title: Risk assessment of GBL as a substitute for the illicit drug GHB in the Netherlands. A comparison of the risks of GBL versus GHB.
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.
authors.affiliation: Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Academic Medical Center, P.O. Box 75867, 1070 AW Amsterdam, The Netherlands. Electronic address: jan.van.amsterdam@amc.uva.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: van Amsterdam
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Da Costakade 45, 3521 VS Utrecht, The Netherlands.
authors.forename: Tibor
authors.initials: T
authors.lastname: Brunt
authors.affiliation: The Maastricht Forensic Institute, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Ed
authors.initials: E
authors.lastname: Pennings
authors.affiliation: Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Academic Medical Center, P.O. Box 75867, 1070 AW Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects*; D000818:Animals; D062787:Drug Overdose; D005060:Europe; D006801:Humans; D006885:Hydroxybutyrates / Q000009:adverse effects*; D013287:Illicit Drugs / Q000009:adverse effects*; D009426:Netherlands; D012306:Risk; D018570:Risk Assessment
chemical_list: D006885:Hydroxybutyrates; D013287:Illicit Drugs; C111420:4-hydroxybutyric acid; D015107:4-Butyrolactone
keywords: Addiction; Illicit drugs; Legislation; Risk assessment