What is butanediol

Analysis of these liquid samples demonstrated that 85 No samples were found to contain 1,4BD. In addition none of the non-liquid seizures were found to contain GHB powder. In this study, we have demonstrated that the majority of patients presenting to our inner-city hospital emergency department with suspected gamma-hydroxybutyrate GHB , gamma-butyrolactone GBL or 1,4-butanediol 1,4BD toxicity, self-report ingestion of GHB rather than its two precursors GBL and 1,4BD.

However, analysis of drugs seized from people attending the same club venues in our catchment area, show that there is significantly more GBL than GHB being seized. There were no self-reports of 1,4BD ingestion and no 1,4BD seizures in this study. Patients who presented to the hospital in our study had very similar clinical presentations and outcomes to those reported in other large case series from the USA, Spain and Switzerland.

Similar to our findings, lone ingestion of GHB was seen in the minority of cases. Both GHB and its precursors have a steep dose—response curve, with rapid onset of symptoms, and previous studies appear to suggest that there is no difference between the clinical effects of GHB or its precursors.

One limitation of our study is that the time periods of data collection for the seized drugs analysis and the clinical cases were not identical, however the peak frequency of presentation for the clinical cases was during the overlapping time period.

There was insufficient information available on whether there is a difference between doses ingested, in terms of amount and number, between users of GHB and GBL who present to the ED with toxicity.

It is our clinical impression that many individual users do not differentiate between GHB and GBL when obtaining either one of them and, therefore, assume that they had ingested GHB when self-reporting what was ingested. Since then, the legal status of its precursors GBL and 1,4BD has remained unchanged and, therefore, it is legal to possess and supply both of these compounds.

This disparity in the legal status of GHB and its precursors, is similar to that in other countries such as Switzerland, Australia and New Zealand. It is difficult to determine whether the change in legal status of GHB has meant that previous users have shifted to using to either GBL or 1,4BD instead, which remain legal. First, and most important, there is currently no readily available toxicological test to differentiate between the presence of GHB, GBL or 1,4BD in patients presenting with self-reported ingestion of one of these drugs.

Therefore, all studies looking at use of GHB and its precursors are based on self-reported ingestions. Studies from Switzerland suggest that since the change in legislation GHB became a controlled substance in December , there has been an increase in the frequency of hospital presentations with self-reported GBL ingestion. There is a need for further work to determine whether GBL is associated with morbidity and mortality similar to GHB; one potential explanation of our finding is that the majority of club seizures are GBL, whereas the majority of ED presentations are self-reported GHB, is that GHB is associated with greater clinical toxicity.

Although there have been no studies directly comparing the two agents we do not feel that it is likely that this is the case, as GBL is rapidly converted to GHB after ingestion in equimolar ratios. It is possible that, with newer analytical techniques, more detailed studies would allow the identification of a potential metabolic product or by-product of GBL that would allow differentiation of GBL and GHB ingestion.

This would allow further studies to be undertaken to differentiate analytically between patients presenting with poisoning with GHB or its chemical precursors and therefore confirm the findings in our study that are based on self-reported ingestion.

As there are no realistic alternatives to either of them available for these current uses, there has been resistance to the reclassification of the precursors under the Misuse of Drugs Act In addition to misdirected imported supplies, users may either obtain the precursors from products freely available on sale in the UK, which contain them, or directly from suppliers overseas and import them in small quantities to circumvent the current voluntary legislation.

Confirmation that GBL and 1,4BD possess a similar adverse effect profile to GHB, and findings from this study demonstrating that GBL is abused as a recreational drug together with the possibility that 1,4BD is used recreationally , strongly suggests that current UK legislation is unlikely to be effective in significantly reducing morbidity and mortality associated with these substances. Mr Christopher Bishop for assistance with the database searches undertaken and Miss Jenny Button for assistance with the analysis of the seized compounds from the clubs.

Conflict of interest : D. Google Scholar. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Wood , D. George's, University of London and 10 Guy's and St. Thomas' Poisons Unit, Guy's and St.

Oxford Academic. Revision received:. Cite Cite D. Select Format Select format. The agency now considers BD to be an unapproved new drug and says it has conducted seizures to prevent sales of the substance to consumers. Nonetheless, "extensive marking continues on the Internet, and the use has increased," the researchers wrote in their study, one of the few formal efforts to examine this substance.

Smith of the Hennepin County Medical Center. We'll notify you here with news about. Turn on desktop notifications for breaking stories about interest? Comments 0.

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