Risk assessment of gamma-hydroxybutyric acid (GHB) in the Netherlands

The Dutch Minister of Health requested the Coordination point Assessment and Monitoring new drugs (CAM) to re-assess the overall risk of GHB. The present paper is a extended redraft of a state of art report used in the risk evaluation procedure. The prevalence of GHB use is low, but the relative proportion of GHB intoxications compared to other illicit drugs is high resulting in a substantial number of GHB related incidents. In recent years the number of GHB intoxications has increased because many inexperienced users seemed unaware of the potential adverse effects, like 'passing out' upon overdosing, a condition where the user is unconsciousness (or comatose) for several hours. The dependence potential of frequent GHB use is now judged by the CAM to be rather high, but users appear not well informed about this risk. In the Netherlands, last month prevalence of GHB use is relatively low (0.2%) and treatment demand is limited (524 of a total of 76,295 referrals to the addiction treatment services in 2010). So far, no public nuisance or criminality associated with GHB use has been reported. The CAM estimated the overall risk potential of GHB use as moderate to high. The Dutch Minister of Health endorsed this conclusion and decided to upgrade GHB to Schedule I (hard drugs) of the Dutch Opium Act.