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

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.