Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs

ABSTRACT

Introduction

GHB is a small molecule and is present in the human CNS. Exogenously, GHB is administered orally in the form of sodium oxybate to treat cataplexy and excessive daytime sleepiness in patients with narcolepsy, and to manage alcohol withdrawal and detoxification in alcoholics. GHB shows a biphasic effect and dose-dependent pharmacokinetics and may interact with neuronal systems different from GABAergic one. The compound is also highly abused among bodybuilders and is associated with drugs of abuse.

Areas covered

This article provides an overview of the risks associated with the recreational consumption of GHB and its analogues, including pharmaceuticals mostly encountered in GHB-related emergency department admissions and postmortem investigations. A literature search was performed using PubMed, Scopus, Google Scholar, and Web of Science databases to identify scientific reports concerning the recreational use of GHB and analogs with prescribed drugs. Further articles were retrieved after consulting international health and regulatory authorities’ reports.

Expert opinion

Due to its dual nature, interpreting and distinguishing GHB concentrations in biological fluid represents a challenge in forensic toxicology. To demonstrate recent exposure, a quick collection of samples is necessary to maximize the chance of detecting an exogenous GHB intake, especially in cases of GHB-facilitated sexual assaults.

KEYWORDS:

• Drug–drug interaction
• GHB
• GBL
• poisoning
• prescribed drugs
• recreational use
• sodium oxybate

Article highlights

• Knowledge of the potential interactions of GHB and its analogues with prescribed drugs is crucial to minimize potential acute GHB toxicity.

• Prescribed drugs that are more frequently involved in GHB-related intoxications are hypnotics/sedatives, opioids/opiates, and antiepileptics.

• Central nervous system depression is the principal symptom encountered in GHB and prescribed drugs overdose.

• Polydrug and polypharmacy in recreational GHB users is an added risk factor that can lead to misdiagnoses of symptoms and misinterpretation of the cause of death.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.