title: Twenty-three deaths with gamma-hydroxybutyrate overdose in western Sweden between 2000 and 2007.
abstract: BACKGROUND
  gamma-Hydroxybutyrate (GHB) is a drug of abuse with a status as being safe. In spite of a reputation of low toxicity, a huge number of deaths associated with this drug have been recorded during recent years in Sweden. It is unclear whether coingestion with other drugs or ethanol causes death in GHB overdoses or whether GHB itself is the main cause of death.
  
  
  OBJECTIVE
  The aim of this study was to analyze the cause of death in GHB-related fatalities seen in our region.
  
  
  METHODS
  All cases of deaths with GHB during the year 2000-2007 in the region of western Sweden were studied retrospectively. The cases were classified as either GHB poisonings without any, with a minor or a major influence of other drugs on the cause of death.
  
  
  RESULTS
  Twenty-three cases were diagnosed as deaths due to GHB overdose. Ninety-one percent coingested other substances. Ninety-one percent of the decedents were male. Age varied between 16 and 46, with the median age at 25 years. Forty-three percent of the cases were classified as GHB poisonings without any or a minor influence of other drugs on the cause of death. Thirty percent also ingested ethanol. Two patients (9%) were only intoxicated with GHB.
  
  
  CONCLUSIONS
  Intoxication with GHB carries some mortality. Combining GHB with ethanol does not explain the many deaths in our region, nor do extremely high plasma concentrations of GHB. The intake of opioids increases the toxicity of GHB. The drug itself has such biological activities that an overdose is dangerous and may lead to death.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. kai.knudsen@aniv.gu.se
authors.forename: K
authors.initials: K
authors.lastname: Knudsen
authors.forename: U
authors.initials: U
authors.lastname: Jonsson
authors.forename: J
authors.initials: J
authors.lastname: Abrahamsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000697:Central Nervous System Stimulants / Q000506:poisoning; D003042:Cocaine / Q000097:blood / Q000506:poisoning; D062787:Drug Overdose; D005260:Female; D006213:Hallucinogens / Q000506:poisoning; D003932:Heroin / Q000506:poisoning; D006801:Humans; D007118:Immunoassay; D008297:Male; D002189:Marijuana Abuse / Q000150:complications; D008694:Methamphetamine / Q000506:poisoning; D008875:Middle Aged; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000506:poisoning; D009294:Narcotics / Q000097:blood / Q000506:poisoning; D055553:Prescription Drugs / Q000506:poisoning; D012189:Retrospective Studies; D012978:Sodium Oxybate / Q000097:blood / Q000506:poisoning*; D019966:Substance-Related Disorders / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D006213:Hallucinogens; D009294:Narcotics; D055553:Prescription Drugs; D008694:Methamphetamine; D003932:Heroin; D012978:Sodium Oxybate; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine