GHB

Overview

GHB is short for gamma-hydroxybutyrate. It is a powerful chemical that slows down the brain and nervous system. It comes as a clear liquid or as a white powder that is often dissolved in water or other drinks. Some people take it recreationally because it can make them feel relaxed, happy and sociable. In a few countries it is also used as a prescribed medicine for a rare sleep problem, but this is tightly controlled. GHB works fast and the gap between a pleasant dose and a dangerous one is very small, which is what makes it risky. It is sometimes called by slang names such as 'G', 'liquid ecstasy' or ' grievous bodily harm' — and it is also one of the drugs used to spike drinks without someone knowing.

GHB is much less common than alcohol, cannabis or cocaine, but it does appear in nightlife and party settings in many countries. Hospital teams do see people who have taken too much, often by accident. Because GHB is not usually picked up by standard drug tests, the true number of people using it is hard to measure, and experts think it is under-reported.

GHB use is seen most often in young adults in club, party and festival settings. It has also been used in some sexual settings, by some bodybuilders, and by people who use several substances. Anyone can be affected if their drink is spiked, and people who take GHB alongside alcohol or other sedatives are at the highest risk of serious harm. People with smaller body size, or with liver or kidney problems, may be affected more strongly.

Symptoms

Common symptoms

• Feeling relaxed, happy, talkative or dizzy within 10 to 20 minutes of taking it
• Drowsiness, heavy limbs, poor coordination and slurred speech — looking like someone who is very drunk
• Nausea and vomiting
• Confusion, poor memory of what happened, or 'blackouts'
• Headache and feeling very sleepy afterwards
• Sudden deep sleep that the person may snap out of briefly and then fall back into
• Agitation or sudden mood swings as the effect wears off

Symptoms in children

• Young children are at risk mainly through accidental swallowing of a liquid or powder found at home
• They may become unusually sleepy, floppy, hard to wake, or have slow or irregular breathing
• Vomiting while drowsy is especially dangerous in small children
• Teenagers may be exposed at parties, often without knowing what they have taken — sudden extreme drowsiness, confusion or collapse should always be treated as an emergency

Symptoms in older adults

• Older adults are more easily affected by sedatives and may become confused, unsteady or fall
• GHB can interact dangerously with prescribed medicines such as sleeping tablets, strong painkillers or medicines for anxiety
• Existing heart, lung, liver or kidney conditions make serious effects more likely
• Sudden confusion or unusual drowsiness in an older person should always be checked by a doctor

Causes

Main causes

• Recreational use — people take it for feelings of relaxation, confidence and pleasure, often in nightlife settings
• Accidental overdose — the strength of street GHB varies hugely, so the same amount from a different batch can be far stronger
• Drink spiking — GHB is odourless and almost tasteless, so it can be added to a drink without the person noticing
• Mixing with alcohol or other sedatives, which multiplies the effects on breathing and consciousness
• Dependence — some people use it regularly and find they need more over time and struggle to stop

Risk factors

• Taking GHB together with alcohol, sleeping tablets, strong painkillers or medicines for anxiety
• Taking it alone or in a place where no one can get help
• Not knowing the strength of what you are taking
• Small body size, or being new to the drug
• Existing heart, breathing, liver or kidney problems
• A history of substance use or mental health difficulties
• Leaving a drink unattended or accepting drinks from strangers

When to see a doctor

See a doctor urgently if:

• You or someone else has taken GHB and feels unwell, very drowsy or confused
• You think a drink may have been spiked
• You have shaking, sweating, a fast heartbeat, severe anxiety, hallucinations or cannot sleep after stopping regular GHB use
• You have fallen or hit your head while under the influence
• You are pregnant and have used GHB

Book a routine appointment if:

• You use GHB regularly and want help to cut down or stop
• You are worried about your use of alcohol or other drugs
• You have noticed changes in mood, sleep or memory
• You would like a sexual health check or advice after unprotected sex
• You want information about harm reduction in a confidential, non-judgemental setting

Diagnosis

There is no simple bedside test for GHB. A doctor will usually make an assessment based on the story — what was taken, when, and how much — along with the person's symptoms, a physical examination, and sometimes information from friends or paramedics. They will also check for other causes of drowsiness or confusion, such as alcohol, other drugs, low blood sugar or a head injury.

Tests that may be done

• Physical examination, including breathing rate, heart rate, temperature and oxygen levels
• Blood sugar and blood gas checks to look for other causes and to see how breathing is affecting the body
• A blood or urine sample, which in some laboratories can detect GHB — but only for a short time after use, so a negative result does not rule it out
• Checks for other substances, such as alcohol or other drugs, which are often taken alongside it
• A scan or other tests if there has been a head injury or a seizure

What to expect at your appointment

In an emergency setting, the focus is on keeping the person safe while the drug wears off — protecting their breathing, keeping them warm and watching them closely. GHB leaves the body fairly quickly, so most people start to improve within a few hours with good supportive care. You may be asked sensitive questions about drug use; this is to keep you safe, not to get you into trouble.

Treatment

There is no antidote that reverses GHB. Treatment is supportive: helping the person breathe and stay safe until the drug leaves their system, then offering ongoing help if there is dependence or a related health concern. Recovery is very possible, particularly with support from addiction or substance use services.

Self-care at home

• After an episode, rest, drink water and eat light food when you feel able, and avoid alcohol and other drugs for at least a couple of days
• Tell a trusted friend or family member what happened so someone can check on you
• Do not use alone. If you or a friend chooses to use any drug, have someone sober nearby who can call for help
• Write down what happened, including time and amount, which can help a doctor if you need to be seen
• Look after your sleep, meals and routine — these help your mood and memory recover
• Keep a note of any withdrawal symptoms and get medical advice rather than stopping suddenly on your own

Medical treatments

In hospital, treatment means close monitoring and supporting the body's basic functions — keeping the airway open, giving oxygen if needed, keeping the person warm and treating seizures or agitation. Someone who is dependent on GHB should not stop suddenly without medical help, because withdrawal can be serious; specialist services can supervise a gradual, safe reduction and provide round-the-clock support during it. Longer term, counselling, talking therapies and substance use services can help people understand their use and build alternatives, and mental health support is offered where anxiety, depression or trauma are part of the picture.

When is surgery considered?

Surgery is not part of treatment for GHB use. It may occasionally be needed for an injury that happened while someone was affected.

Living with this condition

Living with a history of GHB use often means rebuilding routines and confidence. Many people find it helps to avoid the places and people linked to their use for a while, to tell one or two trusted people what they are working on, and to plan ahead for evenings out. Memory and sleep can take a few weeks to settle after heavy use — be patient with yourself.

Lifestyle tips

• Keep a regular sleep and wake routine, which supports mood and memory
• Build in alcohol-free social plans and hobbies that give you a sense of connection
• Learn to recognise your triggers — certain venues, friends, stress or low mood — and plan what you will do instead
• Have a simple plan for nights out: who you are with, how you are getting home, and who to call if things go wrong
• Never leave a drink unattended and avoid accepting drinks from people you do not know well
• Consider a sexual health check if you have had unprotected sex

Diet and exercise

Eating regular meals and staying hydrated helps your body and mind recover. Gentle activity — walking, swimming, cycling, anything you enjoy — supports sleep, mood and energy. Start small and build up; there is no need to do anything strenuous at first.

Mental health and emotional wellbeing

GHB can affect mood, sleep and memory, and coming off it can bring anxiety, low mood or disturbed sleep. These feelings are common and treatable. It is important to tell your doctor how you are feeling, and to reach out to a crisis support service straight away if you ever have thoughts of harming yourself. You deserve support, and help is available.

Prevention

You cannot control what is in a street drug, but you can greatly reduce the risks. The safest option is not to use GHB at all. If someone does choose to use, harm-reduction steps save lives: never use alone, never mix with alcohol or other sedatives, start with a very small amount and wait at least two hours before taking any more, and make sure a sober friend knows what you have taken.

Screening programmes

There is no routine screening test for GHB use. If you are worried about your use, or about a spiked drink, a GP can talk it through with you confidentially and point you to the right support.

Complications

If left untreated

• Overdose leading to deep unconsciousness, slowed breathing and, in the worst cases, death
• Vomiting while unconscious and breathing it into the lungs, which can cause serious chest infection
• Seizures and head injuries from falls
• Dependence, where stopping causes withdrawal with shaking, sweating, severe anxiety, hallucinations and sometimes seizures
• Memory and concentration problems that can last for weeks
• Low mood, anxiety and sleep problems
• Risks linked to spiked drinks, including assault and unprotected sex

Long-term outlook

Most people who have taken too much GHB recover fully with supportive care, because the drug leaves the body fairly quickly. For people who have become dependent, recovery takes more time but is very achievable with medical support, counselling and a good support network. Many people go on to rebuild their health, relationships and routines. If you are struggling, reaching out early gives you the best chance of a good outcome.

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