GHB
GHB (gamma-hydroxybutyrate) is a CNS depressant that occurs naturally in the body and is used medically as sodium oxybate for narcolepsy. Recreationally it produces euphoria, sedation and disinhibition, but it has an unusually narrow dose-response: the gap between a recreational dose and one causing unconsciousness, coma or respiratory arrest is small, and it is measured in millilitres or grams that are easy to misjudge. Combining GHB with alcohol sharply raises the risk of coma and death.
01 Overview
GHB has a genuine clinical role as sodium oxybate, but recreationally it is dangerous chiefly because of its steep, narrow dose-response curve. A dose only modestly above the intended one can move a user from euphoria to deep unconsciousness within minutes, and vomiting while unconscious adds an aspiration risk. Its effects come on fast and last a few hours, and street preparations vary widely in concentration, so dosing by volume is inherently imprecise.
The danger is greatly amplified by alcohol and other depressants: the combination is a leading cause of GHB-related comas and fatalities and acts synergistically on respiration. GHB also produces a distinct and severe physical dependence with heavy, frequent use — daily around-the-clock dosing can lead to a withdrawal syndrome resembling severe alcohol or benzodiazepine withdrawal, with agitation, autonomic instability, delirium and, rarely, death, requiring medical management. These facts are stated plainly because the margin for error is small.
02 Mechanism
Acts as an agonist at GHB-specific receptors and, at higher concentrations, as a weak agonist at GABA-B receptors, producing dose-dependent CNS depression. Endogenously it is a metabolite of GABA.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Light | 0.5–1 g | Oral | Mild relaxation and disinhibition; concentration of liquid preparations varies widely. |
| Common | 1–2 g | Oral | Euphoria and sedation; the margin above this is small. |
| Strong | 2–3 g | Oral | High risk of unconsciousness; a small further increase can cause coma. Do not redose before the peak. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Euphoria and disinhibitionRelaxation, sociability and mild euphoria at low doses. | dose-dependent | Observational | |
| SedationDrowsiness progressing to deep sleep; used clinically to consolidate sleep in narcolepsy. | dose-dependent | Clinical | |
| Increased slow-wave sleepAs sodium oxybate, increases deep sleep and reduces cataplexy in narcolepsy. | clinically established | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Overdose, coma and respiratory arrestThe narrow dose-response means modest overshoots cause sudden unconsciousness, coma, vomiting with aspiration risk, and respiratory arrest. Risk is greatly increased by alcohol. | Life-threatening | Common at recreational doses | Observational | |
| Dependence and withdrawal syndromeAround-the-clock dosing produces physical dependence; withdrawal resembles severe alcohol/benzodiazepine withdrawal with agitation, autonomic instability, delirium and, rarely, death. | Life-threatening | With heavy, frequent use | Observational | |
| Nausea and vomitingNausea and vomiting, dangerous if it occurs while unconscious. | Moderate | Common | Observational |