成瘾研究与治疗杂志

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Evidence for Elevated Endogenous Urinary Gamma-Hydroxybutyric Acid Levels: Two Case Reports

Horacio A Capote, Laura Pyzikiewicz, Chukwunonso C Ilogu, Emma Blackley and Luke Martinic

Gamma-hydroxybutyric Acid (GHB) is a naturally occurring metabolite of the inhibitory neurotransmitter, gamma-aminobutyric acid (GABA) that is found in every human cell. Exogenously synthesized in 1960 for possible use as a surgical anaesthetic, GHB exhibits a weak analgesic effect and the potential for seizure-like activity. Since its brief use as an anaesthetic, GHB has been abused as an illicit drug for its euphoric, sedative, and anabolic effects. GHB is now a popular drug-facilitated sexual assault (DFSA) drug, or a “date rape” drug, due to its colourless, odourless, and tasteless properties. Various street names include “G,” “Georgia home boy,” “liquid ecstasy,” “scoop,” and “soap.” Due to GHB’s recreational popularity, the metabolite is now included in the urine toxicology panels of patients undergoing rehabilitation for drug and alcohol addiction. However, exogenous GHB is indistinguishable from naturally produced GHB, which is an important factor to consider when evaluating the urine toxicology panels of patients. Two recent cases exist regarding patients undergoing outpatient rehabilitation who have tested positive for urinary GHB while denying any substance use. The subjects tested positive according to currently accepted cut-off levels on gas chromatography/mass spectrometry analysis (GC-MS) from a purely analytical perspective. From a forensic and indeed clinical perspective, it was found that the subjects had not used GHB. It can be said that these were false positives. Positive urine tests for GHB not only hinder the rehabilitative process, but can also put a patient’s employment status in jeopardy, and may result in legal implications as well. Providers, as well as their patients, depend on the most up-to-date clinical data to render appropriate treatment and to protect against unnecessary repercussions. Therefore, the cut-off level of urinary GHB, as well as any factors that may affect increased endogenous production, must be thoroughly examined in order to facilitate accurate identification of drug abusers and to avoid false positives.