Preliminary Web-Based Measures Development for GHB: Expectancies, Functions, and Withdrawal

Stein, L. A. R.; Lebeau, Rebecca; Clair, Mary; Martin, Rosemarie A.; Bryant, Monte; Storti, Susan A.

doi:10.3109/00952990.2011.643970

Cited by 6 publications

(3 citation statements)

References 38 publications

(69 reference statements)

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“…Regular GHB use may cause severe dependence and serious withdrawal symptoms upon abrupt discontinuation of chronic, frequent use [39,40,46,101]. Studies on recreational users revealed a high dependence liability in frequent, heavy GHB users [36,102]. In clinical trials with human subjects GHB displayed greater abuse liability than ethanol [16,103].…”

Section: Problematic Use: Ghb Addiction 81 Addiction Liability In Hmentioning

confidence: 99%

GHB, GBL and 1,4-BD Addiction

Brunt¹,

Amsterdam²,

Brink

2014

CPD

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A growing body of evidence shows that gamma-hydroxybutyric acid (GHB) is an addictive substance. Its precursors gammabutyrolactone (GBL) and 1,4-butanediol (1,4-BD) show the same properties and may pose even more risks due to different pharmacokinetics. There are indications that problematic GHB use is increasing in the European Union. This review investigates the existing literature on the neurochemistry of GHB and its precursors, their acute toxicity, addiction potential and withdrawal, the proposed molecular mechanism underlying addiction and the treatment of withdrawal and addiction. Current evidence shows that GHB and its precursors are highly addictive, both in humans and animals, probably through a GABAB receptor related mechanism. Severity of withdrawal symptoms can be considered as a medical emergency. Recent studies suggest that benzodiazepines are not very effective, showing a high treatment resistance, whereas detoxification with pharmaceutical GHB proved to be successful. However, relapse in GHB use is frequent and more research is warranted on relapse prevention. This might aid medical practitioners in the field and improve general understanding of the severity of addiction to GHB, GBL and 1,4-BD.

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Section: Problematic Use: Ghb Addiction 81 Addiction Liability In Hmentioning

confidence: 99%

GHB, GBL and 1,4-BD Addiction

Brunt¹,

Amsterdam²,

Brink

2014

CPD

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“…On the first day of GHB/GBL detoxification, ratings will be obtained from each participant of their symptoms of GHB/GBL withdrawal using a scale widely used for alcohol withdrawal – the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) which is currently used clinically by teams to monitor GHB/GBL withdrawal [ 32 – 35 ]. The CIWA-Ar may not adequately capture all neuropsychiatric symptoms/signs [ 32 , 33 ] and the Sedation Assessment Tool (SAT) will assess behavioural disturbance [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

Improving GHB withdrawal with baclofen: study protocol for a feasibility study for a randomised controlled trial

Lingford-Hughes

Patel

Bowden‐Jones

et al. 2016

Trials

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BackgroundGHB (gamma-hydroxybutyrate) and its pro-drugs GBL (gamma-butyrolactone) and 1,4-butanediol (1,4-BD) are central nervous system depressants whose street names include ‘G’ and ‘liquid ecstasy’. They are used recreationally predominately for their stimulant and pro-sexual effects or for sedation to help with sleep and/or to ‘come down’ after using stimulant recreational drugs. Although overall population prevalence is low (0.1 %), in some groups such as men who have sex with men, GHB/GBL use may reach 20 %. GHB/GBL dependence may be associated with severe withdrawal with individuals presenting either acutely to emergency departments or to addiction services for support. Benzodiazepines are currently prescribed for GHB/GBL detoxification but do not prevent all complications, such as behavioural disinhibition, that may require hospitalisation or admission to a high dependency/intensive care unit. The GABAB receptor mediates most effects of GHB/GBL and the GABAB agonist, baclofen, has shown promise as an adjunct to benzodiazepines in reducing withdrawal severity when prescribed both during withdrawal and as a 2-day ‘preload’ prior to detoxification. The key aim of this feasibility study is provide information about recruitment and characteristics of the proposed outcome measure (symptom severity, complications including delirium and treatment escalation) to inform an application for a definitive randomised placebo controlled trial to determine the role of baclofen in the management of GHB/GBL withdrawal and whether starting baclofen 2 days earlier improves outcomes further.Methods/designThis is a prospective, randomised, double-blind, placebo-controlled feasibility study that will recruit participants (aged over 18 years) who are GHB/GBL-dependent and wish to undergo planned GHB/GBL detoxification or are at risk of acute withdrawal and are inpatients requiring unplanned withdrawal. We aim to recruit 88 participants: 28 unplanned inpatients and 60 planned outpatients.During detoxification we will compare baclofen 10 mg three times a day with placebo as an adjunct to the usual benzodiazepine regimen. In the planned outpatient arm, we will also compare a 2-day preload of baclofen 10 mg three times a day with placebo. Ratings of GHB/GBL withdrawal, sleep, depression, anxiety as well as GHB/GBL use will be collected. The main data analyses will be descriptive about recruitment and characterising the impact of adding baclofen to the usual benzodiazepine regimen on measures and outcomes of GHB/GBL withdrawal to provide estimates of variability and effect size. A qualitative approach will evaluate research participant and clinician acceptability and data collected to inform cost-effectiveness.DiscussionThis feasibility study will inform a randomised controlled trial to establish whether adding baclofen to a benzodiazepine regimen reduces the severity and complications of GHB/GBL withdrawal.Trial registrationISRCTN59911189. Registered 14 October 2015. Protocol: v3.1, 1 February 2016

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“…Regular GHB use may cause severe dependence and serious withdrawal symptoms upon abrupt discontinuation of chronic, frequent use [ 36 - 38 ]. Prevalence of physical dependence in recreational GHB users ranges from 4-21%, with higher rates in heavy users [ 33 , 39 - 41 ]. Upon drug discontinuation, moderate GHB users will usually experience a mild withdrawal syndrome, but withdrawal can be more severe in chronic and heavy users of GHB and can be much more serious than previously assumed [ 42 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review

Amsterdam

Brunt

Pereira

et al. 2022

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Background: GHB (gamma-hydroxybutyric acid; sodium oxybate) is a general anaesthetic that is clinically used for the treatment of narcolepsy, cataplexy, alcohol withdrawal and alcohol relapse prevention. In addition, GHB is recreationally used. Most clinical and recreational users regard GHB as an innocent drug devoid of adverse effects, despite its high dependence potential and possible neurotoxic effects. At high doses, GHB may lead to a comatose state. This paper systematically reviews possible cognitive impairments due to clinical and recreational GHB use. Methods: PubMed and PsychINFO were searched for literature data about the acute and residual cognitive deficits following GHB use. This review is conducted using the PRISMA protocol. Results: A total of 43 reports covering human and animal data on GHB-induced cognitive impairments were eligible and reviewed. This systematic review found no indication for cognitive impairments after clinical GHB use. However, it supports the view that moderate GHB use may result in acute short-term cognitive impairments, whereas regular high-dose GHB use and/or multiple GHB-induced comas are probably neurotoxic resulting in long-term residual cognitive impairments. Conclusion: These results emphasize the need for awareness among clinicians and recreational users to minimize negative health consequences of recreational GHB use, particularly when high doses are used, and GHB-induced comas occur.

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Preliminary Web-Based Measures Development for GHB: Expectancies, Functions, and Withdrawal

Cited by 6 publications

References 38 publications

GHB, GBL and 1,4-BD Addiction

GHB, GBL and 1,4-BD Addiction

Improving GHB withdrawal with baclofen: study protocol for a feasibility study for a randomised controlled trial

Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review

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