title: Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use.
abstract: Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4-butanediol (1,4-BD) use extracted from the UK's National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%); young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0-6500; SD 758)mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.
authors.affiliation: National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK. Electronic address: j.corkery@herts.ac.uk.
authors.forename: John M
authors.initials: JM
authors.lastname: Corkery
authors.affiliation: National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK; Neuroscience Institute, National Research Council of Italy, Section of Cagliari, I-09042 Monserrato, CA, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Loi
authors.affiliation: National Programme on Substance Abuse Deaths, St George's University of London, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Claridge
authors.affiliation: National Programme on Substance Abuse Deaths, St George's University of London, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Goodair
authors.affiliation: Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.
authors.forename: Ornella
authors.initials: O
authors.lastname: Corazza
authors.affiliation: ROAR Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, Worcestershire WR14 3SZ, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Elliott
authors.affiliation: National Programme on Substance Abuse Deaths, St George's University of London, UK; Centre for Clinical Practice, Safe Medicines and Drug Misuse Research, Department of Pharmacy, University of Hertfordshire, UK.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Schifano
mesh_terms: D015107:4-Butyrolactone / Q000009:adverse effects* / Q000378:metabolism / Q000493:pharmacokinetics; D002072:Butylene Glycols / Q000009:adverse effects* / Q000378:metabolism / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D008297:Male; D012978:Sodium Oxybate / Q000009:adverse effects* / Q000378:metabolism / Q000494:pharmacology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002072:Butylene Glycols; D012978:Sodium Oxybate; C039681:1,4-butanediol; D015107:4-Butyrolactone
keywords: Deaths; Fatalities; GBL; GHB; Toxicity; United Kingdom (UK)