GHB and GBL as drugs

GHB (gamma-hydroxybutyric acid) is a chemical compound that also occurs naturally in the human brain. It is a precursor and metabolite of neurotransmitter gamma-aminobutyric acid (GABA). [1] For recreational use, GHB is synthesized from gamma-butyrolactone (GBL), also known as “lakka” in Finnish. [2] GBL is also used as a recreational drug itself and is converted into GHB in the human body. [3] As a substance, GBL is significantly more potent than GHB. [2] [4] Additionally, GBL is widely used in the chemical industry. It can be found in some cleaning agents and solvents. [2] [5]

On the illegal market, GHB is typically sold as a clear liquid, occasionally also as powder or tablets. The powders are usually dissolved in water. [5] GBL resembles liquid gamma in appearance. [4] The dose is taken orally. [5]

Legal status: In Finland, GHB is classified as both a medicinal and a narcotic substance. Its use, purchase, sale, and possession without a doctor’s prescription is prohibited. [6] [7] The Supreme Court has ruled that GHB is a very dangerous narcotic. [8] GBL, in contrast, is classified as a psychoactive substances banned from the consumer market. [9] The manufacture, import, and sale of such substances is prohibited, but possession and use are not. [10] In certain cases, the importer of such substances may be considered to have committed smuggling, in which case acquiring or receiving smuggled substances is also prohibited. [11]

How do GHB and GBL work?

GHB acts on the central nervous system by stimulating GHB receptors at low doses and exerting a sedative effect through GABA_B receptors at higher doses. [12] Both GHB and GBL are rapidly processed in the body. GHB’s effects begin within 5 to 30 minutes of ingestion. [1] GBL acts faster, typically within 10 to 15 minutes. [4] The effects last for several hours. [5]

Effects can vary between individuals due to genetic and metabolic differences. [4] The size of the dose also significantly influences the experience. [13]

Desired effects: GHB and GBL have both stimulating and calming effects. [14] Commonly reported positive effects include relaxation, elevated mood, euphoria, lowered inhibitions, sociability, and increased sexual desire. [2] [5] [13] [14] In clinical trials, gamma has also been observed to increase the desire to help others. [14] These effects may be due to gamma increasing progesterone levels in the body while testosterone and oxytocin levels remain unchanged. [14] GHB’s effects are often compared to those of alcohol and benzodiazepines. [2] [5]

Side effects: At high doses, GHB and GBL can cause confusion, loss of balance, memory loss, and unconsciousness. Hallucinations are also possible. [13] Side effects are usually linked to overdoses, which in severe cases can lead to coma, respiratory depression, and death. [1] [4] [13]

Key risks

Acute risks: The margin between a recreational and toxic dose of GHB and GBL is narrow. The doses are small, increasing the risk of dosing errors. [12] [15] This risk is even higher with GBL, which is significantly more potent than GHB. [4] Moreover, doubling the dose does not double the concentration in the blood but increases it more significantly. [16] [17] Quality of gamma may vary, especially since it is typically synthesized from GBL. Poor manufacturing can leave residual GBL in GHB, making it more potent than expected. [16]

Medical emergencies caused by GHB and GBL are relatively frequent given their lower usage rates compared to other drugs. [15] Overdose is the main risk associated with GHB and GBL. As a central nervous system depressant, an excessive dose of GHB can result in deep coma and respiratory depression. [3] Overdose symptoms may include nausea, drowsiness, uncontrolled body movements, confusion, hypothermia, and slowed heart rate and breathing. [1] [4] GHB can induce unconsciousness from which the person cannot be awakened. However, due to GHB’s mixed stimulant and sedative effects, the individual may temporarily become agitated or regain consciousness before passing out again. [12] For this reason, close monitoring is necessary even after apparent recovery. An unconscious person also risks choking on their own vomit. [4]

In addition to poor dosing practices, combining GHB or GBL with other depressants increases the risk of overdose and toxicity. [2] Most GHB and GBL overdose cases involve concurrent alcohol use. [4] [2] [13]

Polydrug use risks: Alcohol and GHB potentiate each other: when mixed, the risk of toxicity increases significantly. [2] [18] Combining GHB or GBL with other depressants like opioids or benzodiazepines is also dangerous. [4]

Risks of heavy use: The long-term effects of frequent GHB or GBL use are not fully understood. It is suspected that repeated comas can damage the brain. [4] [19]

Dependence: GHB is an addictive substance. Its withdrawal symptoms resemble those of alcohol and benzodiazepine dependence and may include tremors, sleep disturbances, anxiety, and high blood pressure. [5] [18] Withdrawal symptoms begin sooner than with other sedatives, usually within six hours of stopping continued use. [2] Symptoms can last from three to ten days. [14]

Use during pregnancy: The effects of GHB and GBL on pregnancy and the fetus are still unclear. [20] As a precaution, their use should be avoided during pregnancy.

How can risks be reduced?

Using any intoxicant carries risk. With GHB and GBL, risks can be reduced by exercising extreme caution with dosage. It is also critical to avoid using GHB or GBL together with other central nervous system depressants. Alcohol should never be combined with these substances.

People respond differently to the same drugs and dosages. This variability must be taken into account with GHB and GBL as well.

An unconscious person should be placed in the recovery position and immediately taken to the emergency room.