Treatment of a young adult taking gamma butyrolactone (GBL) in a primary care clinic

Gamma-butyrolactone (GBL) has become the new drug of choice for young adults to abuse. The effects it induces include euphoria, disinhibition, depressed levels of consciousness, and eventual respiratory depression. GBL is metabolized into gamma-hydroxybutyrate (GHB), which is also a recreational drug and is now a schedule I drug in some states. Both GBL and GHB are used in social settings similar to those where ecstasy (methylenedioxymethamphetamine, or MDMA) is used, although GBL and GHB are chemically distinct from ecstasy. Recent reports have been published describing toxic effects of GBL that lead to emergency department visits and death. The overall prevalence of GBL use in America is unknown, although it is suspected to be high because the drug is available through underground sources. GBL is also readily available from Internet sources, where it is touted for its ability to induce sleep, enhance libido and sexual performance, and increase lean muscle mass. Despite numerous warnings about the harmful side effects, young adults who continue to use this drug can experience physical and psychological addictions, as well as acute altered mental status and severe respiratory depression. The widespread use of GBL suggests that primary care physicians should become more aware of its potential adverse effects and develop modes of treatment for drug-using patients who attend their clinics. We report a case of a young man seeking medical care because of GBL addiction.