In-patient detoxification after GHB dependence

Gamma-hydroxybutyrate (GHB) occurs naturally in the human brain (Roth & Giarman, 1970). It has a structure similar to γ-aminobutyric acid and has been used as an anaesthetic and in the treatment of narcolepsy (Mamelak et al, 1986) and alcohol dependence (Gallimberti et al, 1989). There have been cases of dependence with withdrawal symptoms (Galloway et al, 1997). I believe this to be the first reported case of in-patient detoxification.

Between October and December 1999 two patients dependent on GHB were admitted to our in-patient unit for detoxification. This report summarises the case history of the first patient admitted. The second patient had a similar history.

A 43-year-old male reported using GHB for 2.5 years. The effects of use were reported as feelings of relaxation, inner well-being, increased appetite and short, restful periods of sleep. Starting doses of GHB were difficult to quantify as it is generally taken in liquid form. The patient said his dose was originally 15 ml irregularly, but had increased to 30 ml every 3 hours by the beginning of 1999. The patient reported withdrawal experiences such as feelings of panic, terror and anxiety, often with a tremor. Other autonomic features included diarrhoea. Adverse effects of GHB were reported, including accidental injury when intoxicated and episodes of bizarre behaviour. In-patient detoxification was thought necessary as both patients were unable to stop using GHB at home.

On admission to the unit physical examination was unremarkable apart from some features of anxiety. Physical investigations were normal. The patient was commenced on a diazepam reducing regime from 20 mg over 11 days. Detoxification was uneventful. The patient was engaged in relapse prevention and referred to psychotherapy services.

Gamma-hydroxybutyrate has adverse effects but also produces euphoria and relaxation; GHB has abuse and dependence potential and so educational campaigns for the public may be important.