GHB is a central nervous system depressant that produces euphoria, disinhibition, and increased sociability and tactile sensation at low doses. GBL is a prodrug that converts to GHB in the body. Widely used in chemsex contexts. Extremely dose-sensitive with a narrow margin between desired effects and overdose.
How It Works
GHB acts on GABA-B receptors and specific GHB receptors in the brain. At low doses, it increases dopamine release (euphoria, stimulation). At higher doses, it enhances GABA activity causing sedation and CNS depression.
Legal Status
Schedule I in the US (Schedule III when prescribed as Xyrem for narcolepsy). Class C in UK. GBL is legal in many places as an industrial solvent but controlled when intended for consumption.
Dosage Guide (Oral (GHB))
| Level | Amount (grams (or mL of solution — concentration varies)) |
|---|---|
| Threshold | 0.5g |
| Light | 0.5-1.0g |
| Common | 1.0-2.0g |
| Strong | 2.0-3.0g |
| Heavy | 3.0g+ (DANGEROUS — high overdose risk) |
Note: CRITICAL: GHB concentration in liquid varies enormously (from 10% to pure). You must know the concentration to dose safely. GBL is ~2x as potent by volume as GHB — do NOT use GHB doses for GBL. When in doubt, start with a tiny amount and wait 45 minutes.
Organ System Impacts
- neurological — Dangerous
- Profound CNS depression at moderate-high doses. Loss of consciousness is NOT natural sleep — it's drug-induced coma-like state. Seizures possible. Chronic use causes severe physical dependence.
- respiratory — Dangerous
- Dose-dependent respiratory depression. At overdose levels, breathing can slow dangerously or stop. This is the primary cause of death from GHB.
- cardiovascular — Moderate
- Slowed heart rate (bradycardia) at higher doses. Generally mild cardiovascular effects at recreational doses.
- gastrointestinal — Moderate
- Nausea and vomiting common, especially on come-up. GBL is more irritating to stomach than GHB. Vomiting while unconscious is a major aspiration risk.
- hepatic — Low
- GBL must be converted to GHB by liver enzymes (lactonase). Generally low hepatotoxicity. Chronic GBL use may increase liver burden.
- renal — Low
- Minimal direct kidney effects. GHB is metabolized to succinic acid and CO2. Dehydration from partying is the main renal risk.
- musculoskeletal — Low
- Muscle relaxation. Loss of coordination at higher doses. GHB is known to increase growth hormone release, though the clinical significance is debatable.
- ocular — Low
- Mild nystagmus (involuntary eye movement) at higher doses. Generally minimal eye effects.
- dermatological — Low
- Occasional flushing and sweating. No significant dermatological effects.
- hematological — Low
- No significant effects on blood chemistry.
Effects
Desired Effects
- Euphoria
- Increased sociability and empathy
- Enhanced tactile sensation and libido
- Relaxation and disinhibition
- Mild visual/auditory enhancement
- Deep restful sleep (at higher doses)
Negative Effects
- Nausea and vomiting
- Dizziness / disorientation
- Memory impairment / blackouts
- Loss of coordination
- Excessive sedation
- Confusion
- Urinary incontinence
Rare but Serious
- Unconsciousness (GHB 'going under' — NOT sleep)
- Respiratory depression
- Aspiration (vomiting while unconscious)
- Seizures (especially during withdrawal)
- Coma
- Death (usually from respiratory failure or aspiration)
Drug Interactions
Alcohol — deadly
Both are CNS depressants acting on GABA system. Combined respiratory depression and sedation is synergistic, not additive.
Action: NEVER combine GHB/GBL with alcohol. This is the most common cause of GHB-related deaths.
Benzodiazepines (Xanax, Valium, etc.) — deadly
Both enhance GABA activity. Synergistic CNS and respiratory depression.
Action: Never combine. No safe dose combination exists.
Opioids — deadly
Both cause respiratory depression through different mechanisms. Effect is synergistic.
Action: Never combine. Naloxone does NOT reverse GHB — only the opioid component.
Ketamine — dangerous
Additive CNS depression and dissociation. Loss of protective reflexes.
Action: Avoid combination. If used together, significantly reduce doses of both.
Stimulants (Meth, Cocaine) — moderate
Stimulants mask GHB sedation, leading to accidental overdose when stimulant wears off. Does not actually reduce GHB's depressant effects.
Action: Stimulants do NOT make GHB safer. You can still go under. Do not increase GHB dose because you feel 'fine' on meth.
Detection Times
GHB is metabolized extremely quickly and requires specialized testing not included in standard panels.
Urine
Requires specific GHB urine test. Very short window. Detection window: up to 1 days.
Blood
Detectable only within hours of use. Detection window: up to 1 days.
Hair
Hair follicle testing can detect GHB with specialized analysis. Detection window: up to 30 days.
Harm Reduction Tips
- Wait at least 2 hours before redosing — impatient redosing is the #1 cause of overdose
- NEVER combine with alcohol, benzos, or opioids — this is how people die
- ALWAYS measure your dose precisely with a syringe (1mL syringe for GBL, 5mL for GHB). NEVER eyeball it
- Always have a sober friend present who knows what you've taken
- Physical dependence develops with daily use — withdrawal is medically dangerous (seizures)
- Label your bottle clearly — GHB in a water bottle has caused accidental poisoning
- Know your concentration — GHB liquid strength varies enormously
- GBL is roughly 2x as potent as GHB — do not confuse them
- Set a phone timer for redosing to avoid losing track while intoxicated
- Do NOT let others dose you — measure your own dose
- If someone goes unconscious: put them in recovery position, call 911, do NOT leave them alone
Withdrawal Symptoms
Severity: Dangerous
Onset 1-6 hours after last dose. Peak severity days 1-3. Physical symptoms resolve in 5-15 days. Insomnia may persist weeks.
Physical
- Tremors
- Tachycardia
- Hypertension
- Insomnia
- Nausea and vomiting
- Muscle cramps
- Seizures (severe cases)
Psychological
- Severe anxiety
- Paranoia
- Confusion
- Delirium
- Hallucinations (visual and auditory)
- Psychosis in severe cases
Emergency Information
Call 911 If:
- Person is unconscious and cannot be woken
- Breathing is very slow, labored, or stops
- Vomiting while unconscious or semi-conscious
- Seizures
- Blue lips or fingernails
- Combined with alcohol or other depressants and showing any sedation
What To Do
- Put unconscious person in RECOVERY POSITION (on their side) immediately
- Do NOT leave an unconscious person alone — they can die from aspiration
- Do NOT try to make them vomit
- Monitor breathing constantly — count breaths per minute
- If breathing stops, begin CPR and call 911
- Do NOT give them stimulants or try to 'wake them up' with cold water
- Call 911 — you cannot 'sleep off' a GHB overdose. Unconsciousness from G is not sleep.
What To Tell EMS
The patient took GHB (gamma-hydroxybutyrate) / GBL. Report dose if known, time of ingestion, and any other substances taken (especially alcohol, benzos, opioids). There is no specific antidote — treatment is supportive. Intubation may be needed for respiratory depression.
Seek Help If
- Vomiting that doesn't stop
- Very confused or disoriented beyond what's expected
- Difficulty staying awake despite wanting to
- Slow or irregular breathing (below 12 breaths/min)
Normal Discomfort
- Mild nausea on come-up that resolves
- Drowsiness within expected dose range
- Mild dizziness
- Slight loss of coordination