Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

John M Corkery; Barbara Loi; Hugh Claridge; Christine Goodair; Ornella Corazza; Simon Elliott; Fabrizio Schifano

doi:10.1016/j.neubiorev.2015.03.012

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

Neurosci Biobehav Rev. 2015 Jun:53:52-78. doi: 10.1016/j.neubiorev.2015.03.012. Epub 2015 Apr 3.

Authors

John M Corkery¹, Barbara Loi², Hugh Claridge³, Christine Goodair³, Ornella Corazza⁴, Simon Elliott⁵, Fabrizio Schifano⁶

Affiliations

¹ National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK. Electronic address: j.corkery@herts.ac.uk.
² National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK; Neuroscience Institute, National Research Council of Italy, Section of Cagliari, I-09042 Monserrato, CA, Italy.
³ National Programme on Substance Abuse Deaths, St George's University of London, UK.
⁴ Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.
⁵ ROAR Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire WR14 3SZ, UK.
⁶ National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.

PMID: 25843781
DOI: 10.1016/j.neubiorev.2015.03.012

Abstract

Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4-butanediol (1,4-BD) use extracted from the UK's National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%); young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0-6500; SD 758)mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.

Keywords: Deaths; Fatalities; GBL; GHB; Toxicity; United Kingdom (UK).

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

4-Butyrolactone / adverse effects*
4-Butyrolactone / metabolism
4-Butyrolactone / pharmacokinetics
Butylene Glycols / adverse effects*
Butylene Glycols / metabolism
Butylene Glycols / pharmacokinetics
Female
Humans
Male
Sodium Oxybate / adverse effects*
Sodium Oxybate / metabolism
Sodium Oxybate / pharmacology
Substance-Related Disorders / epidemiology
Substance-Related Disorders / mortality*
United Kingdom / epidemiology

Substances

Butylene Glycols
Sodium Oxybate
1,4-butanediol
4-Butyrolactone

Grants and funding

Department of Health/United Kingdom