• John M Corkery, Barbara Loi, Hugh Claridge, Christine Goodair, Ornella Corazza, Simon Elliott, and Fabrizio Schifano.
• 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.
• Neurosci Biobehav Rev. 2015 Jun 1; 53: 52-78.

AbstractMisuse 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

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