Gamma-hydroxybutyrate (GHB) is a naturally occurring compound in the brain that is involved in key physiological processes such as sleep regulation and muscle tone. As a physiological neurotransmitter, GHB has been explored for its therapeutic potential in the central nervous system (CNS), particularly in treating conditions such as alcohol withdrawal and sleep disorders.1
Unfortunately, despite its legitimate medical uses, GHB has received attention for the wrong reasons, and people have misused it as a recreational drug for its euphoric and sedative effects, becoming infamously referred to as the “date rape drug” or “liquid ecstasy.”
This is because there is a narrow therapeutic window, meaning that the line between the dose that produces the desired effect and the dose that leads to overdose is very narrow.2 As a recent study in Australia demonstrated, misuse can have serious and potentially fatal consequences.
Recent Australian study reveals rising trend of GHB addiction
A study published in Emergency Medicine Australasia in April 20243 We analyzed data collected from four hospitals in Sydney from 2012 to 2021 to assess trends in reporting of GHB exposure. The researchers found that between 2015 and 2020, emergency department visits related to GHB poisoning increased from 228 to 729 per year, a 114% increase.
Although men still account for the majority of cases, the number of women presenting with GHB intoxication has increased significantly, from 27.9% in 2012 to 37.8% in 2021. The study also highlighted that the 25-34 age group continued to show the largest proportion of GHB-related symptoms, with a notable decrease observed in those affected in the 16-24 age group over the study period.
Of particular concern is the increasing severity of GHB poisoning. The researchers found a significant increase in cases classified as high urgency (category 1), suggesting that GHB-related emergencies are becoming more serious and potentially life-threatening.
Most of these incidents occurred between midnight and 4 a.m., which corresponds to typical nighttime hours. The authors noted that these results mirror trends observed elsewhere in Australia and internationally. They concluded:4
“The increase and severity of GHB overdoses across NSW may be related to the concurrent increase in GHB and methamphetamine use, changing demographics and an increase in overdoses in women.
There is an urgent need to understand the underlying psychological, social and drug market factors behind this increase to better develop risk reduction and overdose prevention strategies.”
In contrast, US data from the 2015-2020 National Survey on Drug Use and Health reported that only 0.05% of adults had used GHB in the past year. However, the survey also highlighted that past year use of methamphetamine, ketamine, and ecstasy were strong predictors of GHB use, suggesting a link between GHB and other substances, which is consistent with the findings of the Australian study.5
Symptoms of GHB overdose usually begin with drowsiness and lethargy, which may progress to coma and respiratory depression. Muscle cramps and seizures may also occur. Fortunately, recovery is often rapid and requires no special treatment, and most patients regain consciousness within a few hours. However, it is important to monitor the patient’s airway and provide respiratory support if necessary.6
Additional Insights into GHB Use
Previous study published in Drug and Alcohol Review in March 20247 To further explore the increasing trend of GHB addiction and provide additional insight into the broader context of drug use in Australia. The study focused on the frequency and impact of exposure to GHB in combination with other substances, particularly methamphetamine. The authors noted:8
“In cases of GHB intoxication, concurrent exposure to multiple drugs has been reported and can significantly affect clinical presentation. Concomitant use of GHB with other CNS depressants (e.g., alcohol, benzodiazepines) increases the risk of severe respiratory depression and coma, and concurrent use of GHB with psychostimulants (e.g., methylamphetamine) increases the risk of cardiovascular complications and seizures.”
Their findings suggest that concomitant use of GHB and methamphetamine is surprisingly common, with methamphetamine being detected in 82.2% of cases identified as GHB. The authors also emphasize that many people who use GHB with other drugs do not report all the substances they use, either because of stigma or because they perceive GHB as the primary cause of their symptoms.
The study also explored new patterns of GHB use beyond traditional nightlife settings. It reported that GHB was increasingly used as a coping mechanism for stress rather than simply for recreational purposes. This change in use patterns may explain the increased number of female users and the different presentation times observed in other studies.
These results emphasize the importance of comprehensive toxicological screening and show that GHB itself is not inherently bad. Rather, it is misuse and lack of understanding of its effects that can pose significant risks.
Controversy over GHB
In a guest article written by Midwestern Doctor, he explores the history of GHB. It was developed in 1874 and used as an intravenous anesthetic in 1964. It slows the heart rate without affecting blood pressure, without stimulating the veins, and without suppressing breathing. It also helps relax muscles, induces sleep without lowering oxygen levels, and protects tissues from damage.
Despite these benefits and the science behind its use, GHB faced significant setbacks in the 1990s. As it gained popularity, especially among bodybuilders, the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) began to highlight its risks, often exaggerating them.
It was later banned by the FDA and misrepresented as a dangerous drug linked to sexual assault, obscuring its real benefits. Interestingly, the pharmaceutical version known as sodium oxybate (Xyrem) is still legal.
Another formulation of GHB called low-sodium oxybate, which has 92% less sodium than sodium oxybate, is approved in the United States to treat narcolepsy and idiopathic hypersomnia. According to a study published in Nature and Science of Sleep:9
“Low sodium oxybate (LXB) is a promising long-term treatment for somnolence and idiopathic hypersomnolence, with demonstrated efficacy for symptoms including excessive daytime sleepiness (EDS), somnolence, and sleep inertia, and a safety profile consistent with that of sodium oxybate (SXB) for somnolence.”
These drugs are very expensive. The cost of sodium oxybate ranges from $60,000 to $100,000 per year, leaving many patients unable to afford the drug despite its benefits for a variety of conditions. To learn more about the history and effects of GHB, I recommend reading the entire guest article.
Strategies to improve sleep without relying on drugs
If there is one positive thing about banning GHB and making prescriptions expensive, it is that it encourages people to focus on addressing the root causes of their sleep deprivation naturally rather than relying solely on drugs. Here are some strategies to help you fall asleep faster and enjoy quality sleep:
Try Emotional Release Techniques (EFT). This technique is a form of psychological acupressure based on the same energy meridians as traditional acupuncture, and has been used to treat physical and emotional ailments for over 5,000 years, but without the invasiveness of acupuncture. It can be very effective in reducing stress and promoting relaxation, which is why people seek out substances like GHB. Check out the video below for basic steps on how to do EFT for relaxation and stress relief. |
Transform your bedroom into an oasis for sleep. The bed is a place to sleep and rest comfortably. Only two other activities do not significantly interfere with a comfortable sleep: reading and intimacy with a lover. Everything else, such as work, computers, mobile phones, or watching television, reduces the quality of sleep.10 Reduce noisy disturbances from pets or outdoor activities. Consider removing pets from the bedroom or using a white noise machine to reduce disturbances from outdoor noise. |
Create a relaxing pre-bedtime routine. Humans are creatures of habit. Establishing a comfortable bedtime routine can help you fall asleep more easily. Activities such as taking a warm bath, reading a good book, or doing relaxation exercises can help you fall asleep more easily. If you have trouble sleeping at night, it is better to leave the bedroom and read a book quietly rather than trying harder to fall asleep. If you do this, it is a good idea to use blue-blocking glasses to prevent the reading light from further reducing melatonin production. |
Keep a consistent schedule. Going to bed and waking up at the same time helps your body get used to the routine. This helps regulate your circadian rhythm, which helps you fall asleep and stay asleep throughout the night. Keep this routine up on weekends, too. |
Get plenty of bright sunlight in the morning and noon. When you wake up in the morning and are exposed to bright light, your body stops producing melatonin, a hormone that helps you sleep, and signals to your body that it’s time to wake up. Outdoor sunlight is best, so taking a quick walk outside can be a good idea. Increasing your physical activity will not only help you fall asleep later, but taking a walk outside early in the morning or around noon when the sun is high will also help you get more exposure to bright sunlight. |
When the sun goes down, dim your lights (or use amber glasses) — In the evening (around 8 p.m.), dim the lights and turn off electronic devices. Normally, the brain starts to secrete melatonin between 9 p.m. and 10 p.m., and these devices emit light that can suppress the process. If you need lighting after dark, switch to low-wattage incandescent bulbs that have yellow, orange, or red light. A salt lamp illuminated by a 5 watt bulb is an ideal solution that does not interfere with melatonin production. If you use a computer or smartphone, install blue light blocking software such as Iris. This is an improved version of f.lux. However, the easiest solution is to use amber glasses that block blue light. I found the Uvex model (S1933X) on Amazon and it worked like a charm to remove almost all blue light. This way, you don’t have to install programs on all your devices or buy special light bulbs for night use. With glasses, it doesn’t matter what light source you have in your home. |
Check the electromagnetic fields (EMF) in your bedroom. EMFs can interfere with the pineal gland and the production of melatonin and serotonin, and can have other negative effects. For this, you will need a gauss meter. You can find a variety of models online, and they cost between $50 and $200. Some experts recommend turning off all power in your home by pulling the circuit breaker before going to bed. |
Exercise every day — The body is energized by exercise and movement. It reduces the risk of cardiovascular disease and metabolic disorders. Exercise helps you fall asleep more easily and sleep more deeply. However, the body secretes cortisol during exercise, which can reduce melatonin secretion. Exercise at least 3 hours before bedtime, or earlier if possible. |
Keep your room cool – The ideal temperature for sleep is 60 to 68 degrees Fahrenheit. If your room is cooler or warmer, you may have a more restless night’s sleep. During sleep, your body’s core temperature drops to its lowest level in a 24-hour period. The cooler the room, the more it can help your body’s natural temperature drop. |
Sleep naked — Sleeping naked helps keep your body cool and offers several health benefits, in addition to increasing your chances of getting a good night’s sleep. |
Rate your mattress and pillows. You will get a more comfortable sleep when your mattress and pillows are comfortable and supportive. You should consider replacing your mattress after 9 or 10 years, which is the average lifespan of a high-quality mattress. |
