title: Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD).
abstract: BACKGROUND
  Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects.
  
  
  OBJECTIVE
  The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs.
  
  
  METHODS
  Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present.
  
  
  RESULTS
  In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions.
  
  
  CONCLUSIONS
  Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.
authors.affiliation: Guy's and St. Thomas' Poisons Unit, Guy's and St. Thomas' NHS Foundation Trust, Avonley Road, London, UK. David.Wood@gstt.nhs.uk
authors.forename: D M
authors.initials: DM
authors.lastname: Wood
authors.forename: C
authors.initials: C
authors.lastname: Warren-Gash
authors.forename: T
authors.initials: T
authors.lastname: Ashraf
authors.forename: S L
authors.initials: SL
authors.lastname: Greene
authors.forename: Z
authors.initials: Z
authors.lastname: Shather
authors.forename: C
authors.initials: C
authors.lastname: Trivedy
authors.forename: S
authors.initials: S
authors.lastname: Clarke
authors.forename: J
authors.initials: J
authors.lastname: Ramsey
authors.forename: D W
authors.initials: DW
authors.lastname: Holt
authors.forename: P I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: D015107:4-Butyrolactone / Q000506:poisoning*; D000328:Adult; D000368:Aged; D002072:Butylene Glycols / Q000506:poisoning*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000331:legislation & jurisprudence / Q000506:poisoning*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012978:Sodium Oxybate / Q000506:poisoning*; D019966:Substance-Related Disorders / Q000175:diagnosis
chemical_list: D002072:Butylene Glycols; D013287:Illicit Drugs; D012978:Sodium Oxybate; C039681:1,4-butanediol; D015107:4-Butyrolactone