Gammabutyrolactone: withdrawal syndrome resembling delirium tremens

Abstract

Gammabutyrolactone (GBL, Liquid Ecstasy) is an emerging drug of abuse in the United Kingdom. It is metabolised to gamma hydroxybutyrate (GHB) in the body and has cross-tolerance with alcohol. We report a case of acute withdrawal resembling delirium tremens: a young male recognised to be withdrawing from GBL was treated with high doses of benzodiazepines. At lower doses GBL and GHB cause euphoria, disinhibition and increased libido. At higher doses they cause CNS and respiratory depression. The risk of toxicity is increased markedly by co-ingestion of other depressant substances such as alcohol, benzodiazepines or opiates. UK Home Office reclassified GHB as Class C controlled substance; however, GBL remains unclassified and it is easily available. Symptoms of withdrawal appear rapidly and the delirium evolves more rapidly. Early symptoms include anxiety, insomnia, mild tremor and intermittent tachycardia. Users of GBL should be aware of the risk of dependence in addition to toxicity. The police and criminal justice system should also be aware of its potential for misuse as a date rape drug. Professionals should be able to recognise and treat the withdrawal syndrome. Greater restrictions should be placed on its availability, and the Home Office should urgently consider reclassifying GBL as a controlled substance.

• Gammabutyrolactone (GBL) Liquid Ecstasy
• gamma hydroxybutyrate (GHB)