Prolonged Withdrawal From Extreme γ-Hydroxybutyrate (GHB) Abuse

Mahr, Greg; Bishop, Cecily; Orringer, David

doi:10.1176/appi.psy.42.5.439

Cited by 20 publications

(11 citation statements)

References 5 publications

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“…[25][26][27] In cases where the same patient presented with multiple episodes of withdrawal, each episode was considered separately. Twenty-seven articles, all case series or case reports, fulfilled study eligibility criteria, [5][6][7][8][9][10][11][12][13][14][15][16][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] describing 57 patients with withdrawal: GHB in 36 cases, 1,4-BD in 3 cases and GBL in 18 cases. Mean age was 31 years (range 18-57 yr) and 65% (37/57) were male.…”

Section: Resultsmentioning

confidence: 99%

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

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1,4-Butanediol (1,4-BD) is an industrial solvent that is metabolized to gamma-hydroxybutyrate (GHB), a gamma-aminobutyric acid agonist and central nervous system depressant. GHB and its analogues are popular drugs of abuse. Withdrawal from these agents is characterized by autonomic instability and altered mental status. We report a case of withdrawal from 1,4-BD lasting 6 days and complicated by new onset of seizures and rhabdomyolysis. In addition, we conducted a systematic review of the English literature pertaining to withdrawal from GHB, 1,4-BD and gamma-butyrolactone (GBL). Data collected from source articles included last use prior to symptom onset, clinical features on presentation, duration of symptoms and outcome. Twenty-seven studies with 57 episodes of withdrawal were included. Thirty-six cases (63%) involved GHB, 3 cases (5%) involved 1,4-BD and 18 (32%) involved GBL. The most common patient symptoms were tremor (67%), hallucinations (63%), tachycardia (63%) and insomnia (58%). Seizures and rhabdomyolysis each occurred in 7% of cases, but only 1 death occurred. Emergency physicians must consider withdrawal from these agents when patients present with clinical features suggestive of a sedative-hypnotic withdrawal syndrome. RÉSUMÉLe butane-1,4-diol (BD-1,4) est un solvant industriel qui se métabolise en 4-hydroxybutanoate (GHB), un agoniste de l'acide 4-aminobutanoïque et un dépresseur du système nerveux central. Le GHB et ses analogues sont des drogues populaires faisant l'objet d'abus. Le sevrage de ces agents se manifeste par une instabilité autonome et un état mental altéré. Nous présentons un cas de sevrage de BD-1,4 ayant duré 6 jours et ayant été compliqué par une nouvelle apparition de convulsions et de rhabdomyolyse. Nous avons en outre réalisé une revue systématique de la littéra-ture anglaise portant sur le sevrage du GHB, du BD-1,4 et du gamma-butyrolactone (GBL). Les données recueillies des articles sources incluaient des renseignements sur la dernière utilisation avant la survenue de symptômes, les manifestations cliniques à l'arrivée des patients à l'urgence, la durée des symptômes et les résultats. La revue portait sur 27 études décrivant 57 épisodes de sevrage. Trente-six cas (63 %) étaient liés au GHB, 3 cas (5 %) au BD-1,4 et 18 (32 %) au GBL. Les tremblements (67 %), les hallucinations (63 %), la tachycardie (63 %) et l'insomnie (58 %) étaient les symptômes les plus courants observés chez les patients. Les convulsions et la rhabdomyolyse se sont manifestées respectivement dans 7 % des cas, mais seulement 1 décès a eu lieu. Lorsqu'un patient présente des manifestations cliniques évoquant le syndrome de sevrage de sédatifs hypnotiques, les médecins d'urgence devraient considérer la possibilité de sevrage de ces agents.

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Section: Resultsmentioning

confidence: 99%

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Wojtowicz

Yarema

Wax

2008

CJEM

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“…The one distinguishing feature of GHB toxicity is the sudden awakening of the patient from a comatose state to a normal or hyperactivated state of arousal. Severe withdrawal reactions have been reported, with some dependent persons escalating their use to every 2 to 4 hours in a pattern of around-the-clock dosing (Bialer, 2002;Freese, Miotto, and Reback, 2002;McDaniel and Miotto, 2001;Mahr, Bishop, and Orringer, 2001;Schneir, Ly, and Clark, 2001). For a detoxification protocol, see http://www.tcada.state.tx.us/research/GHB Withdrawal.pdf.…”

Section: Adverse Effectsmentioning

confidence: 99%

Party Drugs: Properties, Prevalence, Patterns, and Problems

Maxwell

2005

Substance Use & Misuse

111

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This review summarizes the latest literature on "party" or "club" drugs, defined as MDMA, GHB, ketamine, and Rohypnol, as published from 2002 to early 2005. Club drugs have been categorized as being used at raves and dance parties. The literature shows that each drug has different properties, users, and settings. Each drug has different adverse effects and requires different acute care protocols. Although these drugs were identified early, scientific information about them, including the toxicological tests to identify them, is still evolving. Increasing numbers of studies on the short- and long-term effects of these drugs on humans are being published, but because of limitations on research using human subjects, they may not always be as rigorous as desired and can be cited by drug users to discredit findings of harm. The lack of research-based information on these drugs has led to the emergence of web sites that may or may not provide accurate data. Evaluated chemical dependency treatment protocols using the latest research for each of these different drugs are needed.

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“…Psychotic symptoms appear paradoxical in SSADH deficiency as GHB has antipsychotic effects by inhibiting dopamine release (Maitre 1997). However, GHB withdrawal after chronic intoxication in healthy individuals may also induce psychotic features (Sanguineti et al 1997, Craig et al 2000, Mahr et al 2001. Taken together, these findings indicate that the dysfunction of the GHBergic neuromodulatory system most likely accounts for psychotic features in patients with SSADH deficiency.…”

Section: Learning Disability Neurological and Psychotic Featuresmentioning

confidence: 91%

Neurodevelopmental pattern of succinic semialdehyde dehydrogenase deficiency (γ-hydroxybutyric aciduria)

Philippe

Deron

Geneviève

et al. 2004

Dev Med Child Neurol

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Succinic semialdehyde dehydrogenase (SSADH deficiency) (MIM 271980) is a defect in gamma-aminobutyric acid catabolism, resulting in the accumulation of gamma-hydroxybutyric acid (GHB) and causing neurological and cognitive disorders of varying severity. The non-specific nature and the difficulties in detection of urinary GHB explain why this disorder is largely underdiagnosed. Of 350 patients identified worldwide, to date only six adults with SSADH deficiency have been reported in the literature. Here we describe two additional cases in brothers up to ages 26 and 28 years. This retrospective report sheds light on the clinical features of SSADH deficiency in relation to the physiopathological involvement of GHB, and tries to identify the specific neurodevelopmental pattern of this learning disability.* Features of this are: early impaired psychomotor development with hypotonia and disturbances in motor coordination; impaired development of language, mainly due to poor auditory perception; and seizures and psychotic features in late adolescence or adulthood. Moreover, narcolepsy-like symptoms could be a consistent feature of the disease.

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Prolonged Withdrawal From Extreme γ-Hydroxybutyrate (GHB) Abuse

Cited by 20 publications

References 5 publications

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Withdrawal from gamma-hydroxybutyrate, 1,4-butanediol and gamma-butyrolactone: a case report and systematic review

Party Drugs: Properties, Prevalence, Patterns, and Problems

Neurodevelopmental pattern of succinic semialdehyde dehydrogenase deficiency (γ-hydroxybutyric aciduria)

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