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GHB Withdrawal Symptoms, Effects, and Timeline

Crying woman sitting in the dark

Gamma hydroxybutyrate (GHB) is a central nervous system depressant that is used illicitly at bars, nightclubs, concerts, and parties. Bodybuilders also report illegally using GHB to increase muscle and reduce body fat.2 In addition, perpetrators of sexual assault may use GHB, as the drug reduces a person’s ability to resist and may cause victims to lose consciousness.3,4

Users may develop tolerance to GHB and require higher doses to achieve the same effect.1,4 Regular use of GHB for as little as 2 months may result in physiological dependence and give rise to a withdrawal syndrome if stopped.3 Some of the symptoms of GHB withdrawal may include vomiting, confusion, delirium, hallucinations, and insomnia.1

Stopping use without medical assistance can be dangerous.1 GHB users who are not dependent on the drug may be able to cease use with education and outpatient therapy.6 However, for regular users, withdrawal can be severe and may last 2 weeks. A person who is dependent on GHB and wants to quit should consider an inpatient treatment center.1

How Long Does Withdrawal Last?

Alcohol Withdrawal

Woman passed out holding glass of alcoholMany GHBs users also abuse alcohol. Withdrawal from alcohol can be dangerous and may require medical supervision.

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The severity of GHB withdrawal symptoms and the timeline of effects depend on the level of GHB use prior to quitting. Those who were heavy GHB users—for example, taking a dose of GHB every 2-3 hours for a few months or more—are at risk of more serious effects.

As far as the timeline, people may begin to have signs of withdrawal from GHB within 1 to 6 hours after their last dose.1,6 But the symptoms typically appear approximately 1 day after last use. 1

Nervousness and vomiting may occur early on, and over the course of the next 5 days, symptoms may include anxiety, delirium, confusion, insomnia, and hallucinations.1 Withdrawal may last up to 2 weeks.6 Some symptoms, including anxiety, depression, insomnia, and cognitive deficits, may continue for months after initial detox.6

Symptoms

Not all users of GHB users experience the same GHB withdrawal effects.

Common symptoms of GHB withdrawal include: 1,4,6

  • Anxiety.
  • Delirium.
  • Confusion.
  • Insomnia.
  • Hallucinations.
  • Tremors.
  • Tachycardia (rapid heart rate).
  • Nausea.
  • Vomiting.
  • Sweating.
  • Paranoia.
  • Muscle cramps.

Not all users of GHB users experience the same GHB withdrawal effects. The following factors affect the severity of GHB withdrawal: 6

  • Using alcohol with GHB
  • Any concurrent psychiatric illness(es)
  • Daily doses of GHB prior to stopping use

Withdrawal from GHB can also lead to memory loss, which can complicate treatment because the person forgets the consequences of their addiction.3

Dangers of Withdrawal

Man sitting against wall looking depressedUnsupervised withdrawal from GHB can be dangerous and may even lead to death.4,9 Some users have also experienced psychosis and severe agitation.3 

Some people use GHB or other substances such as benzodiazepines or alcohol to feel better.3 Taking additional drugs places the person at risk for overdose and may ultimately increase withdrawal severity.3,6  lt can also lead to the development of other addictions.

Some symptoms of GHB withdrawal may persist for several months and place the person at high risk of relapse. These symptoms include:6

  • Anxiety.
  • Depression.
  • Insomnia.
  • Problems with thinking and memory.

Read next: GHB Withdrawal Medication Options

Sources

  1. Busardo, F. P. & Jones, A. W. (2015). GHB pharmacology and toxicology: Acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Current Neuropharmacology, 13(1), 47-70.
  2. National Institute on Drug Abuse. (2014). Club drugs (GHB, ketamine, and rohypnol).
  3. Substance Abuse and Mental Health Services Administration. (2002). GHB: A club drug to watch.
  4. Government of Canada. (2015). GHB.
  5. University of Maryland Center for Substance Abuse Research. (2013). GHB.
  6. Miotto, K. & Roth, B. (2001). GHB withdrawal syndrome. Austin: Texas Commission on Alcohol and Drug Abuse.
  7. Kamal, R. M., van Noorden, M. S., Franzek, E., Dijkstra. B. A., Loonen. A. J., and DeJong, C. A. (2016). The neurobiological mechanisms of gamma-hydroxybutyrate dependence and withdrawal and their clinical relevance: A review. Neuropsychobiology, 73(2), 65-80.
  8. Freese, T. E., Miotto, K., & Reback, C. J. (2002). The effects and consequences of selected club drugs. Journal of Substance Abuse Treatment, 23, 151-156.
  9. Towsend, C. (2015). The Scary Reason GHB Is Making a Comeback. The Daily Beast.

GHB Withdrawal Medication Options

Gamma-hydroxybutyrate (GHB)—sometimes known as liquid ecstasy—is an FDA-approved drug for the treatment of narcolepsy.1 In recent years, GHB has gained a reputation as a “club drug,” and users have taken it illegally to enhance their experiences at bars and nightclubs.

Repeated use of GHB over time can lead to dependence and physical and emotional withdrawal symptoms when a person attempts to stop or cut down.2,3 Some GHB users may also abuse other drugs, such as alcohol, which can cause an additionally complicated withdrawal.1,3,6

Withdrawal from GHB can be dangerous and should be monitored by a medical professional. Some users may resist seeking help until they are already experiencing severe withdrawal symptoms. Unfortunately, more severe withdrawal reactions may be harder to treat and can lead to long-term physical and emotional health problems and, in rare cases, even death.3

Seeking help early on can prevent severe symptoms and ensure a safer withdrawal process.

Seeking help early on can prevent severe symptoms and ensure a safer withdrawal process. A variety of treatment options can provide medical care as well as medications to manage symptoms.

Withdrawal Management

Detox Treatment

doctor meeting with patient about detox treatmentMedical detoxification is carried out under supervision, as it entails administration of medications that stop or lessen cravings and physical dependence upon one or more substances.

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Medications used to treat GHB withdrawal include:2,3,4,5

  • Benzodiazepines, such as diazepam and lorazepam. These longer-acting benzodiazepines can help reduce symptoms of anxiety and delirium. Higher doses may be prescribed in cases of severe withdrawal.
  • Barbiturates, which have similar effects to benzodiazepines. Though increasingly rarely used, they can sedate and reduce agitation and anxiety that might not respond well to other pharmaceutical interventions.
  • Gabapentin, a mood stabilizer.
  • Baclofen, a GABAB agonist that works on the same receptor as GHB.
  • Antipsychotic drugs, such as phenothiazines. This class of drugs can treat psychotic symptoms during withdrawal, such as hallucinations.
  • Anticonvulsant drugs, which can reduce the risk of seizures.

The specific dose of a medication for GHB withdrawal may depend on several factors, including the severity of withdrawal symptoms and a person’s physical and emotional health. Users who are treated with certain medications, such as benzodiazepines and barbiturates, may be slowly tapered off of them after their withdrawal symptoms are controlled.2

Users may also be in withdrawal from other drugs, such as alcohol, marijuana, stimulants, and opioids. Treatment programs can help the user detox from multiple drugs by treating symptoms for each specific drug. This can reduce the likelihood of adverse reactions.

Withdrawal treatment programs may also monitor the user’s vital signs and check for other dangerous conditions, such as hyperthermia and rhabdomyolysis (a condition of muscle tissue breakdown).3 Participants can rest in a calm environment with little stimulation.

After Detox

Users who are addicted to or dependent on GHB may need more than medications to effectively quit the drug. Cognitive behavioral therapy, or CBT, helps people understand the relationship between their thoughts, feelings, and behaviors and develop coping skills to manage cravings. Medications combined with behavioral therapies can help prevent relapse and increase the likelihood of a full recovery.

Treatment programs can provide both medical treatment for withdrawal and psychological interventions such as group, individual, and family therapy.

Detox Centers and Rehab Programs

person in counseling session for GHB rehabDetox facilities can provide medical and psychological therapies to help ease withdrawal symptoms and prevent dangerous and life-threatening symptoms. GHB withdrawal treatment may take place in one or more of the following settings:

  • Detox centers provide 24-hour support and monitoring for the duration of withdrawal. Some hospitals also have their own detox programs staffed with doctors and nurses who provide necessary treatments, including medications. Once detox is complete, a person may be referred to a rehab program for continued treatment.
  • Inpatient treatment programs provide both detox and addiction treatment. Staff members monitor vital signs and symptoms and provide medications to reduce the risk of adverse reactions. Participants are encouraged to rest during the early stages of withdrawal. Once withdrawal is complete, participants can take part in group, individual, and family therapy sessions and other therapeutic activities.
  • Outpatient treatment programs provide detox and addiction treatment for people that have a safe place to stay, a good support system in place, and are at low risk of experiencing a complicated or life-threatening withdrawal. Participants may go to the treatment facility several days a week, where staff members can monitor their withdrawal and provide any treatments that may be necessary. Medical professionals may also prescribe medications for participants to take home if they feel that they are medically stable.

The right type of withdrawal treatment depends on each person’s needs. Choosing the best type of treatment may depend on several factors:

  • How long a person has been using GHB
  • How much GHB a person has been using
  • Whether the person used GHB with other drugs or alcohol
  • Whether a person is experiencing other physical or mental health conditions
  • Severity of withdrawal symptoms in the past
  • How much family and peer support a person has in place
  • Whether a person has stable housing or transportation to get to treatment

Some GHB users may choose not to seek help for withdrawal because of the cost of treatment. Fortunately, low-cost inpatient and outpatient treatment programs are available. Users and their families can also cover the cost of treatment with savings, credit cards, loans, health insurance, and payment plans. The cost should not prevent you from seeking help.

Going Cold Turkey at Home

GHB withdrawal can lead to psychotic symptoms, and rarely, seizures.

Detoxing from GHB cold turkey can be dangerous. GHB withdrawal can lead to psychotic symptoms, such as hallucinations, as well as rapid heart rate, high blood pressure, and rarely, seizures.2 Symptoms may appear mild at first and then quickly escalate. If not properly treated, these symptoms can have long-term consequences and may even lead to death.3

Going through GHB withdrawal in a licensed treatment program is the safest method of detoxing. Treatment programs are staffed with medical and mental health professionals that can monitor and treat mild to severe withdrawal symptoms. If you or someone you know needs help for GHB withdrawal, consider a detox center.

Read next: GHB Withdrawal Symptoms, Timeline, and Effects

Sources

1. National Institute on Drug Abuse. (2014). DrugFacts: Club drugs: GHB, Ketamine, and Rohypnol.
2. Ries, R. K., Fiellin, D. A., Miller, S. C., & Saitz, R. (2014). The ASAM principles of addiction medicine (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
3. McDonough, M., Kennedy, N., Glasper, A., & Bearn, J. (2004). Clinical features and management of gamma-hydroxybutyrate (GHB) withdrawal: A review. Drug and Alcohol Dependence, 75(1), 3-9.
4. LeTourneau, J. L., Hagg, D. S., & Smith, S. M. (2008). Baclofen and gamma-hydroxybutyrate withdrawal. Neurocritical Care, 8(3), 430-433.
5. Tarabar, A. F., & Nelson, L. S. (2004). The γ-hydroxybutyrate withdrawal syndrome. Toxicological Reviews, 23(1), 45-49.
6. Miotto, K. & R. B. (2001). GHB withdrawal syndrome. Austin: Texas Commission on Alcohol and Drug Abuse.