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γ-Butyrolactone and 1,4-Butanediol

Abused Analogues of γ-Hydroxybutyrate

  • GHB Symposium
  • Published:
Toxicological Reviews

Abstract

γ-Hydroxybutyrate (GHB) is a GABA-active CNS depressant, commonly used as a drug of abuse. In the early 1990s, the US Drug Enforcement Administration (DEA) warned against the use of GHB and restricted its sale. This diminished availability of GHB caused a shift toward GHB analogues such as γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) as precursors and surrogates. Both GBL and 1,4-BD are metabolically converted to GHB. Furthermore, GBL is commonly used as a starting material for chemical conversion to GHB. As such, the clinical presentation and management of GBL and 1,4-BD intoxication shares a great deal of common ground with that for GHB. This similarity exists not only for acute intoxication but also for withdrawal in those patients with a history of extended high-dose abuse. This review examines the history of GHB analogue abuse as well as the clinical presentation and management of acute intoxication and withdrawal associated with abuse of these compounds.

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Acknowledgements

This project was not funded by any source and does not represent any conflict of interest for the author.

The authors wish to thank Dr Carl S. Hornfeldt of Orphan Medical, Inc., Minnetonka, Minnesota, USA, for his invaluable assistance detailing the historical and legal aspects of GHB and GHB analogue use, providing reference material and his critical eye and suggestions for this manuscript.

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  1. Toxicology Associates, Prof LLC, 2555 South Downing, Suite 260, Denver, Colorado, 80210, USA

    Robert B. Palmer

  2. Rocky Mountain Poison & Drug Center, Denver, Colorado, USA

    Robert B. Palmer

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Correspondence to Robert B. Palmer.

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Palmer, R.B. γ-Butyrolactone and 1,4-Butanediol. Toxicol Rev 23, 21–31 (2004). https://doi.org/10.2165/00139709-200423010-00003

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