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GHB (Sodium Oxybate, Xyrem)
by Erowid
When taken occasionally as a prescribed sleep aid, GHB is a fairly mild, low toxicity chemical. When taken as a recreational intoxicant, it can be dangerous when the dose is too high or it is combined with alcohol or some other drugs. Accidental ingestions, accidental overdoses, idiosyncratic reactions, and mixing GHB with other depressants can lead to vomiting, convulsions, unconsciousness ("GHB coma"), serious hangovers, and sometimes death.

Regular use of GHB or equivalents can cause marked physical addiction. With 4-6 uses per week (single dose per use) at 'normal' dosages, people report finding that they need to increase their dose somewhat to get the same level of intoxication and many also report that they often feel like they need a little GHB to feel normal.

With very heavy use (one or more doses per day), many people report very serious physical addiction. Stopping cold turkey results in anxiety, inability to sleep, feeling like the heart is arrhythmic (irregular), and often very unpleasant and potentially dangerous effects. Many heavy users report being able to taper off their use to zero by reducing their intake slowly over 2-3 weeks.

When taken infrequently with carefully measured doses and no chance of accidental Overdose (this is nearly impossible to guarantee), many people find GHB to be a pleasant alcohol replacement. Unfortunately because its often kept as a clear liquid and even in drinking-water bottles, accidental ingestions are somewhat common. Also, because GHB is generally available as a liquid, it is impossible to know the concentration and thus accidental Overdoses are also common.

GHB's effects last only a few hours during which it metabolizes into CO2 and H2O leaving no toxic metabolites [Vickers, 1969, Laborit, 1972]. GHB can no longer be detected in urine 4-5 hours after taken by injection [Laborit, 1964]. But its likely that it is detectable for 10-20 hours when taken orally.

As a sleep aid, GHB induces sleep (unconsciousness). The sleep induced by normal doses of GHB is fairly safe when it has not been mixed with other chemicals, but be aware that it's hard to convince anyone of this if you fall asleep in public and are unable to be awakened. Bar owners, police, and emergency personnel need to be educated about the effects of GHB in order to reduce the problems caused by misinformation. GHB became approved as a pharmaceutical sleep drug for narcoleptics by the FDA in 2002 as "Xyrem".

GHB by itself can be fatal. A dozen or two fatalities have been directly tied to GHB or GBL use. Unfortunately, some deaths reported as being caused by GHB were not properly verified and the human body's natural levels of GHB after death could cause misattributions and controversy exists surrounding the issue of how many deaths have actually been caused by GHB.

  • Combination with Alcohol, Sedatives, Hypnotics. Avoid mixing GHB with alcohol. GHB can be dangerous when used improperly or when mixed with other depressants. Combining a normal GHB dose with alcohol can trigger the overdose reaction of temporarily unrouseable sleep. GHB has been associated with 60 deaths in the US, according to the DEA, though most have involved other drugs (most commonly, alcohol) or high doses.

    Although low dose alcohol with low dose GHB is not particularly dangerous, the two drugs' effects are additive and can often result in very unpleasant, nauseating vertigo (spinny head). At higher doses, vomiting, respiratory depression, suppression of gag reflex, etc. become common. Also the slower onset of GHB can result in dangerous and potentially fatal results and people redose alcohol or GHB before the effects have peaked.

  • Breathing Depression, Vomiting, and Gag Reflex Suppression. GHB may dangerously depress breathing in some people, at very high doses, or in combination with other drugs (primarily alcohol). GHB can also cause vomiting in combination with unconsciousness, which can be a fatal combination. It has also been known to cause breathing similar to Cheynes-Stokes Breathing. GHB has been associated with 60 deaths in the US as of Jan 2000, according to the DEA, though only ~20 have been confirmed as GHB-only deaths.

  • Dosage and Sensitivity. Be extremely careful with your GHB dose. Just as you don't want to drink 4x the amount of alcohol needed to get you intoxicated, you don't want to ingest more than a single dose of GHB. As with other substances, start low and work up slowly to find your own, individual level.

    If you take 3 - 4 times your Personal Threshold Dose, you may find yourself Unconscious and Vomiting.

  • Sleep, Unconsciousness, and Coma. If you take a double dose of GHB you may FALL UNCONSCIOUS and be UNROUSEABLE for up to 4 or 5 hours. This is sometimes considered "sleep" as it is prescribed for use by narcoleptics at the same dose that causes unrousable unconsciousness. This unconsciousness is sometimes referred to as a "coma" in medical case reports and texts.

    If you take GHB, make sure your friends know about its sleep inducing characteristics.

    One of the most common dangers of a mild GHB overdose is being taken to a hospital and treated as if you have OD'd on a depressant. This include stomach pumps, breathing tubes and IV's, not to mention huge hospital bills.

  • Treatment of Insomnia. GHB is a powerful sleep-inducing drug and has been used to treat insomnia by individuals since at least the 1980s. 2.
  • Treatment of Sleep Disorders (narcolepsy). GHB (as the patented and trademarked product "Xyrem") was approved in 2002 by the FDA as a treatment for narcolepsy. This treatment is nearly identical to its use in treating general insomnia (although that treatment is not approved by the FDA). Patients take a high dose of GHB (3-10 grams!) and then take a second dose (3-10 grams) when they awake after 3-5 hours. As with Zolpidem and other Z-sleep drugs, GHB causes people to wake up after 3-5 hours. It also causes substantial tolerance with daily use, requiring narcoleptic patients to take around 10 grams of GHB per dose. That dosage level could be dangerous or fatal for small, non-tolerated users. See GHB Patent for Treatment of Narcoleptics.
  • Treatment of Alcoholism. GHB has been used to keep alcoholics from relapsing and to stop withdrawal symptoms.3. See GHB Patent for Treatment of Alcoholism.
  • Sleep Improvement and Increase in Growth Hormone. GHB users in the mid 1990s reported that they noticed improved muscle tone and GHB was used widely by weight lifters. Research showed that GHB increases growth hormone production in humans experiments 1.