Complex management of Gamma Hydroxyl Butyrate withdrawal

First published: 10/05/2019 | Last updated: May 20th, 2019

Dr Krishna Mohan Gangineni

Psychiatrist

Introduction

Gamma hydroxyl butyrate (GHB) is an emerging drug of abuse with anesthetic and hypnotic effects. GHB and its analogs are readily available on internet with different names which are used for both legitimate and for illicit purposes. It is used in treatment of narcolepsy, depression and also in alcohol withdrawal.

Case Report

MR X is 29 year old single man assessed with history of poly substance misuse (including alcohol) but dependence use of GHB for last 1 year.  He was using GHB every 2-3 hourly and used up to 300ml per day with half the dose at night time to aid sleep. GHB detoxification was conducted effectively in hospital setting using withdrawal rating scales (CIWA-AR, used for alcohol withdrawal) every half hourly with regular review of his physical state. He was prescribed GABA agonists such as baclofen, acamprosate during the acute phase and was continued on them in addition to sodium valproate. The use of benzodiazepines which is considered to be the main drug was very minimal. Even though MR X had lapsed once, is maintaining abstinence with improved quality of life and on gradual reduction of baclofen.

Conclusion

In contrast to peoples and views available on internet GHB is addictive and difficult to treat its withdrawal. There isn’t much medical literature available but usage of GABA agonists in treatment of GHB dependence could be valuable alternative instead of benzodiazepines. Improved clinical awareness and research on treatment is important in managing this rapidly emerging complex problem.

Co-Authors

Dr Zelda Summers MRCPsych, Dr Krishna Mohan Gangineni MRCPsych

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Dr Krishna Mohan Gangineni