Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use.

John M Corkery, Barbara Loi, Hugh Claridge, Christine Goodair, Ornella Corazza, Simon Elliott, Fabrizio Schifano

Journal: Neuroscience and biobehavioral reviews 2016;53():52-78

PMID: 25843781

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Abstract

Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4-butanediol (1,4-BD) use extracted from the UK's National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%); young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0-6500; SD 758)mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.

Address: National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK. Electronic address: [email protected].; National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK; Neuroscience Institute, National Research Council of Italy, Section of Cagliari, I-09042 Monserrato, CA, Italy.; National Programme on Substance Abuse Deaths, St George's University of London, UK.; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.; ROAR Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire WR14 3SZ, UK.; National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.

DOI: 10.1016/j.neubiorev.2015.03.012

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MeSH Terms: 4-Butyrolactone, Butylene Glycols, Female, Humans, Male, Sodium Oxybate, Substance-Related Disorders, United Kingdom