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Recreational drug poisoning with gamma-butyrolactone and 1,4-butanediol in Taiwan

1 Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung; Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
3 Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
4 Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center; Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan

Correspondence Address:
Cheng-Hsuan Ho,
No. 325, Sec. 2, Cheng-Kung Road, Taipei, Taiwan. Tel: (02) 87923311 ext. 12755; Fax: (02) 66008289
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmedsci.jmedsci_138_22

Restriction of gamma-hydroxybutyrate (GHB) in 1990 resulted in a shift toward the use of gamma-butyrolactone (GBL) or 1,4-butanediol (1,4-BD), which remain unregulated in most countries, including Taiwan. Self-reported GBL and 1,4-BD use are less common than GHB use, and the prevalence of GBL or 1,4-BD abuse may be underestimated. The first patient, a 45-year-old male, used GBL to enhance his sexual activity. He developed respiratory system and central nervous system (CNS) suppression; he was intubated and admitted to the intensive care unit. His urine GHB concentration was 289.5 mg/L. The second patient was a 24-year-old male who used 1,4-BD in conjunction with mixed new psychoactive substances to enhance his sexual activity. He also developed CNS suppression, and his urine GHB concentration was 1192.4 mg/L. By reporting these cases, we highlight the recreational use of GHB precursors, such as GBL and 1,4-BD, which is relatively unfamiliar to clinicians. Patients may present with CNS and respiratory depression after the voluntary recreational use of these drugs.


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