Dear editor;

Gamma-hydroxybutyrate (GHB) is a substance that is structurally related to gamma-aminobutyric acid (GABA) and is found as a metabolite of GABA in the human brain. First developed as an anesthetic agent in 1960, and in subsequent years the abuses have been reported in body building activities as dietary supplements and growth hormone stimulant. Starting from the eighties, it started to be used especially as a “club drug” because of its sexual desire enhancing effects, and an increasing number of case reports of GHB acute poisoning have been reported (1-4).

Although GHB has similar cellular and behavioral effects with classic sedatives-hypnotics such as benzodiazepines and barbiturates, it has been suggested that GHB functions as a separate neurotransmitter/neuromodulator, and for this reason, it must be accepted as a disparate pharmacological agent (3). Typical poisoning symptoms include drowsiness, confusion, bradycardia, hypothermia, hypotension, nausea and vomiting (5). Life-threatening conditions such as epileptic seizures, respiratory depression, coma and deaths associated with GHB use have also been reported (4-6).

GHB has attracted attention in recent years due to its use in bar, club, and party environments with other psychoactive substances such as alcohol, ecstasy, cocaine, amphetamines and it has been drawn since it has been used in sexual assaults (3-7). It is stated that besides the effects such as euphoria, giving energy, increasing sexual desire, and sociality, lack of side effects such as night falling, the ease of production and selling at low prices makes it preferable (8,9). According to literature; especially teenagers (9) and homosexual and bisexual population, given that widespread use (10). GBH is referred as “liquid ecstasy”, “liquid X”, “scoop”, “soap”, “salty water”, “grievous bodily harm”, “vitamin G” in abroad (3,7) and “G” in Turkey, among the people. In foreign countries, there has been no mention of the use of GHB in Turkey, as it has been found in the literature for many years.

Given the increasing use of GHB in our country today and its potential dangers, we would like to remind of the importance of developing psychoeducational approaches, making legal regulations, performing clinical researches about determination of clinical parameters including laboratory screening tests to detect the use of GHB, full of GHB intoxication and withdrawal symptoms, and informing clinicians about effects of GHB, to the prevention of GHB use.

REFERENCES

1. Wood DM, Brailsford AD, Dargan PI. Acute toxicity and withdrawal syndromes related to gamma-hydroxybutyrate (GHB) and its analogues gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD). Drug Test Analy 2011; 3:417-425. [CrossRef]

2. Degenhardt L, Darke S, Dillon P. GHB use among Australians: characteristics, use patterns and associated harm. Drug Alcohol Depend 2002; 67:89-94. [CrossRef]

3. Nicholson KL, Balster RL. GHB: a new and novel drug of abuse. Drug Alcohol Depend 2001; 63:1-22. [CrossRef]

4. Anderson IB, Klm SY, Dyer JE, Burkhardt CB, Iknolan JC, Walsh MJ, Blanc PD. Trends in gamma-hydroxybutyrate (GHB) and related drug intoxication: 1999 to 2003. Ann Emerg Med 2006; 47:177-183. [CrossRef]

5. Liechti ME, Kunz I, Greminger P, Speich R, Kupferschmidt H. Clinical features of gamma-hydroxybutyrate and gamma-butyrolactone toxicity and concomitant drug and alcogol use. Drug Alcohol Depend 2006; 81:323-326. [CrossRef]

6. Okun MS, Boothby LA, Bartfield RB, Doering PL. GHB: an important pharmacologic and clinical update. J Pharm Pharm Sci 2001; 4:167-175.

7. Efeoglu P, Daglioglu N, Hilal A, Gulmen MK. Drugs used in sexual assaults: features and toxicological investigations. Archives Medical Review Journal 2013; 22:418-425.

8. Nemeth Z, Kun B, Demetrovics Z. The involvement of gamma-hydroxybutyrate in reported sexual assaults: a systematic review. J Psychopharmacol 2010; 24:1281-1287. [CrossRef]

9. Brunt TM, Koeter MW, Hertoghs N, van Noorden MS, van den Brink W. Sociodemographic and substance use characteristics of gamma hydroxybutyrate (GHB) dependent inpatients and associations with dependence severity. Drug Alcohol Depend 2013; 131:316-319. [CrossRef]

10. Palamar JJ, Halkitis PN. A qualitative analysis of GHB use among gay men: reasons for use despite potential adverse outcomes. Int J Drug Policy 2006; 17:23-28. [CrossRef]