Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)
From the 1Guy's and St. Thomas’ Poisons Unit, Guy's and St Thomas’ NHS Foundation Trust, 2UCL Centre for Infectious Disease Epidemiology, 3Barts and The London, Queen Mary's School of Medicine and Dentistry, 4Guy's and St. Thomas’ Poisons Unit, Guy's and St Thomas’ NHS Foundation Trust, 5Guy's and St. Thomas’ NHS Foundation Trust, 6Emergency Department, Guy's and St. Thomas’ NHS Foundation Trust, 7Emergency Department, Frimley Park Hospital, 8TICTAC Communications Ltd, 9Analytical Unit, St.George's, University of London and 10Guy's and St. Thomas' Poisons Unit, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
Address correspondence to Dr David Wood, Guy's and St. Thomas Poisons Unit, Avonley Road, London, SE14 5ER. email: David.Wood{at}gstt.nhs.uk
Received 29 August 2007 and in revised form 29 October 2007
 |
Abstract |
|---|
Background: Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects.
Aim: The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs.
Design and methods: Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present.
Results: In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions.
Conclusions: Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.