U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

Substance Abuse Treatment 

ADVISORY

Breaking News for the Treatment Field 

November 2002
 

Volume 2
 

Issue 1 

GHB: A Club Drug To Watch 

Treatment Guidelines for 

GHB Withdrawal 

Many clients who use GHB are not dependent on it and 

therefore can be educated about its risks and referred for 

outpatient therapy. However, clients with a history of 

frequent dosing may experience withdrawal symptoms 

and require supervised medical detoxification. In these 

situations, providers should note the following: 

•	 GHB withdrawal and detoxification require

close medical supervision. Most clients require 

hospitalization ranging from 7 to 14 days. 

•	 Most people who become dependent on GHB find the

withdrawal symptoms unbearable and may try to selfmedicate or self-detoxify with other drugs, including 

benzodiazepines, or alcohol. Using other substances 

in this way appears to contribute to withdrawal 

severity and may lead to respiratory depression, 

coma, and death. 

•	 Benzodiazepines can help ease some of the symptoms

of GHB withdrawal, particularly psychotic agitation, if 

given in appropriate (and medically supervised) doses. 

•	 Other medications (e.g., barbiturates, anticonvulsants,

and antihypertensives) may be required to effectively 

manage GHB withdrawal and detoxification. 

•	 Another result of GHB withdrawal is amnesia or

memory loss, which greatly complicates a client’s 

treatment at every stage and “may contribute 

to a revolving door of treatment episodes and 

relapse when the patient has little awareness of 

the consequences of his or her GHB addiction.”* 

Therefore, ongoing client education is critical. 

•	 Although clinicians have gained some insight

into GHB dependence and withdrawal, research 

on treatment is an important area to be further 

developed. n

*Miotto, K., and Roth, B. “GHB Withdrawal Syndrome.” 

Austin: Texas Commission on Alcohol and Drug Abuse. 

What is GHB? 

Gamma hydroxybutyrate (GHB) is one of a group of 

club drugs that often are abused by people who attend 

a variety of all-night parties sometimes called “raves.”1 

In addition to GHB, the five drugs commonly identified 

as club drugs are lysergic acid diethylamide (LSD), 

ketamine, methamphetamine, methylenedioxymethamphetamine (MDMA, or ecstasy), and rohypnol 

(flunitrazepam).2 

GHB is a synthetically produced central nervous system 

depressant. On the street, it is usually sold as a liquid 

by the dose (a capful from a bottle or drops). In some 

cities, GHB is put into water guns, and users buy it by 

the squirt. In other instances, candy, such as a lollipop, 

is dipped in GHB and sold.3

 In liquid form, GHB is 

colorless and odorless and has a salty or soapy taste.4 

GHB is also sold in powder or capsule form. It is made 

of lye or drain cleaner mixed with GBL, a 

chemical cousin of GHB and an industrial solvent 

often used to strip floors. GBL itself is often abused 

and produces the same effects as GHB. GBL and 

another chemical cousin, 1,4 butanediol (1,4 BD), 

convert to GHB in the body. Recipes for GHB can 

easily be found on the Internet. Some GHB users brew 

the drug in bathtubs at home.5 

Who uses GHB? 

The majority of GHB users are young adults. Many of 

these users do not realize that GHB affects each person 

differently or that differences in the purity and strength 

of the dose can mean the difference between life and 

death. Misinformation on the Internet, a medium 

widely used by young adults, may also contribute to 

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ADVISORY .............................................................................. 
 

the problem. According to a report titled “Drugs and the 

Internet,” by the National Drug Intelligence Center, GHB 

is described on many Web sites as a relatively benign 

drug.6

 Addiction and the possibilities of overdose and 

death generally are downplayed. The use of GHB as a 

date-rape drug is often dismissed as media hype. 

GHB use is most common among white, middle-class 

males between ages 13 and 30. GHB users are likely to use 

it with other drugs, particularly ecstasy.3

 However, there 

are geographical and population variances in GHB use. 

[For instance, in New Orleans, there have been reports of 

GHB use among secondary school and college students, 

whereas, in other areas, it is reputed to be widely accessible 

at gay male party venues.7

] 

Bodybuilders have reported that they use GHB because it 

stimulates the release of growth hormones. People who are 

alcohol dependent may use it to try to eliminate alcohol 

cravings, even though there is no medical approval for this 

use in the United States. 

Despite the belief of some users that GHB is a safe bodybuilding or sleep aid, or a party drug that poses no risk for 

addiction or overdose, the effects of GHB can be tragic. 

The only legitimate use of GHB in the United States is for 

the treatment of cataplexy, a symptom of the sleep disorder 

narcolepsy in which muscles lose strength. The U.S. Food 

and Drug Administration approved GHB, under the brand 

name Xyrem, on July 17, 2002, but mandated some of the 

most severe restrictions ever imposed on a medicine.8 

Why has there been so much media 

attention focused on GHB lately? 

During the past decade, the use of GHB and GBL 

has increased. According to the Substance Abuse and 

Mental Health Services Administration’s (SAMHSA’s) 

Drug Abuse Warning Network (DAWN), the number 

of emergency department (ED) visits in which GHB is 

mentioned, including those in which GBL is mentioned, 

increased from 56 in 1994 to 4,969 in 2000.9

 In 2000, 

GHB—again, including GBL—ranked 34th among 50 

most mentioned drugs in ED drug-related episodes. 

Why is GHB so dangerous? 

GHB, usually in combination with alcohol, was linked 

to more than 60 deaths from January 1992 to May 2001. 

Almost 60 percent of these deaths were people between 

ages 20 and 29. However, the number of GHB-related 

deaths may be underestimated because GHB does not 

remain in the body long and is usually not tested for at 

autopsy.1

 GHB may be missed by many conventional 

urine drug screens.4 

The effects of GHB vary each time a person takes it, and 

it affects each person differently.4

 A small increase in dose 

can increase the drug’s sedative effects to a lethal level. 

High doses of GHB may overwhelm the body’s ability to 

eliminate the drug; therefore, the effects are greater and 

last longer than expected.1 

The adverse effects of GHB include vomiting, seizure-like 

activity, loss of consciousness, respiratory arrest, coma, 

and death. GHB often is produced in clandestine laboratories; 

therefore, the purity and strength of doses vary. This 

situation makes it difficult for emergency personnel to 

obtain useful information on the amount of GHB that a 

person took. 

How is GHB used in date rape? 

GHB has been slipped into unsuspecting victims’ drinks. 

GHB’s taste can be masked by adding it to a flavored 

beverage. Because it is hard to detect GHB in a beverage, 

and because only small amounts are needed to achieve 

the desired effect, GHB has been used to facilitate rapes. 

Victims given GHB become unconscious and cannot 

defend themselves from these sexual assaults. They cannot serve as witnesses in court because amnesia is another 

effect of consuming GHB.4 

GHB has been implicated in deaths as well. For instance, 

in January 1999, 15-year-old Samantha Reid was 

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November 2002, GHB: A Club Drug To Watch 

Substance Abuse Treatment

ADVISORY .............................................................................. 
 

“scooped” (the street term for slipping GHB into 

someone’s drink). Reid lost consciousness and died the 

next day.5 The teenage boys who scooped her drink were 

sentenced to prison for manslaughter.10 Hillary J. Farias 

was raped after being slipped GHB. On February 18, 

2000, the Hillary J. Farias and Samantha Reid Date-Rape 

Drug Prohibition Act of 2000 became law, making GHB a 

Schedule 1 drug. 

Do people on GHB develop 

dependence and experience 

withdrawal symptoms? 

Severe GHB dependence was found to follow daily use 

of varying amounts of GHB over a period ranging from 

2 months to 3 years according to the findings in a retrospective study of eight patients with prolonged withdrawal 

symptoms after discontinuing chronic use of GHB.11 

Researchers found that withdrawal symptoms started 

between 1 and 6 hours after the last dose and lasted 

between 5 and 15 days. One person died from cardiac 

complications on the 13th day in the hospital. Reported 

withdrawal symptoms included: 

•	 Psychosis and severe agitation requiring self-protection

procedures and sedation 

•	 Mild tachycardia (increased heart rate) and hypertension

•	 Neurologic effects, including prolonged delirium

•	 Hallucinations

•	 Diaphoresis (profuse sweating), nausea, and vomiting.

What are the symptoms of a GHB 

overdose? 

Symptoms of GHB overdose include nausea, bradycardia 

(slow heart rate), and a decreased level of consciousness. 

Alcohol, opioids, barbiturates, and benzodiazepines 

potentiate the effects of GHB.12 In GHB overdoses, it is 

imperative to keep patients’ airways open, with assisted 

ventilation if necessary, and provide supportive care. GHB 

use should be considered when any patient presents with a 

coma of unknown origin.4 

What can treatment providers

do to help? 

Providers should learn all they can about GHB—including 

regional trends related to its use—because client education about the dangers of GHB is critical, particularly as 

reports of its euphoric effects may cause an increase in 

experimentation. 

Substance abuse treatment professionals should assess a 

client’s lifestyle and drug use habits before the client experiences adverse effects and requires medical intervention. 

If a client is known to be experimenting with GHB or other 

club drugs, treatment providers should alert him or her to 

the adverse effects and provide emergency medical information from a poison control center or appropriate healthcare facility. Some experts suggest that clients with 

a history of bodybuilding be assessed for GHB abuse 

because this drug is commonly used in this patient population.4

 Providers should also warn clients that misinformation 

about GHB is available on the Internet. Many people who 

take the drug do not know of its dangers. For instance, 

only 9 GHB users in a study of 42 regular GHB users were 

aware that it could produce a withdrawal reaction.12 (See 

the box on the back page for more information about 

regular GHB users.) 

Knowing when patients need medical attention and 

referring them to appropriate care are key. n

Notes 

1Whitten, L. “Conference Highlights Increasing GHB Abuse.” 

NIDA Notes. Bethesda, MD: National Institute on Drug 

Abuse. Retrieved April 5, 2002, from the World Wide Web, 

www.drugabuse.gov/NIDA_Notes/NNVol16N2/Conference.html.
 

2Office of Applied Studies. “Club Drugs.” The DAWN Report. 

Rockville, MD: Substance Abuse and Mental Health Services 

Administration, 10 pp., December 2000.
 

3Executive Office of the President, Office of National Drug 

Control Policy. Pulse Check: Trends in Drug Abuse. ONDCP 

Pub. No. (NCJ) 191248. Washington, DC: Office of National 

Drug Control Policy, pp. 75–88, November 2001.
 

3 
ADVISORY ..............................................................................

November 2002, Volume 2, Issue 1

4

Substance Abuse Treatment

4Teter, C.J., and Guthrie, S.K. “A Comprehensive Review of 

MDMA and GHB: Two Common Club Drugs.” Pharmacotherapy

21(12):1486–1513, 2001.

5Cannon, A. “Sex, Drugs, and Common Death.” U.S. News and 

World Report, May 24, 1999.

6National Drug Intelligence Center. “Drugs and the Internet—

An Overview of the Threat to America’s Youth.” Retrieved 

April 30, 2002, from the World Wide Web, www.usdoj.gov/

ndic/pubs/682.

7Community Epidemiology Work Group. Epidemiologic 

Trends in Drug Abuse, Advanced Report. Bethesda, MD. 

National Institute on Drug Abuse, June 1999. Retrieved 

September 13, 2002, from the World Wide Web, 

165.112.78.61/CEWG/AdvancedRep/699ADV/699adv.html.

8Center for Drug Evaluation. “FDA Drug Approvals List.” U.S. 

Food and Drug Administration. Retrieved July 31, 2002, from 

the World Wide Web, www.fda.gov/cder/whatsnew-date.htm.

9Office of Applied Studies. Emergency Department Trends 

From the Drug Abuse Warning Network, Preliminary 

Estimates January–June 2001 With Revised Estimates 1994–

2000. DAWN Series D-20. DHHS Pub. No. (SMA) 02–3634. 

Rockville, MD: Substance Abuse and Mental Health Services 

Administration, p. 104, 2002. 

10Associated Press. “Three Convicted in Date-Rape Drug 

Trial.” March 14, 2000. Retrieved September 13, 2002, 

from the World Wide Web, abcnews.go.com/sections/us/

DailyNews/daterape000314.html.

11Dyer, J.E.; Roth, B.; and Hyma, B.A. “Gammahydroxybutyrate Withdrawal Syndrome.” Annals of Emergency 

Medicine 37(2):147–53, 2001.

12Miotto, K.; Darakjian, J.; Basch, J.; Murray, S.; Zogg, J.; 

and Rawson, R. “Gamma-hydroxybutyric Acid: Patterns 

of Use, Effects, and Withdrawal.” American Journal on 

Addictions 10(3):232–41, 2001.

Survey of 42 Self-Reporting Regular GHB Users12

Positive Effects of GHB Use—Euphoria, increased sex drive, and tranquility.

Adverse Effects—Sweating and loss of consciousness (reported by 69 percent),

nausea, auditory and visual hallucinations, headaches, vomiting, exhaustion, 

sluggishness, amnesia, confusion, and clumsiness.

Rate of Use—18 participants used GHB 2 or 3 times daily, 12 participants 

4 or more times daily, and 12 participants once daily.

Positive effects of GHB use, as compared with adverse 

experiences, were emphasized by participants. However, 

family members reported a “change in personality,” including 

increased aggression, irritability, and memory problems. 

Participants who used GHB with other substances reported 

more severe adverse events than those who used GHB alone. n

Notes (continued)

Substance Abuse Treatment Advisory

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Recommended Citation: Center for Substance Abuse Treatment. “GHB: A Club Drug to Watch.” Substance Abuse Treatment 

Advisory, Volume 2, Issue 1, November, 2002.

HHS Publication No. (SMA) 03-3766

First printed 2002

Revised 2011