In emergency medicine and anesthaesiology liquid ecstasy (LE), the street name for GHB, GBL or 1,4-B, has become infamous for causing severe intoxications and withdrawal. In general psychiatry, however, it is little known. Therefore, we set out to gather data about the role of LE in general psychiatry, typical users and common clinical problems associated with the use of LE.
We retrospectively identified and studied all patients with a reported the use of LE seen at the Department of Psychiatry, University of Ulm, Germany, between 1998 and 2011.
In 14 years, 19 users of LE were identified, the first dating from 2005. The majority reported a use of GBL (63 %), GHB was less common, and 1,4-B was not reported. Patients were predominantly young men (median age 25 years, 79 % men) with a history of multiple substance abuse. Ten patients had only a former use of LE, the other nine patients used it at the time of presentation. Of these, every third patient had to be transiently treated in an intermediate care unit, usually because of very severe and sudden withdrawal symptoms. Otherwise, detoxification was possible in psychiatry, but often required high doses of benzodiazepines. Three patients met the criteria for dependence from GBL.
In recent years, a small number of users of LE is seen also in general psychiatry, The problem is rather the severity of withdrawal than the number of cases. Close cooperation with intermediate care units is needed. In any case of coma of unknown origin or delirium with sudden onset LE use or withdrawal has to be taken into consideration, respectively. Many clinical problems result from the fact that LE cannot be detected in routine drug screenings. According to our experience, withdrawal from LE can be controlled with benzodiazepines.
"), including one case with GBL only (EMCDDA, 2008). Furthermore, in Germany from 1998 to 2011, 19 users of GHB (37%) or GBL (63%) were treated in the emergency department because of severe withdrawal symptoms or coma; three of the 19 patients were dependent on GBL (Freudenmann et al., 2013 "
[Show abstract][Hide abstract] ABSTRACT: In the Netherlands, γ-hydroxybutyric acid (GHB) was recently banned, but γ-butyrolactone (GBL) was not. As such, GBL remained a legal alternative to GHB. This review compares the risks of GBL and GHB.
Pure GBL is per unit of volume about threefold stronger and therefore threefold more potent than currently used GHB-preparations in the Netherlands. Like GHB, GBL use hardly leads to organ toxicity, although, as with GHB, frequent GBL use may lead to repeated comas that may result in residual impairments in cognitive function and memory. Little is known about the prevalence of GBL use in Europe, but the recent increase in improper trading in GBL confirms that users of GHB gradually switch to the use of GBL. This shift may result in an increase in the number GBL dependent users, because the dependence potential of GBL is as great as that of GHB. Severe withdrawal symptoms and a high relapse rate are seen following cessation of heavy GBL use. GBL-dependent users seem to be severe (dependent, problematic) GHB users who started using GBL, the legal GHB substitute. Subjects who are solely dependent to GBL are rarely reported. About 5-10% of the treatment seeking GHB dependent subjects also use GBL and this subpopulation forms a vulnerable group with multiple problems. Fatal accidents with GBL are rarely reported, but non-fatal GHB (or GBL) overdoses frequently occur for which supportive treatment is needed. It is recommended to monitor the recreational use of GBL, the rate of GBL dependence treatment, and the improper trading of GBL.
[Show abstract][Hide abstract] ABSTRACT: Akutpsychiatrie ist ein wichtiges Gebiet der Medizin, das von den Psychiatern häufig gemieden wird, weil es stark in andere medizinische Fächer hineingreift. Psychiatrische Kompetenz ist aber gerade in der Akutsituation mehr und mehr gefragt und muss immer wieder aktualisiert sowie weiterentwickelt werden.
[Show abstract][Hide abstract] ABSTRACT: γ-Butyrolacton (GBL) ist als potentes Reinigungs- und Lösungsmittel für die Industrie unverzichtbar. Daher unterliegt es nicht – wie sein Stoffwechselprodukt γ-Hydroxybuttersäure (GHB) – dem Betäubungsmittelgesetz (BtMG) und ist im Internethandel leicht verfügbar. Studien belegen ein körperliches und psychisches Abhängigkeitspotenzial sowie komplizierte, mitunter letale Verläufe in der Behandlung des GBL/GHB-Entzugssyndroms. Der toxikologische Nachweis einer Ingestion von GBL/GHB gelingt aufgrund der kurzen Halbwertszeit in Blut und Urin häufig nicht. In der vorliegenden Kasuistik wurde durch interdisziplinäre Zusammenarbeit von Psychiatrie, Toxikologie und Rechtsmedizin ein vollständiges Konsumprofil erhoben, das durch die Ergebnisse einer Haaranalyse untermauert werden konnte. Daraus ergeben sich Informationen und Ansatzpunkte für die Aufarbeitung GBL/GHB-assoziierter Fälle in der rechtsmedizinischen Praxis.
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