Characterization of the GHB Withdrawal Syndrome.

Casper J H Wolf,Marcia Spoelder,Boukje A G Dijkstra,Judith R Homberg,Arnt F A Schellekens,Harmen Beurmanjer,Alexander C Geerlings

doi:10.3390/jcm10112333

Abstract

The gamma-hydroxybutyric acid (GHB) withdrawal syndrome can have a fulminant course, complicated by severe complications such as delirium or seizures. Detoxification by tapering with pharmaceutical GHB is a safe way to manage GHB withdrawal. However, a detailed description of the course of the GHB withdrawal syndrome is currently lacking. This study aimed to (1) describe the course of GHB withdrawal symptoms over time, (2) assess the association between vital signs and withdrawal symptoms, and (3) explore sex differences in GHB withdrawal. In this observational multicenter study, patients with GHB use disorder (n = 285) were tapered off with pharmaceutical GHB. The most reported subjective withdrawal symptoms (SWS) were related to cravings, fatigue, insomnia, sweating and feeling gloomy. The most prevalent objective withdrawal symptoms (OWS) were related to cravings, fatigue, tremors, sweating, and sudden cold/warm feelings. No association between vital signs and SWS/OWS was found. Sex differences were observed in the severity and prevalence of specific withdrawal symptoms. Our results suggest that the GHB withdrawal syndrome under pharmaceutical GHB tapering does not strongly differ from withdrawal syndromes of other sedative drugs. The lack of association between vital signs and other withdrawal symptoms, and the relative stability of vitals over time suggest that vitals are not suitable for withdrawal monitoring. The reported sex differences highlight the importance of a personalized approach in GHB detoxification.

Highlights

The repeated use of the recreational drug γ-hydroxybutyric acid (GHB) can lead to gamma-hydroxybutyric acid (GHB) use disorder (GUD) [1,2]
Men and women differed in GHB-related characteristics (Table 1: one-way MANOVA, F(6,174) = 2.227, p < 0.05; Wilk’s λ = 0.929)
One-way MANOVA showed that men and women differed in the severity of indiThis study set out to analyze the course of the GHB withdrawal syndrome in patients vidual subjective withdrawal symptoms (SWS) (F(33, 233) = 2550, p < 0.001; Wilk’s λ = 0.735)

Summary

Introduction

The repeated use of the recreational drug γ-hydroxybutyric acid (GHB) can lead to GHB use disorder (GUD) [1,2]. Similar to other substance use disorders (SUDs), GUD is characterized by a loss of control over GHB intake and physical dependence on GHB [3]. GHB use is involved in ~12% of drug-related emergency care cases in Europe, caused by accidental overdosing or severe withdrawal symptoms upon sudden abstinence [2,4]. Due to the rapid onset of action (Tmax = 25–40 min) and the short half-life (T 2 = 30–60 min) of GHB, patients with GUD typically consume GHB every 2–3 h to prevent withdrawal symptoms [5,6]. Cessation of GHB use results in a severe withdrawal syndrome, characterized by an erratic and fulminant course.

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Results

Discussion

Conclusion