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Gamma-Hydroxybutyrate (GHB): Addiction & Abuse

GHB addiction and abuse

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Gamma-hydroxybutyrate (GHB) is a substance of abuse in the United States. However, gamma-hydroxybutyrate can also be found in a medication called Xyrem. The medication, as well as its street substitute, has a high potential to abuse, so they are controlled.

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Learn About GHB Abuse & Addiction:

Is GHB Legal?

Back in the 1990s, GHB was legal in the US, being promoted as a dietary supplement, especially among bodybuilders due to the drug’s purported property to boost growth hormone. Soon, the substance became a drug of abuse, known as a party drug or date rape drug. The number of drug-induced coma victims started to increase.

All these lead to the FDA’s decision to change the GHB legal status and label gamma-hydroxybutyrate as unsafe and a drug of abuse, listing it as an illicit Schedule I substance. Therefore, in the US, GHB is illegal to sell, possess, or manufacture gamma-hydroxybutyrate.

For possession one can get up to two years in prison and/or an unlimited fine, for selling or even giving the drug to other persons can lead to 14 years in prison and/or an unlimited fine.

In 2002, the FDA approved the prescription formulation of GHB, Xyrem (sodium oxybate), for the treatment of cataplexy. Sodium oxybate can be prescribed and purchased only through a patient restricted-access program.

It is illegal to sell or give Xyrem to someone else and the government makes sure that the drug’s purchase is carefully monitored.

GHB Generic And Street Names

Gamma-hydroxybutyric acid is also generically known as sodium oxybate. The trade name for the drug is Xyrem. Considering its wide use among addicts, there are many GHB nicknames such as:

  • blue nitro
  • GBH (grievous bodily harm)
  • GHB (Georgia home boy)
  • G
  • liquid x
  • liquid ecstasy
  • liquid e
  • Gamma-OH
  • salty water
  • cherry meth
  • soap
  • scoop
  • fantasy

These are only a few of the street names for GHB. Those who sell and buy it on the streets constantly make up new names to cover their activity, as selling, possessing, and manufacturing of gamma-hydroxybutyrate are illegal. Those suspected in its illegal use can be obliged to pass a GHB drug test.

GHB drug class

GHB Drug Class

Is GHB A Depressant Or Stimulant?

The GHB drug class is a central nervous system (CNS) depressant, with anesthetic and sedative effects. Gamma-hydroxybutyric slows down the activity of the brain and certain areas of the central nervous system.

Is GHB A Controlled Substance?

According to the FDA, the GHB classification is Schedule I controlled substance. Such GHB drug classification was declared in 2000 by the Controlled Substances Act. At the same time, Xyrem medication is considered to have a moderate potential for dependence. That is why Xyrem is a Schedule III controlled substance.

In the US, Xyrem is strictly controlled and the treatment is given only to patients who take part in a specially developed risk evaluation and mitigation strategy program.

Where And How To Get Xyrem

Not taking into account the illegal selling and buying of GHB,  Xyrem can be purchased only through a special program. Sodium oxybate is manufactured at a single factory and is sold through a Central Pharmacy.

What is Xyrem REMS Program?

Approved Risk Evaluation and Mitigation Strategies or REMS was developed to prevent and mitigate the risks of abuse, misuse, inappropriate prescribing, and diversion of the drug. Through the Xyrem REMS program, patients, pharmacists, and prescribers are informed about the risk of respiratory and CNS depression, the interactions of this drug with alcohol and sedative-hypnotics, and the safe storage, handling, and use of Xyrem.

Xyrem REMS also ensures that there are strict pharmacy controls before filling prescriptions for sodium oxybate, such as monitoring for diversion and inappropriate prescription of the drug, notifying prescribers if patients have received concomitant medications that are contraindicated or if there are signs of misuse or potential abuse.

How To Get Xyrem Via REMS

To have access to the medication, the patient has to be enrolled in the Xyrem REMS program and comply with its requirements. There is no other way of where to buy GHB except for a Central Certified Pharmacy, the only distributor in the US which is permitted to sell Xyrem.

Through this program, the patient has access to a pharmacist specially trained on the proper GHB uses, available 24/7. The Xyrem medication can be purchased only with the patient’s signature; in the case of a child, the designated adult’s signature. The drug is delivered to the patient’s door or another location approved by the Certified Pharmacy. The treating physician is notified when the patient gets Xyrem. Within two days after receiving the medication, the patient will be contacted by a nurse case manager to answer questions.

Xyrem Cost

In the US, the cost for Xyrem is about $5,500 for a 10 to 15 days supply. Fortunately, there are several programs and plans aimed at helping patients afford the treatment. Although Xyrem medication is 100% covered by some insurance plans, some plans do have restrictions when it comes to this drug, such as quantity limits or prior authorization needed from the patient’s health provider.

Patients can also access the Xyrem Coupon Program, which helps them cut out-of-pocket expenses, including any plan deductible and copays. Patients who are eligible for this program will pay about $35 per prescription.

For the moment, Xyrem medication is not available as generic sodium oxybate, which is much cheaper compared to the branded option, but this might become possible in 2024.

GHB abuse

GHB Abuse

People prone to GHB abuse are high school and college students who use the drug for its intoxicating effects. The night club-goers and party ravers also abuse gamma-hydroxybutyrate.

Gamma-hydroxybutyrate is abused for various purposes, including:

  • increased sociability
  • enhanced appreciation for dancing and music
  • to reach high and forget the daily troubles
  • boosted sex drive
  • to cope with depression and other mental states, etc.
Xyrem abuse leads to dangerous GHB effects such as seizures, profound sedation, severe respiratory depression, coma, and even death.

GHB High

Can GHB Get One High?

Gamma-hydroxybutyrate is a strong CNS depressant with serious effects on the body and mind. It means that Xyrem high is possible and those who use it as prescribed can also experience it. People with substance use disorder usually take the drug for its calming and euphoric effects, as well as hallucinations.

What Does GHB High Feel Like?

At a low dose, GHB high effects are similar to alcohol intoxication, leading to lightheadedness and less inhibition, making people more sociable. At a higher dose, the effects are intensified, making the user dizzy and drowsy. Increasing the dosage would lead to nausea and vomiting and make the user fall into a deep sleep, coma, and even lead to death.

A much greater high is achieved when the drug is combined with alcohol or other substances, increasing the risk of a GHB overdose.

 

Is GHB Addictive?

When gamma-hydroxybutyrate is taken recreationally or by prescription for a long time, the user might soon develop a tolerance to the drug and need more of it to achieve the same effects. Prolonged use may lead to GHB addiction, too. Given the potency of gamma-hydroxybutyrate, even an extra dose can push the user into a life-threatening condition. So, GHB treatment is required to prevent them.

Xyrem interactions

Xyrem Drug Interactions

Xyrem can interact with many medications and substances, leading to uncomfortable states and life-threatening side effects.

Alcohol. Combining GHB and alcohol can lead to increased drowsiness and sleepiness, but also the risk of an overdose.

Amphetamines. While gamma-hydroxybutyrate slows down the CNS, amphetamines speed it up. The combination of these two drugs can lead to unexpected interactions.

Antipsychotics. Since both antipsychotics and GHB act upon the CNS, mixing these two drugs can lead to extensive brain damage.

Narcotics. Gamma-hydroxybutyrate combined with narcotics, such as pain medication might lead to drowsiness, sleepiness, and other severe side effects. Some of the pain medications that GHB might interact with are morphine, hydrocodone, and meperidine.

Muscle relaxants. Taking muscle relaxants together with gamma-hydroxybutyrate can boost the effects of the drugs leading to extreme drowsiness and even coma.

CNS depressants. Interaction of GHB and other CNS depressants can result in nausea, vomiting, respiratory, and CNS over-depression.

HIV/AIDS drugs. Medications such as saquinavir and ritonavir are used in patients with HIV/AIDS can interact with gamma-hydroxybutyrate, which might cause the drugs to stay longer in the system, leading to serious side effects and even overdosing.

Other drugs can also interact with Xyrem. That’s why it is important to inform a doctor about all the medications a patient is currently taken to prevent any adverse side interactions.

Treatment For GHB Addiction

People who become addicted to gamma-hydroxybutyrate (GHB) might experience unpleasant GHB withdrawal symptoms after stopping the drug. It might prevent them from being able to quit the drug by themselves. For this reason, many drug rehab clinics have developed programs for such addicts. The patients will be admitted to long-term treatment for substance abuse, which includes learning coping skills, positive decision-making, and the improvement of overall health.

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Sources
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  7. Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Current Neuropharmacology. 2015; 13(1): 47‐70. doi:10.2174/1570159X13666141210215423. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462042/.
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Olivier George

About Author

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

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