Bio: Associate Professor Shaun Greene is a clinical toxicologist and emergency physician based in Melbourne, Australia. Shaun is the lead investigator of the Emerging Drugs Network of Australia Victoria (EDMAV) illicit drug research project. EDNAV has performed advanced toxicological analysis of biological samples from over 4000 acute illicit drug presentations to hospital emergency departments.

Abstract: Gamma-hydroxybutyrate (GHB) is GABA receptor agonist. GHB is a common drug of misuse in numerous jurisdictions. Desired clinical effects include relaxation and euphoria. GHB is a common intoxicant in polysubstance illicit drug presentations that require intensive care unit management. Toxicity includes profound central nervous system depression, bradycardia and hypothermia. GHB is administered orally in its parent form, and as the precursors 1,4-butandiol (1,4-BD) and gamma-butyrolactone (GBL). Pharmacokinetic differences between GHB and GHB precursors, particularly in regard absorption and metabolism, give rise to differences in clinical toxicity. Additionally, co-ingestion of ethanol alters ph1,4-BD metabolism and the pattern of GHB toxicity. The widespread use of GHB precursors within industry limits the use of regulation as a mechanism to reduce availability and limit GHB-related harm. Recently, comprehensive toxicological analysis combined with prospective collection of clinical data obtained from acute illicit drug presentations has provided new insights into the pharmacological and clinical characteristics of GHB intoxication.