A case of severe and prolonged γ-hydroxybutyrate (GHB) withdrawal syndrome successfully managed with a slow benzodiazepine and baclofen taper.

Summary

GHB withdrawal can be far more prolonged than the typical 5-7 days, sometimes recurring over 56 days despite initial stabilization and toxicological evidence of abstinence. A male patient in his 30s with a 15-year history of daily high-dose GHB use experienced three hospital admissions over 8 weeks, each requiring intravenous sedation and intubation for agitated delirium. His withdrawal delirium was successfully treated with a slow, six-month taper of benzodiazepines and baclofen, preventing further re-emergence of the debilitating delirium. This case demonstrates that severe GHB withdrawal may require extended support and slow medication tapering, with benzodiazepines and GABA-B agonists as effective treatments.

Study at a glance

Abstract

γ-hydroxybutyrate (GHB) is a GABA-B agonist that rapidly produces effects that are likened to both alcohol and MDMA/ecstasy. GHB use can lead to neuroadaptation with a characteristic withdrawal syndrome. There is currently a paucity of data on the progression of GHB withdrawal, however, due to the drug's short half-life it is generally considered to be typically 5-7 days, although some cases can be severe and complicated by life threatening delirium. Here, we present a case of severe GHB withdrawal, which recurred on multiple occasions over 56 days, despite initial clinical stabilisation on each occasion and toxicological evidence of abstinence from GHB between episodes. A male patient in his 30s presented with agitated delirium on a background of severe GHB use disorder with a 15-year history of daily high dose GHB use. Following 3 hospital admissions over 8 weeks, all requiring intravenous sedation and tracheal intubation, the patient's withdrawal delirium was successfully treated with a slow benzodiazepine and baclofen wean over a period of 6 months. Relapse to GHB use between hospitalisations was excluded toxicologically via blood analysis performed at an institute of forensic pathology. This case highlights that GHB withdrawal can be more prolonged than previously reported in the literature and in some cases may require slow and prolonged tapering of treatment to prevent re-emergence of delirium. Similar to previous case reports, benzodiazepines and GABA-B receptor agonists appear to be appropriate drug classes to manage GHB withdrawal.