GHB and cases of rape

The drug-facilitated rape is defined as a sexual assault made easier by the offender's use of an anesthetic-type drug that renders the victim physically incapacitated or helpless and unable to consent to sexual activity.

According to several researches, GHB is the most common substance used in drug-facilitated sexual assaults because it can mentally and physically paralyze an individual. Victims may not seek help until days after the assault, in part because the drug impairs their memory and in part because they may not identify signs of sexual assault. Even when they do seek help, GHB is only detectable in the system for a limited amount of time and the opportunity to detect the drug can quickly pass. 

Dangers of usage

• Mixing GHB with alcohol is extremely dangerous and has caused many deaths due to respiratory failure.
• Passing out on GHB by itself is also dangerous and potentially life-threatening.
• Driving a car while on GHB could be extremely dangerous! It is proven that only one dose can impair motor coordination by as much as six drinks of alcohol. 
• Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms.
• GHB is illegal and possession can result in long prison terms.

Withdrawal from GHB

Patients with a history of around-the-clock use of GHB (every 2 to 4 hours) exhibit withdrawal symptoms including:

• anxiety,
• insomnia,
• tremors,
• episodes of tachycardia
• delirium
• agitation

Because GHB has a short duration of action and quickly leaves the user's system, withdrawal symptoms may occur within 1 to 6 hours of the last dose. These symptoms may last for many months.

Other signs and symptoms of acute GHB abstinence syndrome may include

• Anorexia, abdominal cramps
• Nightmares
• Impaired concentration, memory, and judgment
• Increased sensitivity to sounds and tactile sensations
• Delusions
• Tonic-clonic activity (it is unclear if actual seizures occur during GHB withdrawal)
• Elevated temperature
• Dehydration

Therapy of GHB dependence

Benzodiazepines
Benzodiazepines such as Lorazepam (Ativan®, Temesta®), chlordiazepoxide (Librium®, Mitran®, Poxi®), and diazepam (Valium®, T-Quil®), are useful in relieving some of the signs and symptoms of GHB withdrawal.
Big doses of oral or intravenous benzodiazepines do not decrease the likelihood of withdrawal delirium, but are important for controlling psychotic agitation. The big problem is that most patients in GHB withdrawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal. Such large benzodiazepine doses require close medical attention and the application of continuous pulse oximetry to monitor for oxygen desaturation. 
 
Barbiturates
Barbiturates in combination with benzodiazepines have been used successfully to improve withdrawal symptoms. Pentobarbital, a short acting barbiturate, can be titrated intravenously in 100-200 mg increments to symptoms.
 
Sedating Agents
Propofol is an anesthetic agent used for sedation which has been reported to provide relief for the psychotic agitation in patients with severe GHB withdrawal symptoms.
 
Antihypertensive Medications
It is not uncommon for patients to request medications such as beta-blockers for the treatment of minor autonomic hyperactivity such as elevated heart rate, elevation of blood pressure, sweating, tremor, or panic attacks. Beta-blockers used to control vital sign abnormalities via peripheral beta-blockade, without central nervous system sedation, may be detrimental.
 
Haloperidol and Other Antipsychotic medications
Clinicians have reported using large doses of antipsychotic medication in an attempt to control GHB withdrawal psychosis and they provided limited control of symptoms. Neuroleptics may also increase the risk of neuroleptics malignant syndrome and malignant hyperthermia.