The γ-hydroxybutyric acid (GHB), improperly called among liquid ecstasy users , is a potent depressant of the CNS, being an analog of gamma aminobutyric acid ( GABA ). It is a recreational drug not especially known in comparison with other narcotics.
GHB occurs in a clear liquid state. This is why, normally, it appears mixed with water or different drinks, making it difficult to control its consumption. It is produced naturally by the body in small quantities, although its neurological function is still unclear . Although at present its use is limited to some cases of narcolepsy, it was initially used as an anesthetic in medicine.
It is known to be an immediate precursor of the neurotransmitter GABA that regulates the state of wakefulness, physical activity and sleep. It also interacts with receptors of other neurotransmitters such as opioids , dopaminergics, serotonin, glutamate and cholinergic.
In addition, the effects of GHB are unpredictable, varying greatly from one person to another. The risk of poisoning or overdose is very high. It was cataloged and introduced as a drug of abuse in Europe in 1994.
Routes of administration and mechanism of toxicity
GHB is generally found in liquid, colorless, odorless and slightly salty form. However, we can also find this drug in powder form.
Although it can be consumed in several ways, the most common form of use is directly drink. Consumers usually mix it with alcohol and the recreational dose varies between 1 or 2 grams.
On the other hand, the mechanism of action is complex and includes several ways. It seems that GHB acts physiologically through the GHB receptor, coupled to the G protein.
In addition, when administered exogenously, it acts on other receptors, which explains the main manifestation observed in the care practice in case of overdose, which is the depression of the level of consciousness.
Toxicokinetics of GHB
GHB is a short-chain fatty acid that is produced endogenously in the tissues of mammals. It is a precursor and metabolite of gamma aminobutyric acid (GABA), which is the main inhibitory neurotransmitter of the CNS.
GHB is hydrosoluble and is rapidly absorbed in the gastrointestinal tract , easily crossing the blood-brain barrier and placenta. It reaches a plasma peak after 20 or 45 minutes.
As for its metabolism, it undergoes biotransformations at the plasma level and in the mitochondria, transforming into succinic semialdehyde and gamma aminobutyric acid. The latter is finally degraded in the Krebs cycle . Once metabolized, it is eliminated in the urine in a few hours, (approximately 1% of the dose administered).
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Because the effects of GHB are not predictable, it is not possible to ensure what the consumer response will be. Generally, people who take it seek to obtain the excitatory effects, although there have been cases in which they occurred, in addition:
- Hallucinations and delusions.
- States of intense euphoria.
- Anesthetic effects and drowsiness.
- Muscular hypotonia
- Headaches and states of confusion.
In the most serious cases, intoxication can progress to a coma , with severe respiratory depression and even death. They can also suffer burns of the digestive tract because the drug has a pH too acid depending on how it is synthesized.
Considering these effects, the consumption of GHB is contraindicated in people suffering from respiratory or cardiac disorders , in cases of hyperprolactinemia, in epileptic patients or those who suffer seizures, and those suffering from Cushing’s syndrome.
It should be mentioned that along with flunitracepam and ketamine, GHB enters into the so-called date rape drugs . This is because people with this drug can be incapacitated, usually by mixing it with alcohol, so that the possible victims of a rape could not defend themselves.
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Tolerance, dependence and withdrawal syndrome
Among the long-term and intensive consumers dependence has been demonstrated, it is believed that due to the regular consumption of the drug. Dependence is the compulsive need to consume the drug in order to re-experience its effects or, at other times, to avoid the discomfort caused by not being able to consume it.
Among the most marked behaviors of dependent people highlights a marked alteration of mood . They may suffer episodes of:
- Delusions and agitation.
- Panic crisis
- Depressions that may entail a hindering of expressiveness on a physical and verbal level.
On the other hand, these patients may also suffer tolerance and withdrawal syndrome . Tolerance develops when the same dose is given as at the beginning, but they do not suffer the same effects, which leads to an increase in doses in order to have the same effects.
Finally, when consumers suffer a very high degree of addiction and stop taking GHB abruptly, they may suffer a set of physical and mental changes called abstinence syndrome.