Effect of γ-hydroxybutyrate (GHB) on driving as measured by a driving simulator

Liakoni, Evangelia; Dempsey, Delia; Meyers, Matthew J.; Murphy, Nancy G.; Fiorentino, Dary; Havel, Christopher; Haller, Christine; Benowitz, Neal L.

doi:10.1007/s00213-018-5025-2

Cited by 16 publications

(8 citation statements)

References 55 publications

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“…64 In simulated driving tasks, subjects exposed to therapeutic doses of GHB as sodium oxybate had significant impairments at 1-hour post-dose. 65 The impairments identified included simulations of collision and off-road accidents at 1-hour post-dose. 65 Evaluation at 3-and 6-hours post-dose indicated gradual recovery from driving impairments over time as plasma concentrations fell, suggesting a concentration-dependent effect-impairment relationship.…”

Section: Other Associated Problemsmentioning

confidence: 99%

“…65 The impairments identified included simulations of collision and off-road accidents at 1-hour post-dose. 65 Evaluation at 3-and 6-hours post-dose indicated gradual recovery from driving impairments over time as plasma concentrations fell, suggesting a concentration-dependent effect-impairment relationship. 65 In an analysis of real-world GHB associated driving incidents, observed clinical signs included sedation, agitation, confusion, ataxia and dysarthria.…”

Section: Other Associated Problemsmentioning

confidence: 99%

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Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

Tay¹,

WKW²,

Murnion³

2022

SAR

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Recreational gamma-hydroxybutyrate (GHB) use, although less common than other substance use, is increasingly recognised and is over-represented in emergency toxicology presentations. This narrative review summarizes GHB pharmacology, current patterns of use, potential harms and management of GHB toxicity and withdrawal. There is a complex interplay between GHB and GABA as GHB is both a prodrug and metabolite of GABA and GHB activates both GHB and GABA receptors. GHB is rapidly absorbed, with effects seen within minutes of ingestion. Metabolism is non-linear at higher doses. While GHB is listed as a controlled substance, its precursor's gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are easily available as both have industrial applications. National surveys indicate low rates of GHB use, with identification of high-risk populations in men who have sex with men and polysubstance users. GHB is one of the three drugs most commonly used in chemsex. GHB is often co-ingested with other interacting psychoactive substances. Acute toxicity is dose-dependent, and management is supportive care. Withdrawal management is generally with benzodiazepines with addition of baclofen for more severe withdrawal. Barbiturates may have a role. Titration and tapering of pharmaceutical GHB is commonly used in the Netherlands. Complicated withdrawal with delirium may require intensive care and treatment with intravenous sedation. There are high rates of relapse after withdrawal and medications for longerterm management are currently being investigated. Chronic use is associated with poorer mental, physical and sexual health, social dysfunction and poor work performance. Laboratory detection is complicated as GHB is an endogenous substance with a short halflife, and therefore not often routinely assayed in the clinical setting. Future research should focus on improving GHB detection and management of GHB withdrawal and dependence. Interventions specific for high-risk groups should be developed and assessed.

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Section: Other Associated Problemsmentioning

confidence: 99%

Section: Other Associated Problemsmentioning

confidence: 99%

Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

Tay¹,

WKW²,

Murnion³

2022

SAR

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“…39 As a sodium salt of GHB, sodium oxybate can impair driving after being ingested due to profound sleepiness and reduced consciousness, and there have been reports of "sleep driving" in patients while taking it. [40][41][42][43][44][45] However, sodium oxybate has a half-life of only 30-40 minutes, with rapid clearance, reducing the incidence of these medication-related parasomnias. 46 One study assessed driver simulator performance on sodium oxybate and found severe driving impairment one hour after dosing that was similar to drivers with breath alcohol concentrations of 0.08% to 0.1%, which is considered legally impaired for drivers in the US.…”

Section: Sodium Oxybatementioning

confidence: 99%

“…However, driving performance returned to baseline after three and six hours, and no GHB was detected in the serum of participants after 6 hours. 40 Patients should be counseled regarding their dose times to ensure at least 6 hours have passed since their last dose before driving. (Xyrem product information, www.xyrem.com )…”

Section: Pharmacologic Treatments As Risk Mitigationmentioning

confidence: 99%

<p>Therapeutic Strategies for Mitigating Driving Risk in Patients with Narcolepsy</p>

McCall

Watson

2020

TCRM

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Narcolepsy is a central nervous system hypersomnia disorder characterized by uncontrollable episodes of daytime sleep, sleep state instability, and cataplexy (sudden loss of muscle tone precipitated by emotion). Individuals with narcolepsy report more frequent sleep-related crashes, near crashes, and drowsy driving than drivers with other sleep disorders. As such, evaluating risk of sleep-related crashes is of great importance for this patient population. There are no established guidelines for ensuring driving safety in patients with narcolepsy; however, many providers currently use a combination of subjective report, report of prior crashes or near-misses, report of previously falling asleep while driving, sleepiness screening tools, and maintenance of wakefulness testing (MWT) to determine risk. Driving simulator tests, though often unavailable to the clinician, provide data to support the use of MWT for evaluation of alertness in drivers with narcolepsy. Treatments such as modafinil may improve driving performance; however, the impact of other treatments such as stimulants and sodium oxybate on driving has not been extensively studied. Behavioral and lifestyle modifications may also reduce risk, including scheduled naps, driving only short distances, and avoiding driving after meals, sedating medications, and alcohol intake. Even with effective treatment, alertness in patients with narcolepsy may never reach that of normal drivers; however, studies have suggested that narcolepsy patients may be able to drive safely with appropriate limitations.

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“…Im Bereich der Drogen wurden Vorschläge für ein generalisiertes Protokoll zu FS-Studien erstellt [22]. Neben MDMA [23], GHB [24], Methamphetaminen, [25], psychotropen Substanzen [26] und Kava [27] [44]) -an systematische Dosis-Wirkung-Studien von Cannabinoiden in FS angelehnt werden.…”

Section: Diskussion Der Wertigkeit Von Ergebnissen Aus Fahrsimulationsstudien Für Die Praxisunclassified

Buckle up!

2020

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Zusammenfassung Die Verkehrsmedizin als Teil der Rechtsmedizin erfüllt in der Schweiz eine wichtige präventive Aufgabe in der Sicherung aller Verkehrsteilnehmer: Sie begutachtet die medizinisch basierte Fahrfähigkeit und Fahreignung. Als empirisch konsolidiertes Querschnittsfach hat sie Informationen aus einer Vielzahl von medizinischen Fachgebieten. Wie reagiert die Verkehrsmedizin aber auf den vermehrten Anspruch evidenzbasierter Gutachten und auf anstehende Herausforderungen? Über einen historischen Abriss motivierten wir die Vorteile und das Potential einer teilweise durch Fahrsimulation ergänzten Untersuchung und einer dediziert auf Fahrsimulation basierenden, klinisch-prospektiven Forschung. Neben vorhandener Literatur stützen sich historische Aspekte u.a. auf vorhandene Expertise. Die Bewertung der Fahrsimulation für die Verkehrs- bzw. Rechtsmedizin der Schweiz stützt sich auf die Diskussion selektierter Literatur. Auftrag und Anspruch der Verkehrsmedizin haben sich mehrfach verändert. Eine übersichtsartige Betrachtung existenter Literatur legt nahe, dass massgeschneiderte Fahrsimulatoren Teil einer modernisierten Verkehrsmedizin sein können, um anstehende Herausforderungen adäquat adressieren zu können. Bisher existiert kein derartiges dediziertes Forschungsinstrument in der Schweiz. Eine auf verkehrsmedizinische Fragestellungen massgeschneiderte, realitätsnahe und niedrigschwellige Fahrsimulation als Werkzeug für klinische Studien und Individualuntersuchungen verspricht neben einer wissenschaftlichen Produktivität einen umsetzbaren und vermittelbaren Mehrwert für das übergeordnete Ziel der Sicherheit aller Verkehrsteilnehmer.

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Effect of γ-hydroxybutyrate (GHB) on driving as measured by a driving simulator

Abstract: GHB in doses used to treat narcolepsy resulted in severe driving impairment at 1 h post dosing. After 3 to 6 h, there was full recovery indicating that safe driving is expected the next morning after bedtime therapeutic GHB use in the absence of other substances.

Cited by 16 publications

References 55 publications

Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

Current Insights on the Impact of Gamma-Hydroxybutyrate (GHB) Abuse

<p>Therapeutic Strategies for Mitigating Driving Risk in Patients with Narcolepsy</p>

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