Overview of management of disorders of GHB use

Overview of substance use and addictive behaviours explains key principles of care for a person with a disorder of substance use. Establishing a therapeutic relationship that engages the person (and ideally those close to them) is central to the management of substance dependence and addictive behaviours.

Note: The most important element of treatment for substance use is a therapeutic relationship.

Specialist advice on any aspects of care for patients with GHB or other substance dependence is available and contact is encouraged; see Contact details for substance use clinical advisory services for clinicians.

Note: Specialist advice is available by phone on any aspect of the management of substance use; contact is encouraged.

Treatment of GHB overdose is supportive; see Gamma-hydroxybutyrate (GHB) poisoning. Patients may display aggressive behaviour on waking from coma. For advice on ensuring the safety of patients with disorders of substance use, including during an acute behavioural disturbance, see Ensuring the safety of a person with a disorder of substance use or addictive behaviour.

Offer all patients who use GHB brief intervention; brief advice can include information on harm reduction strategies as outlined in Safer use of gamma-hydroxybutyrate (GHB)—patient information sheet. Seek specialist advice if the person uses more than one substance (polysubstance use) or has features of GHB dependence, to minimise the risk of complications including withdrawalPhan, 2020. For GHB dependence, managed withdrawal is recommended (rather than gradual dose reduction) because it is difficult to make small dose adjustments without risking unplanned withdrawal.
Figure 1. Safer use of gamma-hydroxybutyrate (GHB)—patient information sheet.

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Novel Psychoactive Treatment UK Network (NEPTUNE) Expert Group, 2015The Australian and New Zealand Committee on Resuscitation (ANZCOR), 2021Australian Red Cross, 2022

Seek medical attention immediately if you or someone with you has taken too much GHB.

Signs of a GHB overdose include slow and shallow breathing, irregular heart rate, vomiting, sweating, being irritable or very anxious, fitting, losing consciousness.

Act in an emergency—call 000 for an ambulance if someone has collapsed or is unconscious.

Place an unconscious person on their side in the recovery position to keep their airway open.

Start CPR (cardiopulmonary resuscitation) if the unconscious person stops breathing or has abnormal breathing (eg they are gasping with gaps between gasps). The 000 operator will tell you what to do.

Do not try to reverse the effects of GHB with other drugs.

Prepare GHB safely

Never drink GHB without diluting it.

To avoid drinking GHB by mistake, add food colouring and label the container. Never keep GHB in drink bottles or leave it unattended.

Always measure GHB doses accurately using a standard device (eg syringe or pipette).

Use GHB responsibly

Use GHB in a safe place; have someone who has not taken drugs watch you for any signs of overdose.

Do not drive after using GHB.

Make sure the people with you know that you use GHB and how to give you first aid; it is common to become unconscious on GHB. You might want to write ‘GHB’ on the back of your hand to help alert first-aiders.

Avoid using GHB with other sedative drugs (eg ketamine) or alcohol; the risk of overdose is much higher.

Do not re-dose too soon. Wait for at least 2 hours after you feel the effects of GHB; this reduces the risk of overdose.

Sleep on your side after using any substances in case you are sick.

Avoid frequent use, especially daily use. GHB is addictive and dependence (the need to keep using) can occur quickly.

Manage long-term use of GHB

If you are dependent and you miss a dose of GHB or suddenly reduce your dose, you might experience severe withdrawal symptoms (eg severe anxiety, confusion, fitting). Go to an emergency department if you feel unwell after missing or reducing a dose.

If planning to stop GHB use, get medical advice. Do not try to quit GHB suddenly on your own. If you want to reduce your dose, do so in very small amounts until you can get medical advice.

Stabilise your GHB use. Keep a record of your doses and the times you use in your phone or a diary.