Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem): differences in characteristics and misuse - PubMed (original) (raw)

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Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem): differences in characteristics and misuse

Lawrence P Carter et al. Drug Alcohol Depend. 2009.

Abstract

There are distinct differences in the accessibility, purity, dosing, and misuse associated with illicit gamma-hydroxybutyrate (GHB) compared to pharmaceutical sodium oxybate. Gamma-hydroxybutyrate sodium and sodium oxybate are the chemical and drug names, respectively, for the pharmaceutical product Xyrem (sodium oxybate) oral solution. However, the acronym GHB is also used to refer to illicit formulations that are used for non-medical purposes. This review highlights important differences between illicit GHB and sodium oxybate with regard to their relative abuse liability, which includes the likelihood and consequences of abuse. Data are summarized from the scientific literature; from national surveillance systems in the U.S., Europe, and Australia (for illicit GHB); and from clinical trials and post-marketing surveillance with sodium oxybate (Xyrem). In the U.S., the prevalence of illicit GHB use, abuse, intoxication, and overdose has declined from 2000, the year that GHB was scheduled, to the present and is lower than that of most other licit and illicit drugs. Abuse and misuse of the pharmaceutical product, sodium oxybate, has been rare over the 5 years since its introduction to the market, which is likely due in part to the risk management program associated with this product. Differences in the accessibility, purity, dosing, and misuse of illicit GHB and sodium oxybate suggest that risks associated with illicit GHB are greater than those associated with the pharmaceutical product sodium oxybate.

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Figure 1

Figure 1

National estimates of the availability, use, and abuse of GHB in the U.S. Top panel: Percent of items confiscated in law enforcement operations in the U.S. from 2000 through 2007 that were positive for GHB or GBL. Data are from the annual reports from The National Forensic Laboratory Information System (NFLIS). Data are not available before the year 2000 because GHB was not illegal until 2000. Middle panel: Number of emergency department visits in which GHB was mentioned. Data are from the annual reports from the Drug Abuse Warning Network (DAWN) coordinated by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. Note: trends prior to 2003 are not shown due to methodological changes made to the DAWN surveillance system that preclude the comparison of DAWN data from before and after 2003. Bottom panel: Number of exposures (circles) and deaths (numbers in parentheses) attributed to illicit GHB, GHB analogs, and GHB precursors in each of the following years. Data are from the Annual Reports from the American Association of Poison Control Centers National Poison Database (formerly named the Toxic Exposure Surveillance System).

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