronic administration.<ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)) | journal=Pharmacology Biochemistry and Behavior | title=Adolescent γ-hydroxybutyric acid exposure decreases cortical N-methyl-d-aspartate receptor and impairs spatial learning | volume=79 | issue=4 | pages=701–708 | date=1 December 2004 | url=https://www.sciencedirect.com/science/article/pii/S009130570400320X | issn=0091-3057 | doi=10.1016/j.pbb.2004.09.022}}</ref><ref>{{cite journal | vauthors=((García, F. B.)), ((Pedraza, C.)), ((Arias, J. L.)), ((Navarro, J. F.)) | journal=Psicothema | title=[Effects of subchronic administration of gammahydroxybutyrate (GHB) on spatial working memory in rats] | volume=18 | issue=3 | pages=519–524 | date= August 2006 | issn=0214-9915}}</ref><ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)), ((Sircar, D.)) | journal=Annals of the New York Academy of Sciences | title=γ-Hydroxybutyric Acid-Induced Cognitive Deficits in the Female Adolescent Rat | volume=1139 | issue=1 | pages=386–389 | date= October 2008 | url=http://doi.wiley.com/10.1196/annals.1432.044 | issn=00778923 | doi=10.1196/annals.1432.044}}</ref><ref>{{cite journal | vauthors=((Pedraza, C.)), ((García, F. B.)), ((Navarro, J. F.)) | journal=The International Journal of Neuropsychopharmacology | title=Neurotoxic effects induced by gammahydroxybutyric acid (GHB) in male rats | volume=12 | issue=09 | pages=1165 | date= October 2009 | url=https://academic.oup.com/ijnp/article-lookup/doi/10.1017/S1461145709000157 | issn=1461-1457 | doi=10.1017/S1461145709000157}}</ref> These effects are associated with decreased [[NMDA receptor]] expression in the cerebral cortex and possibly other areas as well.<ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)) | journal=Pharmacology, Biochemistry, and Behavior | title=Adolescent gamma-hydroxybutyric acid exposure decreases cortical N-methyl-D-aspartate receptor and impairs spatial learning | volume=79 | issue=4 | pages=701–708 | date= December 2004 | issn=0091-3057 | doi=10.1016/j.pbb.2004.09.022}}</ref> | In multiple studies, GHB has been found to impair spatial memory, working memory, learning and memory in rats with chronic administration.<ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)) | journal=Pharmacology Biochemistry and Behavior | title=Adolescent γ-hydroxybutyric acid exposure decreases cortical N-methyl-d-aspartate receptor and impairs spatial learning | volume=79 | issue=4 | pages=701–708 | date=1 December 2004 | url=https://www.sciencedirect.com/science/article/pii/S009130570400320X | issn=0091-3057 | doi=10.1016/j.pbb.2004.09.022}}</ref><ref>{{cite journal | vauthors=((García, F. B.)), ((Pedraza, C.)), ((Arias, J. L.)), ((Navarro, J. F.)) | journal=Psicothema | title=[Effects of subchronic administration of gammahydroxybutyrate (GHB) on spatial working memory in rats] | volume=18 | issue=3 | pages=519–524 | date= August 2006 | issn=0214-9915}}</ref><ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)), ((Sircar, D.)) | journal=Annals of the New York Academy of Sciences | title=γ-Hydroxybutyric Acid-Induced Cognitive Deficits in the Female Adolescent Rat | volume=1139 | issue=1 | pages=386–389 | date= October 2008 | url=http://doi.wiley.com/10.1196/annals.1432.044 | issn=00778923 | doi=10.1196/annals.1432.044}}</ref><ref>{{cite journal | vauthors=((Pedraza, C.)), ((García, F. B.)), ((Navarro, J. F.)) | journal=The International Journal of Neuropsychopharmacology | title=Neurotoxic effects induced by gammahydroxybutyric acid (GHB) in male rats | volume=12 | issue=09 | pages=1165 | date= October 2009 | url=https://academic.oup.com/ijnp/article-lookup/doi/10.1017/S1461145709000157 | issn=1461-1457 | doi=10.1017/S1461145709000157}}</ref> These effects are associated with decreased [[NMDA receptor]] expression in the cerebral cortex and possibly other areas as well.<ref>{{cite journal | vauthors=((Sircar, R.)), ((Basak, A.)) | journal=Pharmacology, Biochemistry, and Behavior | title=Adolescent gamma-hydroxybutyric acid exposure decreases cortical N-methyl-D-aspartate receptor and impairs spatial learning | volume=79 | issue=4 | pages=701–708 | date= December 2004 | issn=0091-3057 | doi=10.1016/j.pbb.2004.09.022}}</ref> | ||
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===Overdose=== | ===Overdose=== | ||
To avoid a possible overdose of GHB, it is important to start with a low dose and work your way up slowly by increasing the dosage in small increments. While a common recreational dose is 3g, a dose of 5g - 10g can result in convulsions, unconsciousness and vomiting. [[toxicity::Doses above 10 grams are associated with a risk of death]].<ref name="ErowidGHBVault"/> One must also factor in the added difficulty of knowing the purity of the product (among other problems like its hygroscopy may lower the concentration of GHB in one solution, which is the form which is commonly bought and sold in the illicit market). This makes it hard for even the experienced user to dose properly.<ref>https://www.erowid.org/chemicals/ghb/ghb_health.shtml</ref> | To avoid a possible overdose of GHB, it is important to start with a low dose and work your way up slowly by increasing the dosage in small increments. While a common recreational dose is 3g, a dose of 5g - 10g can result in convulsions, unconsciousness and vomiting. [[toxicity::Doses above 10 grams are associated with a risk of death]].<ref name="ErowidGHBVault" /> One must also factor in the added difficulty of knowing the purity of the product (among other problems like its hygroscopy may lower the concentration of GHB in one solution, which is the form which is commonly bought and sold in the illicit market). This makes it hard for even the experienced user to dose properly.<ref>https://www.erowid.org/chemicals/ghb/ghb_health.shtml</ref> | ||
===Tolerance and addiction potential=== | ===Tolerance and addiction potential=== | ||
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*'''New Zealand:''' GHB, 1,4-B and GBL are all Class B illegal drugs, along with any possible esters, ethers and aldehydes.{{citation needed}} | *'''New Zealand:''' GHB, 1,4-B and GBL are all Class B illegal drugs, along with any possible esters, ethers and aldehydes.{{citation needed}} | ||
*'''Norway:''' GHB is considered a narcotic and is only available by prescription under the trade name Xyrem.{{citation needed}} | *'''Norway:''' GHB is considered a narcotic and is only available by prescription under the trade name Xyrem.{{citation needed}} | ||
*'''Romania''': GHB is considered a Schedule I illegal drug.<ref>https://legislatie.just.ro/Public/DetaliiDocument/23629</ref> | |||
*'''Switzerland:''' GHB is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.<ref>{{cite web|url=https://www.admin.ch/opc/de/classified-compilation/20101220/index.html|title=Verordnung des EDI über die Verzeichnisse der Betäubungsmittel, psychotropen Stoffe, Vorläuferstoffe und Hilfschemikalien|publisher=Bundeskanzlei [Federal Chancellery of Switzerland]|access-date=January 1, 2020|language=de}}</ref> | *'''Switzerland:''' GHB is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.<ref>{{cite web|url=https://www.admin.ch/opc/de/classified-compilation/20101220/index.html|title=Verordnung des EDI über die Verzeichnisse der Betäubungsmittel, psychotropen Stoffe, Vorläuferstoffe und Hilfschemikalien|publisher=Bundeskanzlei [Federal Chancellery of Switzerland]|access-date=January 1, 2020|language=de}}</ref> | ||
*'''United Kingdom:''' GHB was made a Class C drug in June 2003.{{citation needed}} | *'''United Kingdom:''' GHB was made a Class C drug in June 2003.{{citation needed}} | ||
*'''United States:''' GHB was placed on Schedule I of the Controlled Substances Act in March 2000. However, when sold as sodium oxybate, it is considered a Schedule III substance but with Schedule I trafficking penalties.<ref>{{Citation | year=2010 | title=Laws | url=http://web.archive.org/web/20100116121252/http://www.projectghb.org/laws.htm}}</ref> It is one of several drugs that are listed in multiple schedules. | *'''United States:''' GHB was placed on Schedule I of the Controlled Substances Act in March 2000. However, when sold as sodium oxybate, it is considered a Schedule III substance but with Schedule I trafficking penalties.<ref>{{Citation | year=2010 | title=Laws | url=http://web.archive.org/web/20100116121252/http://www.projectghb.org/laws.htm}}</ref> It is one of several drugs that are listed in multiple schedules. | ||
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*[https://www.erowid.org/chemicals/ghb/ghb.shtml GHB (Erowid Vault)] | *[https://www.erowid.org/chemicals/ghb/ghb.shtml GHB (Erowid Vault)] | ||
*[https://isomerdesign.com/PiHKAL/explore.php?id=12265 GHB (Isomer Design)] | *[https://isomerdesign.com/PiHKAL/explore.php?id=12265 GHB (Isomer Design)] | ||
*[https://drugs-forum.com/wiki/GHB GHB (Drugs-Forum)] | |||
==References== | ==References== | ||
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[[Category:Neurotransmitter]] | [[Category:Neurotransmitter]] | ||
[[Category: | [[Category:Gamma-Hydroxy acid]] | ||
[[Category:Depressant]] | [[Category:Depressant]] | ||
{{#set:Featured=true}} | {{#set:Featured=true}} | ||