Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs

Introduction: GHB is a small molecule and is present in the human CNS. Exogenously, GHB is administered orally in the form of sodium oxybate to treat cataplexy and excessive daytime sleepiness in patients with narcolepsy, and to manage alcohol withdrawal and detoxification in alcoholics. GHB shows a biphasic effect and dose-dependent pharmacokinetics and may interact with neuronal systems different from GABAergic one. The compound is also highly abused among bodybuilders and is associated with drugs of abuse. Areas covered: This article provides an overview of the risks associated with the recreational consumption of GHB and its analogues, including pharmaceuticals mostly encountered in GHB-related emergency department admissions and postmortem investigations. A literature search was performed using PubMed, Scopus, Google Scholar, and Web of Science databases to identify scientific reports concerning the recreational use of GHB and analogs with prescribed drugs. Further articles were retrieved after consulting international health and regulatory authorities’ reports. Expert opinion: Due to its dual nature, interpreting and distinguishing GHB concentrations in biological fluid represents a challenge in forensic toxicology. To demonstrate recent exposure, a quick collection of samples is necessary to maximize the chance of detecting an exogenous GHB intake, especially in cases of GHB-facilitated sexual assaults.