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What Is GHB?

Gamma Hydroxybutyrate (GHB Drug) is another name for the generic drug Sodium oxybate. Xyrem (which is sodium oxybate) is the trade name of the Food and Drug Administration (FDA)-approved prescription medication. GHB is used to treat two symptoms of narcolepsy, such as sudden muscle weakness and excessive daytime sleepiness. GHB can have an addictive potential if used repeatedly. When a person stops taking these drugs, they may experience withdrawal symptoms, especially if their body has become physically dependent on the drug. Recovery professionals recommend beginning the first phase of treatment in a supervised facility. This will all start by undergoing medically assisted GHB detox.

According to the United States Drug Enforcement Administration (DEA) [1] GHB is classified as a Schedule I drug. It means there is a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision. However, when sold as FDA-approved GHB products (such as Xyrem), it is considered Schedule III.

Xyrem is not available at regular retail pharmacies. When taken repeatedly at low doses, a person can develop a tolerance to the effects of the drug. This means they’ll need to take more of the drug to get the same effects. GHB is available as a liquid, powder, tablet, or capsule. It is colorless, odorless, and has a salty taste. It is generally swallowed as a pill. GHB is also sold illicitly as supplements for bodybuilding, and as a party drug. It can produce effects ranging from euphoria (at low doses) to blackouts and amnesia.

Withdrawal GHB
When someone overdoses on GHB, often onlookers mistakenly believe the person is sleeping while the person is actually asphyxiating.

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Withdrawal from GHB

GHB is a dangerous substance, and its chronic use can negatively impact a person’s health. It has a short duration of effects and is cleared from the body quickly. Because of this, users may experience a relatively rapid onset of withdrawal—typically within a few hours after the last use of the drug [2]. 

Because GHB acts on the GABA receptors like benzodiazepines and alcohol do, GHB has similar withdrawal symptoms. This also means that withdrawal can be complicated, may lead to post-acute withdrawal syndrome (PAWS), and can cause life-threatening symptoms. 

GHB Withdrawal Symptoms

The acute GHB withdrawal symptoms may include signs and symptoms such as:

  • Insomnia
  • Anxiety
  • Agitation
  • Sweating
  • Tachycardia
  • Paranoia
  • Hypertension
  • Tremors
  • Confusion
  • Psychosis
  • Muscle cramps
  • Delirium
  • Seizures

The harm caused by these symptoms alone can cause a person to begin abusing GHB again in an effort to stop the experiences. This puts a person at risk of overdose because their body will have a lower tolerance to the substance if the individual abuses it again. Severe cases of withdrawal from GHB can be life-threatening if not appropriately managed. For this reason, detoxing under supervision is crucial.

Not all users of GHB users experience the same GHB withdrawal effects. The following factors affect the severity of GHB withdrawal: 

  • Any concurrent psychiatric illness(es)
  • Using alcohol with GHB
  • Daily doses of GHB prior to stopping use

GHB withdrawal symptoms may also include memory loss, which can complicate treatment because the person forgets the consequences of their addiction.

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GHB Withdrawal and Detox

Why should I detox? GHB withdrawal is hard— and possibly life-threatening — and typically requires professional help. In many cases, the process of withdrawal should be handled in an inpatient addiction rehab. GHB chemically alters the brain, and because of the addictive nature of this drug, the brain grows to rely on it. GHB slows the brain’s activity when going off the drug abruptly or “cold turkey.” The brain is suddenly flooded with held-back functions. This attempt to suddenly stop is dangerous both psychologically and physically, leading to life-threatening seizures and severe hallucinations.

People combining GHB with alcohol or other drugs can experience delirium tremens (DTs), which can also be life-threatening. Moreover, psychological withdrawal symptoms tend to last longer than physical symptoms. People abusing this drug may experience an intense outburst of anger, irritability, agitation, hallucinations, and psychosis and show symptoms of extreme paranoia lasting from two to four days. Detoxing under the supervision of substance abuse professionals is required to safely rid the body of the drug and receive psychological support to contend with the emotional and mental withdrawal symptoms.

Some medical detox specialists may use small doses of anticonvulsant medications, barbiturates, or antipsychotic medications to treat specific symptoms like seizures, sleeplessness, and hallucinations. It is crucial to reduce physical and psychological distress as much as possible, so the person can safely detox and enter an evidence-based drug rehab and detox program. Inpatient drug rehab programs focus on changing behaviors around drugs like GHB, which further reduces the risk of symptoms of GHB overdose, relapse, and later addiction.

GHB Withdrawal Timeline

GHB is rapidly metabolized rapidly, so a person who has been abusing the drug may start to feel the GHB withdrawal symptoms within a few hours. The general withdrawal timeline is as follows:

1-6 HOURS

The first signs of GHB withdrawal can begin to show within the first few hours after taking the last dosage. These withdrawal symptoms can include nausea, dizziness, vomiting, and sweats. In some people, GHB withdrawal symptoms may take up to 24 hours to appear.

1-6 DAYS

Peak GHB withdrawal symptoms will start to appear within one to six days from the last dosage. A progressive change in GHB withdrawal symptoms includes panic attacks, severe anxiety, restlessness and insomnia, tremors, sweating, and hypertension. During this peak time, it is crucial to monitor these GHB withdrawal symptoms and seek immediate medical attention as users can enter a psychotic state, have severe hallucinations, and become delirious.

1-2 WEEKS

GHB Withdrawal symptoms can last a week or two depending on the factors mentioned above. In some instances, GHB withdrawal symptoms can stay on for a few months, including anxiety, depression, confusion, and insomnia.

Most individuals can safely get through GHB withdrawal symptoms within a couple of weeks, though medical monitoring is recommended for the safest detox. Please be reminded that seizures could happen at any time during the GHB withdrawal process, and these seizures could be life-threatening. This is the primary reason why medical supervision is so important.

Withdrawal GHB
Asking for help and accepting help will be your first step to recovery.

Complications of GHB Withdrawal

According to the National Center for Biotechnology Information (NCBI) [3], withdrawal treatment from GHB is a severe and potentially dangerous condition. The prevalence of complications was higher than for most other drugs, and the rate of intensive care and withdrawal delirium was very high.

Several complications can arise during GHB withdrawal. These problems can include fluid and electrolyte imbalances, fever, and rhabdomyolysis (a catastrophic breakdown of muscle tissue that can overwhelm and damage the kidneys). In addition, people who become severely agitated and violent may have to be physically restrained for their own protection. Inpatient detox centers can medically manage these issues and any other complications that may arise during GHB withdrawal.

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GHB Addiction

GHB has been reported to be making a comeback as a party drug, used most often in raves, and various dance parties as an alternative to ecstasy. Another demographic in which GHB is popular is among bodybuilders. This substance has been shown to elevate human growth hormones significantly. Men attempting to build muscle mass, and often wanting to do so quickly, may use recreational GHB to facilitate this process. Many take to it due to misinformation about the substance as a miracle drug for muscle growth that induces sleep and produces a high at the same time.

A growing body of evidence shows that gamma-hydroxybutyric acid (GHB) is an addictive substance [4]. Current evidence shows that GHB and its precursors are highly addictive, both in humans and animals, probably through a GABA receptor-related mechanism [5]. The severity of GHB withdrawal symptoms can be considered a medical emergency. Recent studies suggest that benzodiazepines are not very effective, showing a high treatment resistance, whereas detoxification with pharmaceutical GHB proved to be successful [6].

Chronic use of GHB is also associated with the development of physical dependence. Tolerance to GHB appears to develop very rapidly. The withdrawal syndrome occurs in three phases that often begin within 24 hours after the individual has stopped taking the drug and continue for 10 days to several weeks. Withdrawal from GHB is similar to the withdrawal syndrome that occurs in individuals with an alcohol use disorder or who have abused benzodiazepines.

GHB Addiction Treatment

There is a strong link between mental health and substance abuse. Individuals who struggle with mood disorders like depression, and anxiety are more susceptible to developing an addiction to drugs or alcohol, often to self-medicate symptoms of their underlying mental health condition. These co-occurring disorders can make each other worse without proper treatment.

If you are experiencing withdrawal GHB, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of mental condition is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional. 

Medically-Assisted Detox

Detox is often considered the first stage of treatment. It will help you navigate the complicated process of GHB withdrawal, but it doesn’t address patterns of thought and behavior that contribute to drug use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of GHB withdrawals.

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Psychotherapy 

Several different modalities of psychotherapy have been used in the treatment of mental health disorders along with addiction, including:

  • Cognitive Behavioral Therapy (CBT) – is an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
  • Dialectical Behavioral Therapy – is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.” 
  • Person-Centered Therapy – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
  • Solution Focused Therapy – is an approach interested in solutions that can be quickly implemented with a simple first step leading to further positive consequences.

Dual Diagnosis Treatment

Drug abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the substance abuse problem and the mental disorder are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for substance use disorders and mental health disorders are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

If you or a loved one are struggling with long-term drug abuse and a co-occurring mental health condition such as depression, contact one of our helpful treatment specialists today. We Level Up can provide information on dual diagnosis and detox programs that may fit your specific needs.

Withdrawal GHB
Medically-assisted detox can help reduce needless harsh withdrawal suffering while minimizing the risks of GHB drug withdrawal.

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Sources:

[1] DEA – https://www.dea.gov/sites/default/files/2020-06/GHB-2020_0.pdf

[2] NCBI – https://pubmed.ncbi.nlm.nih.gov/18226321/

[3] NCBI – https://pubmed.ncbi.nlm.nih.gov/30362026/

[4] [5] [6] NCBI – https://pubmed.ncbi.nlm.nih.gov/24001290/