Harmen Beurmanjer

10 Chapter 1 of GHB experience both activating and sedating effects of GHB. Given that GHB has a particular fast metabolism and a small dose-response window (Busardo & Jones, 2015), there’s a high risk of overdose. GHB induced overdose results in a transient coma, often lasting one to four hours (Korf, Nabben, Benschop, Ribbink, & Van Amsterdam, 2014). The exact mechanism of action and function of endogenous GHB are currently unknown, in large part due to the limited number of studies. Recreational GHB use GHB has been reported to be mainly used and misused in Australia, the US and Europe (Louisa Degenhardt, Darke, & Dillon, 2003; European Monitoring Centre for Drugs and Drug Addiction, 2016; Phan, Arunogiri, & Lubman, 2020; O. C. Snead & Gibson, 2005). Overall, the prevalence of GHB use seems limited, however GHB is often not systematically studied in national drug monitors. Estimates of last-year GHB use among the general population varied from 0.1 to 1.7% (Kamal et al., 2017). The use of GHB seems to be considerably higher in specific subpopulations, such as gay and bisexual men (Bourne A, Reid D, Hickson F, Torres Rueda S, 2014; Ramchand, Fisher, Griffin, Becker, & Iguchi, 2013; Theodore, Durán, & Antoni, 2014). GHB has shown to have prosocial (Bosch et al., 2015) and erotogenic properties (Bosch et al., 2017). This explains why the common motives for using GHB are associated with relaxing, social disinhibition and increased sexual drive Figure 1 Schematic view of metabolic inter-relationships between GHB and its precursors GBL (γ-Butyrolactone) and BD (1,4-Butanediol) and the biosynthesis and degradation of the GABA.