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GHB Withdrawal Timeline

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 01/25/2021

Number of References: 19 Sources

GHB (gamma-hydroxybutyric acid/gamma-hydroxybutyrate) is a very powerful and highly addictive depressant and anesthetic drug. Capable of producing physical dependence within weeks of regular use, withdrawal is extremely unpleasant and potentially fatal. The symptoms of GHB withdrawal may last around a week or two and can include delirium, seizures, and psychosis. Our comprehensive guide outlines everything you need to know about GHB withdrawal, including the symptoms, timeline, specific effects on both the mind and body, and more.

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GHB Withdrawal Symptoms

Withdrawal from GHB often begins soon after the last time someone used the drug. On average, symptoms will begin between 30 minutes to 4 hours after the last use and escalate in intensity over the first few days. Since GHB has a very short half-life, these symptoms will appear soon, but this should not give the impression that the symptoms are short-lived. The typical timeline for acute withdrawal is between 1 and 2 weeks, while post-acute withdrawal may last for several months.

The acute phase of withdrawal is by far the most severe and is considered a “medical emergency” by medical professionals. During the acute withdrawal phase, the risks for brain damage and/or death are real and someone is likely to be suffering from psychosis or delirium. Medical attention is absolutely required if someone is to make it through acute withdrawal. This phase may begin as soon as a couple of hours or less after the last time someone used GHB, as it has an extremely short half-life of between 30 and 60 minutes.

Withdrawal from GHB will present two distinct phases of withdrawal symptoms; the acute and the post-acute phases. The acute phase is by far the most intense and can potentially be fatal, while the post-acute phase is less intense but much longer-lasting. Both phases are extremely uncomfortable, but the acute phase can be very dangerous. Acute withdrawal is a very scary, intense, and dangerous experience but with medical help, the symptoms can be reduced and managed. One of the characteristics of GHB withdrawal that differentiates it from withdrawal from other drugs is the quickness of onset. It is possible to experience minor withdrawal symptoms within 30 minutes of the last dose, but it is more common for symptoms to appear after 2 to 4 hours of abstinence. These symptoms are extremely uncomfortable, potentially fatal, and quite long-lasting often taking around 1 to 2 weeks to fully subside.

A general timeline for GHB withdrawal may look like this:

Week 1

The first week of GHB withdrawal will be the most dangerous and intense by far. Within hours of the last use of GHB, symptoms will begin to appear. The most common initial symptoms include intense sweating, tremors, rapid heart rate, and elevated blood pressure. Anxiety and irritability will emerge early and persist throughout the entire acute phase of withdrawal, possibly persisting for several weeks. Soon after these symptoms appear, they may be joined by tactile hallucinations such as strange feelings or sensations in the limbs or extremities. Body temperature may begin to rise or lower, accompanied by the tactile hallucinations transforming into a feeling of the skin burning or freezing. Around 48-72 hours after these symptoms begin, they will reach peak intensity. Additionally, the appearance of GHB withdrawal delirium usually occurs during this timeframe as well and it may be very long-lasting, or even appear to resolve before reemerging. This may or may not include paranoid delusions, but may include profound confusion and disorientation. The symptoms of GHB withdrawal typically reach their peak intensity around the fourth day after they have begun and will begin a gradual decline from this point onwards.

Some of the symptoms of GHB withdrawal that may appear during the first week could include:

  • Delirium and Confusion
  • Hallucinations (visual, auditory, tactile, or a combination)
  • Psychosis and Paranoid Delusions
  • Seizures
  • Tremors and Shaking
  • Rhabdomyolysis (muscle tissue breaking down and entering the blood)
  • Hyper/Hypothermia (high or low body temperature)
  • Hypertension (high blood pressure)
  • Tachycardia (rapid heart rate)
  • Insomnia
  • Nausea, Vomiting, and Diarrhea
  • Extreme Anxiety
  • Intense Cravings for GHB
  • Agitation and Irritability
  • Diaphoresis (excessive sweating)

Week 2

The beginning of the second week of GHB withdrawal is often much less severe than the first week, however, it is still may be extremely unpleasant. While the worst of the hallucinations and cardiovascular symptoms may have subsided, anxiety and insomnia may still be prominent. In addition, someone may expect delirium to persist to some degree early into the second week in some cases. A unique feature of GHB withdrawal compared to other drug withdrawal syndromes is that delirium may come and go over the first two weeks. Symptoms of delirium are inconsistent during GHB withdrawal, and often emerge early, but have also been observed to manifest with a delayed onset.

Some GHB withdrawal symptoms that someone may expect during the second week can include:

  • Delirium and Confusion
  • Hallucinations (visual, auditory, tactile, or a combination)
  • Psychosis and Paranoid Delusions
  • Seizures
  • Mild Tremors
  • Insomnia
  • Nausea
  • Strong Cravings for GHB
  • Intense Anxiety
  • Deep Depression
  • Agitation and Irritability
  • Diaphoresis (excessive sweating)

Usually, by the end of the second week, these symptoms will have resolved for the most part, with only lingering vestiges possibly remaining by the week’s end.

Weeks 3 & 4

There is quite a bit of variability in the individual experience of GHB withdrawal, with reports of acute withdrawal symptoms lasting between 2 to 15 days. On average, the beginning of week three will mark the end of acute withdrawal, and a probable transition into post-acute withdrawal over the third and fourth weeks. This may exhibit symptoms of elevated anxiety, depression, irritability, continued insomnia, and intense cravings. This is often the time of greatest relapse risk, as the worst of the symptoms are gone, yet someone feels mentally drained and depressed with a strong feeling that more GHB will “fix” their state of mind and give them relief. It is highly recommended to enter counseling or therapy at this time if someone has not already done so.

  • Insomnia
  • Anxiety
  • Irritability
  • Cravings for GHB
  • Depression

The brain is able to restore the imbalances produced through heavy GHB use, but this must be given time. It is a slow process and even though it is uncomfortable, the symptoms should decrease gradually over the next few weeks.

Post-Acute Withdrawal

This phase is much less severe, but it is still very unpleasant. While the physical symptoms may have resolved, there are still multiple psychological symptoms that may persist for quite some time. The most common post-acute withdrawal symptom is anxiety. Most anti-anxiety medications work in a very similar way as GHB, so dependence and tolerance to GHB will act to increase global anxiety and social anxiety in particular. These symptoms will begin very intense and slowly dissipate over the next few months.

Some of the most common symptoms of post-acute withdrawal from GHB are:

  • Anxiety
  • Cravings for GHB
  • Depression

There have been relatively few controlled studies done on the long term withdrawal symptoms of GHB in humans. This phase of GHB withdrawal is not very well understood at present. The above symptoms are the common course of post-acute withdrawal, although not necessarily unique to GHB withdrawal.

While these symptoms are much less dangerous from a physical standpoint, they are unpleasant and very persistent. Issues with anxiety and depression are bad enough on their own, but these issues may also worsen cravings for GHB. This time is very sensitive and critical for someone trying to recover from GHB addiction, and professional medical help is often recommended to help reduce these symptoms.

What Factors Influence the Intensity of Withdrawal?

GHB withdrawal symptoms can vary quite a bit between individuals, both in symptom intensity and duration. There is certainly an element of control with some of these factors such as GHB use habits, but some of these are out of someone’s control such as genetics. These differences in withdrawal symptoms may affect both the intensity as well as the very presence of certain symptoms. Very light or infrequent GHB users may not experience delirium, psychosis, or seizures and the likelihood of these particular symptoms is dependent upon both the amounts of GHB someone used and the duration of their use.

Some of the greatest contributors of GHB withdrawal intensity and duration include:

  • Amount of GHB someone used
  • Length of time that someone used GHB
  • A genetic predisposition for addiction
  • Co-occurring mental health issues (particularly congenital GABA dysregulation conditions)

The largest contributing factors to the intensity and duration of GHB withdrawal are certainly the amounts of GHB someone used and the duration of use. The amounts of GHB used will directly impact the degree of downregulation which the brain undergoes. This greater the degree of downregulation, the greater the intensity of GHB withdrawal symptoms will be. As for the duration of use, this may affect the intensity of withdrawal symptoms, but it absolutely affects the duration of the withdrawal symptoms. The longer the brain has operated after undergoing downregulation, the more “fixed” these neurotransmitter changes become, and subsequently the longer these changes will take to reverse. This could prolong the duration of both phases of GHB withdrawal.

Genetics play a very large role in someone’s propensity towards addiction and indirectly may play a role in the GHB withdrawal symptoms someone experiences. While this is a very tangential influence, it is an influence nonetheless. While anyone is capable of becoming physically dependent on a drug, if someone has a genetic predisposition it may take less of the drug to produce dependence. The exact reasons for this are currently unclear, but it may have to do with neuroplasticity and genetically carried neuroadaptive potential. This means that someone with a heavy family history of addiction may become addicted to a drug more quickly and with lower total amounts used than someone with no family history of addiction. The end result is that the brain of someone with a genetic predisposition for addiction may undergo greater downregulation at an earlier time than someone with no such disposition, with greater downregulation translating to a more intense GHB withdrawal experience.

Preexisting mental health issues may also affect the symptoms of GHB withdrawal. For example, if someone were to suffer from epilepsy, schizophrenia, or bipolar disorder then they would be much more likely to experience seizures and psychosis during acute withdrawal. Likewise, if someone suffered from anxiety or depression then these withdrawal symptoms would be greatly amplified due to their preexisting neurotransmitter imbalance which led to these conditions in the first place. These symptoms may also increase the incidence of cravings as well as making the cravings more appealing, thus increasing the chances of relapse.

More About GHB Addiction

To paint the clearest possible picture of GHB withdrawal, let’s look at exactly how GHB works. GHB is a naturally occurring compound in the brain which is a derivative of the neurotransmitter GABA. The way that GHB works is through stimulating GABA and GHB receptors in the brain, in particular the GABA-β receptors as well as specific GHB receptors. Through stimulation of these receptors, GHB exerts its euphoric, depressive, and amnesiac effects. GABA is a major inhibitory neurotransmitter that acts to slow, dampen, and moderate a huge array of other nerve signals, and its effects are far-reaching. GHBs potent stimulation of GABA receptors will strongly affect someone’s state of mind and perceptions as well as physical processes such as breathing and heart rate.

Due to the intensity with which GHB stimulates GABA receptors, the brain will take steps to protect itself from damage. When neurotransmitter receptors are overstimulated they can be damaged or killed and this is known as excitotoxicity or neurotoxicity (depending on the receptor type). To avoid neurotoxic brain damage, the brain will reduce the number and the sensitivity of both GABA and GHB receptors which are activated by GHB through a process called downregulation.

Downregulation may begin to occur quite soon after someone has been using GHB regularly, sometimes as soon as a month or less. The most immediate effect of this is the development of tolerance. Tolerance is when someone needs more of the drug to produce the same effects as they experienced during previous use. This often leads to increased use and subsequently speeds up the process of downregulation. Further use will lead from tolerance to a physical dependence on GHB. This means someone will become physically and mentally unwell unless they use GHB.

Aside from the multifaceted effects on GABA and GHB receptors which are produced through prolonged GHB use, several other neurotransmitter systems are affected in an indirect manner. This includes dopamine, serotonin, and glutamate systems. The exact way these systems are affected is currently unclear, but levels of dopamine and glutamate become elevated in the nucleus accumbens and ventral tegmental area, parts of the limbic system or “reward center” of the brain which are known to play a large role in the development of drug addictions. Additionally, serotonin levels become increased during GHB use, subsequently leading to severe serotonin imbalances during GHB withdrawal.

Due to extensive downregulation, once an addict stops using GHB their body and brain will enter a hyperstimulated state and will not be able to calm or slow itself down. The normal dampening effects of GABA will not be enough to maintain balance, and this hyperactivity can result in an array of negative consequences including brain damage or death.

The Importance of Detox

Withdrawal from GHB can be fatal if it is left untreated, and GHB detox centers can provide a wide range of resources to ease this process. With trained professionals to provide medical monitoring, medications, and psychiatric care the withdrawal process can be undergone in the least dangerous and uncomfortable manner possible, and the symptoms of GHB withdrawal minimized. In addition, these centers can provide connections, therapies, and aftercare planning for continuing treatment and recovery after detox has been completed.

GHB Detox Centers

Related Guides

There are several other depressant drugs that can produce uncomfortable or even dangerous withdrawal symptoms. We have more in-depth withdrawal guides for drugs such as:

Marijuana Withdrawal Timeline

Spice Withdrawal Timeline

Gabapentin Withdrawal Timeline

Lyrica Withdrawal Timeline

Phenibut Withdrawal Timeline

Article References (In Addition to 5 in-article references)

  1. 1 Trials: Improving GHB Withdrawal with Baclofen - Study Protocol for A Feasibility Study for A Randomised Controlled Trial
  2. 2 Neptune Clinical Guidance: Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances
  3. 3 Psychiatria Danubina: Inpatient Management of GHB/GBL Withdrawal
  4. 4 Medical Journal of Australia: Severe GHB Withdrawal Delirium Managed with Dexmedetomidine
  5. 5 Current Neuropharmacology: GHB Pharmacology and Toxicology - Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome
  6. 6 Journal of Advanced Pharmaceutical Technology & Research: GHB Acid - A Rage or Reprieve
  7. 7 World Health Organization: Pre-Review of Gamma-Hydroxybutyric Acid (GHB)
  8. 8 Journal of Analytical Toxicology: A Reference Range for Endogenous Gamma-Hydroxybutyrate in Urine by Gas Chromatography-Mass Spectrometry
  9. 9 Annals of Emergency Medicine: Gamma-Hydroxybutyrate Withdrawal Syndrome
  10. 10 CNS Drug Reviews: A Review of Pharmacology of NCS-382, a Putative Antagonist of γ-Hydroxybutyric Acid (GHB) Receptor
  11. 11 Toxicology In Vitro: Toxicologic/Transport Properties of NCS-382, a γHydroxybutyrate (GHB) Receptor Ligand, in Neuronal and Epithelial Cells - Therapeutic Implications for SSADH Deficiency, a GABA Metabolic Disorder
  12. 12 Frontiers in Pharmacology: A Gut Feeling About GABA - Focus on GABA-β Receptors
  13. 13 Canadian Society of Intestinal Research: Irritable Bowel Syndrome (IBS) and Serotonin
  14. 14 Schizophrenia Bulletin: Altered Cortical Expression of GABA-Related Genes in Schizophrenia - Illness Progression vs Developmental Disturbance

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