Pharmacological treatment of GHB withdrawal syndrome (2024)

Purpose of Review: Gamma-hydroxybutyrate (GHB) is an illicit drug used for many reasons: during music festivals or parties, for self-management of sleep and anxiety, or in combination with other drugs to facilitate chemsex. Most people who use GHB do so occasionally, without harm. However, a minority of users experience dependence or withdrawal symptoms. GHB withdrawal syndrome often has a specific course, with rapid onset and swift progression of severe complications. In this narrative review, we aimed to summarize recent evidence related to the pharmacological treatment of GHB withdrawal syndrome.
Recent Findings: The management of GHB withdrawal syndrome is challenging due to the lack of specific evaluation tools and pharmacological treatment guidelines. From current findings, two pharmacological regimens could be considered for inpatients and outpatients with GHB dependence during detoxification: benzodiazepines and pharmaceutical GHB.
Summary: Few detoxification protocols for GHB or its analogs have been reported in the literature. The main available evidence is based on case studies and uncontrolled open-label studies, which support the efficacy of pharmacological interventions, notably high-dose benzodiazepines and titration and tapering with pharmaceutical GHB, for the management of GHB withdrawal. Barbiturates such as phenobarbital and baclofen might also represent new therapeutic options. Future research should examine these pharmacological interventions with large-scale randomized trials, withdrawal scales, or validated treatment protocols.