GHB / GBL intoxication

GHB / GBL Intoxication and Overdose: Understanding  symptoms and what to do

Last week a friend took too much G. He fell asleep for hours and we didn’t know whether to call an ambulance or not. Finally,  finally woke up but we were very scared. Is GHB / GBL intoxication or overdose dangerous?

Originally posted in SR 2.0 . Reviewed 20/2/22

GBL  / GHB intoxications or overdoses are a relatively frequent problem with this substance.

At recreational doses (approximately 1 to 2 grams/ 0.5- 2 ml of pure GBL/GHB) it produces an effect relatively similar to that of alcohol (euphoria, disinhibition, loquacity, relaxation…).

Effects start 20-30 minutes after ingestion and last for about two hours. The safety margin of GHB is lower than that of other substances. Doses above 3 grams can produce deep sleep.

Also, the fact that it can be diluted in water makes proper dosing difficult. On the other hand, mixing GHB with depressants (alcohol, benzodiazepines, ketamine, etc.) increases the risk of intoxication exponentially.

So, if one knows for sure the source and concentration of GBL/GHB it is possible to use it relatively safely. But if one wants to get into trouble, taking undetermined amounts of unknown origins and mixing it with beer is an excellent way.

And GHB intoxication also resembles alcohol intoxication. Depending on the dose: grogginess, drowsiness, deep sleep, coma. Another characteristic of GHB/GBL intoxication is that it reverses spontaneously and quickly (although sometimes the sleepy state lasts for hours).

When we meet someone who has taken too much GHB, at a practical level we can distinguish two situations

  • We know for sure that the intoxicated person has taken only GHB, is breathing normally, there are no other symptoms (convulsions, fever, delirium…) and we are in a safe internal space. In that case it may be reasonable to place the person on his side (to prevent him from swallowing possible vomit), cover him to prevent him from getting cold and wait.
  • In all other situations: we do not know what the person has taken or we do not know, there are other symptoms, the condition is getting worse instead of better… or we are simply not sure… In this case the most prudent attitude is to call an Emergency Department.

To assess the seriousness of an intoxication, or to assess whether it improves or worsens over time, these simple tests can be done:

  • First, the «ocular response». If a person has his eyes open and moves them normally, he is not asleep (or intoxicated by GHB/GBL). If someone opens his eyes just when you shout «open your eyes», that means his brain is functioning reasonably well. Opening his eyes only to a painful stimulus (or even worse, not opening them at all) indicates a higher degree of severity.
  • Second, the «verbal response». A  person who has a coherent conversation is not intoxicated. But if he does not remember where and with whom he is, there is at least some degree of disorientation.  Incomprehensible speech, sounds such as «mmmmrpf», «arggggh», «brumreunfrondix» or the absence of verbal response indicate a higher degree of severity.
  • Third, the ability to stand upright, obey verbal commands («raise an arm»), motor response to painful stimuli.

By the way, «Applying a painful stimulus» does not imply drilling with a drill, burning with a cigarette or other sadistic attitudes. Twisting a nipple or applying pressure to a fingernail is sufficient. Other very stupid  ideas include putting the intoxicated person in a cold shower, giving him a drink while he is unconscious, or slapping him.


The photograph shows the difference between recreational (2-2.5 ml) and toxic (4-5ml) doses of pure GHB. The amount of liquid that fits in one or two portable contact lens cases.

Cannabis, pain and fibromyalgia

I have a question about cannabis, pain and fibromyalgia. Is therapeutic cannabis an option?

I am 54 years old and have been diagnosed with fibromyalgia . I am in pain most of the day and almost no treatment has been effective. I have read that cannabis could help me get better and would like to know your opinion. Thank you very much.

Originally posted in SR 2.0 . Reviewed 20/2/22

Fibromyalgia is a musculoskeletal disease that causes persistent pain, extreme fatigue, muscle stiffness. Also, there are also other symptoms such as psychological distress, sleep difficulties, headaches, and forgetfulness.

This condition is  controversial. Some physicians do not believe that this is a «disease» due to the lack of physical, laboratory, or imaging test alterations,. But others disagree and state that there are still no laboratory markers available

There are different hypotheses about  the triggers of fibromyalgia. The widely accepted theory considers that physical and mental stress, psychological and social factors, are the main causes. Other authors think that certain viruses or vaccines may be the cause.

In any case, most experts agree that the mechanisms of fibromyalgia involve a decreased pain threshold in the brain. And also an increased sensitivity of the body’s pain receptors.

The fact has led some researchers to hypothesize that  a deficiency of endogenous cannabinoids could cause fibromyalgia. These molecules contribute to the control and regulation of pain in vertebrates.

This hypothesis is still under investigation. But some studies have found elevated levels of anandamide, one of the cannabinoids naturally occurring in the body, in fibromyalgia patients.

Several studies have examined the efficacy of cannabinoid-based treatments for fibromyalgia. In 2006, a study showed improvement in a subgroup of patients treated with oral delta-9-THC in doses between 2.5 and 15 mg.

Another synthetic cannabinoid called Nabilone proved some benefits in at least two small clinical trials . However, some patients did not tolerate the medication well, and others did not experience any relief.

Recently, some studies suggest that vaporized marijuana or THC-rich cannabis oil may be an effective treatment for fibromyalgia. In any case, more research is needed to confirm these findings.

In fibromyalgia, no treatment is completely effective in a majority of patients. Some individuals improve with different types of drugs. Medications available include anti-inflammatory medications, analgesics, corticosteroids, antidepressants, and antiepileptics. Psychological and non-pharmacological therapies are useful, too.

Therefore,  cannabinoids may provide benefits for certain individuals. But there is need of more research determine their overall efficacy and safety for the treatment of fibromyalgia.

venlafaxine and MDMA interactions

Are there relevant venlafaxine and MDMA interactions?

Hi Doc
I take 150mg Venlafaxine daily. Now, when I take MDMA it doesn’t do anything. So it takes about 600mg to feel a mild effect is this down to the venlafaxine. In fact, Im not a regular MDMA user as now a standard dose of 200mg does nothing.

Originally posted in Evolution 3/11/14 . Reviewed 4/3/23

Venlafaxine belongs to a family of drugs (selective serotonin and norepinephrine reuptake inhibitors (SNRIs)) that decrease some psychological effects of MDMA.

There are no clinical trials that have studied the pharmacological effects of the combination MDMA + venlafaxine.

But, based on the mechanism of action and studies with similar drugs, this effect is likely to be present: that of decreasing the pleasant properties of MDMA.

Consequently, some people try to compensate for this problem by increasing the dose of MDMA. But that is not a good idea.Because this decrease in the psychological effects of MDMA does not necessarily imply that the effects on the heart and the rest of the body also decrease.

So, 600 mg is a very high dose that can be dangerous. On the other hand, the negative psychological effects of MDMA and the after effects can be potentiated, not only by the pharmacological combination, but also by the problem that motivated the use of venlafaxine (a depressive or anxiety disorder, in many cases).

To enjoy the effects of MDMA, it is advisable to be in a good state of health, both physically and mentally. It would be more reasonable to wait until your treatment is over and use safer doses.

Finally, a recent study linked the combination MDMA + venlafaxine to an increase in mortality. The impact in real conditions is probably low, but it is a fact to consider.


Antidepressants and psychedelic interactions

Is it safe to combine psychedelics and antidepressants?

I’m on the medication for depression and anxiety, which certain psychedelic drugs seem to help a little bit. I’m not on antipsychotics for anything like bipolar disorder or schizophrenia So, correct me if I’m wrong, but I feel like it is safe for me to use psychedelics.I have one more question. On the part about counteracting the effects of the medication by increasing psychedelic dosage, is this safe to do with DMT? Also, is there any cross tolerance between 2C-X, NBOMe series, and DMT?

Originally posted in SR 2.0 . Reviewed 3/3/23

It depends on what we mean by «safe». The pharmacological combination of the prescription drug you refer to (probably an SSRI) and DMT or 2C-X is unlikely to produce acute or permanent organ damage. On a psychological level, however, psychedelics always have an unpredictable nuance.

Experiences of anxiety or depression afterwards are likely to be more frequent, not so much because of the combination of drugs but because of your state of mind.

The risks of 25x-NBOMe are potentially much higher. Cases of seizures, hyperthermia and renal failure are relatively frequent and human research is nil compared to DMT and 2C-X. So, their use is strongly discouraged.