Gamma-hydroxybutyrate (GHB): a review for the prehospital clinician
Abstract
Background:
Gamma-hydroxybutyrate (GHB) is a depressant of the central nervous system with euphoric effects. It is being increasingly used recreationally in the UK, despite associated morbidity and mortality. Because evidence is lacking, health professionals remain unsure as to the optimum management of GHB acute toxicity.
Methods:
A literature review was undertaken on GHB pharmacology and the emergency management of its acute toxicity.
Findings:
GHB is inexpensive and readily available over the internet. Treatment of GHB acute toxicity is supportive. Clinicians should pay attention to the airway as emesis is common. Mechanical ventilation is required in a minority of cases. Polydrug use is common and worsens prognosis.
Conclusion:
GHB is an inexpensive and readily available drug, and acute toxicity can be difficult to identify and treat. GHB acute toxicity is generally treated conservatively. Further research is needed to ascertain the indications for and the benefits and risks of intubating patients with GHB acute toxicity.
Gamma-hydroxybutyrate (GHB) was first used in humans by the French pharmaceutical industry in the 1960s (Laborit et al, 1960). Originally used as a gamma aminobutyric acid (GABA)-ergic central nervous system (CNS) depressant, it induces neurotoxicity in animals (Ainslie et al, 2016).
From the early 1990s, it became an attractive drug of recreational abuse because of its low cost and widespread availability (Nicholson and Balster, 2001). GHB and its precursor gamma-butyrolactone (GBL) are now witnessing widespread illegal use in clubs for gay men and the chemsex scene (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2008).
Few studies focus on the prehospital management of GHB acute toxicity. The purpose of this literature review is to broaden the prehospital clinician's knowledge and serve as a guide for their future encounters.
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