GHB, or γ-Hydroxybutyric acid, is a central nervous system depressant used both medicinally and recreationally
. Its uses in medicine are to treat narcolepsy (sodium oxybate) and works as an anaesthetic, although not widely used for the latter purpose. In recreational use, GHB is used by athletes as a means to reduce fat and build muscle. It's also commonly used in parties as a way to increase lust and euphoria. It is easy to accidentally overdose on GHB, especially in parties where alcohol and other drugs are also taken. The number of accidental deaths caused by GHB surpassed MDMA in 2014. The reason why GHB isn't used as a method of suicide is that it's less lethal than heroin and fentanyl, making the latter options worth the time and money instead. Now that the introduction is over - let's get to the important stuff!
- How does suicide by GHB work?
- Symptoms, pharmacokinetics and antiemetics
- Drug interactions
- Frequently asked questions
GHB works
almost indifferently to pentobarbital. It's a CNS depressant that works via GABA-B (pentobarbital works via the more common GABA-A). GABA stands for γ-aminobutyric acid, and it works as an inhibitory (blocker) neurotransmitter. There are three different types of GABA; GABA-A (GA), GABA-B (GB) and GABA-C (GC). GA and GC are both ligand-gated ion channels - this means that the receptors work via ions travelling through a receptor channel. The GA receptor channel opens when a GA ligand binds to it, thus letting Cl- ions run through it. When the Cl- ions have entered the postsynaptic site, it becomes hyperpolarized. Hyperpolarized neurons are less susceptible to action potential, which creates the CNS depressant effects. The GB receptor is a G-coupled protein receptor, much like the D2 and 5-HT3 in antiemetics, and not a ligand-gated ion channel. GHB also binds to the GHB receptor (full agonist). GBL and 1,4-butanediol are precursors to GHB and are converted to GHB by enzymes in the body. I won't get into too much detail about the different receptors, but the bottom line is: GA and GB work differently but have the same outcome. The amount of GHB is needed for a swift suicide depending on the person. The lethal dose is stated as 50mg/kg, but a higher dose is recommended for suicide (100mg+/kg).
GHB often comes in a liquid or salt. It is important to be aware of the concentration of GHB that you're taking. GHB does not leave any physical damages to users who aren't chronic abusers. No long-term problems will affect someone who overdoses on GHB.
The cause of death by a GHB overdose is the same as pentobarbital: respiratory depression followed by respiratory arrest. The person will not be conscious when the respiratory failure sets in and will thereby not suffer pain or psychological symptoms of hypercapnic alarm responses. Symptoms of a moderate GHB ingestion are:
Euphoria
Drowsiness
Sensitivity to touch
Increased lust
Memory lapses
When taken in a moderate and safe amount, GHB is a pleasurable drug. GHB becomes a lot more potent when other CNS depressants and sedatives are taken with it. Other common CNS depressants are alcohol, benzodiazepines, non-benzodiazepines, barbiturates, anticonvulsants, etc. GHB can be potent by itself, but when you're using it as a means of suicide, it is important to always combine them with
at least alcohol. Symptoms of a severe GHB overdose are:
Bradycardia
Bradypnea
Hypotension
Somnolence
Confusion
Vomiting
Seizures/convulsions
Euphoria
Apnea
Respiratory depression -> respiratory failure -> respiratory arrest
Periodic Cheyne-Stokes respiration
Coma
Death
Now, that's quite the intimidating list! It is not as bad as it actually sounds. I'll go through the symptoms.
Bradycardia, hypotension & bradypnea
These symptoms are present in all CNS depressants. They're not painful, and they prevent panic and stress. The symptoms of these are often dizziness and tiredness (chest pain may be present).
Somnolence
Somnolence is very peaceful and will make you fall asleep.
Confusion
You may struggle to pay attention and think properly.
Vomiting
Vomiting is dreaded when it comes to suicide. Vomiting it GHB overdoses often occur when the person is unconscious, and that's where the real
(second to respiratory depression) danger lies for people who accidentally overdose on it. Antiemetics aren't completely necessary for a GHB overdose since it's very unlikely that the person will experience it before they pass out. Nausea may be present, so prepare for that. Using antiemetics can make the method more comfortable. Not using them can make it more lethal. If a person decides to do this method without antiemetics, it is important to remember that lying in recovery position or on the stomach will decrease the odds of death.
Seizures/convulsions/ataxia
Like vomiting, these symptoms occur in the late stages of consciousness in which the person is almost entirely unconscious. I would still recommend taking anticonvulsants just because they have an additive CNS depressant effect and will make this method more comfortable. Convulsions may be treated by taking benzodiazepines. Convulsions often occur if GHB is taken together with stimulants (more on this later). Seizures are actually uncommon. Many of the seizure diagnoses connected to a GHB overdose is mistaken for the real reason: myoclonus. Seizures can occur via hypoxia (unconscious)
Euphoria
Euphoria might be felt in the beginning.
Apnea
Apnea occurs when the person is unconscious.
Respiratory depression
All pulmonary symptoms are most likely felt in the late stages of consciousness and are most prevalent when the person is unconscious.
Periodic Cheyne-Stokes respiration
PCC occurs when the person is unconscious.
Coma/death
Self-explanatory.
Pharmacokinetics
GHB reaches its peak concentration in blood plasma after 25-60 minutes. Symptoms often occur within 15-45 minutes. GHB metabolizes extremely fast (short half-life), which means that people who have overdosed on the drug often aren't intubated or even treated with activated charcoal. All symptoms of a moderate dose go away within 1-3 hours, and a full recovery of a GHB overdose may occur within 4-8 hours.
Drug interactions
Drugs that potentiate GHB are:
Alcohol (essential, recommended dose at 300-400ml+ of 40-70% ethanol)
Benzodiazepines (recommended to use short-acting ones such as alprazolam)
Anticonvulsants (recommended)
Antiemetics (recommended, see below)
Beta-blockers (can be used for comfort and increased lethality)
Opioids (not recommended due to increased nausea and premature vomiting, not worth it)
Drugs that hinders the potency of GHB are:
ADHD medication
Amphetamine
Methamphetamine
Cocaine
Ecstasy
Nicotine (don't smoke!)
Pseudoephedrine
Atropine <-
Naxolone <-
basically all types of stimulants
Stimulants together with GHB may promote seizures whilst alcohol does the opposite.
FaQ (just kidding, no one asks these)
Q: GABA inhibits dopamine- and serotonin release, how come it activates the reward system?
A: Low doses of any type of GABA agonists does this. This is the reason why it's used in medicine for schizophrenia (too much dopamine) and against narcolepsy (basically mini-seizures). However, in higher doses, GABA does the exact opposite! Crazy!
Q: Oh, I see! Antiemetics aren't necessary for this method.
A: Technically, you are right. GHB metabolizes so fast that vomiting is
mostly futile. I still heavily recommend it if you're planning on taking GHB since it's a lot more comfortable. Antiemetics do have CNS depressant effects, whilst being only slight, is still something. I wouldn't skip them if I were you.
Q: Are you saying that GHB is superior over [insert method here]?
A: Not at all. The only reason I wrote this was because people should know their options.
Anyways, that's it!
