Pharmaceutical GHB Titration for Detoxification in Patients With GHB/GBL Use Disorder: A Retrospective Cohort Study

Objectives: Gamma-hydroxybutyric acid (GHB) is a highly addictive substance with a narrow therapeutic window. Detoxification using benzodiazepines carries a high risk of complications including respiratory depression. This retrospective cohort study describes one of the largest cohorts of patients with GHB use disorder to date and evaluates a detoxification protocol for GHB/gamma-butyrolactone (GBL) withdrawal using pharmaceutical GHB titration. Methods: Patient records between 2019 and 2025 from a psychiatric addiction ward in Berlin, Germany, serving a defined urban catchment area were reviewed, and data were extracted manually using a predefined template. Elective and acute admissions were included. Primary outcomes were defined a priori: intensive care unit (ICU) transfer during detoxification, discharge type (completion vs. premature discharge), and the occurrence of withdrawal-related complications. Sociodemographic and clinical characteristics were also extracted. Results: Among 87 cases (50 individuals) treated over 6 years, 72% were male and the mean age was 33±8 years. 68% of patients had completed a higher education, 30% were employed. Fifty-four percent reported same-sex sexual activity. Concomitant regular substance use, particularly amphetamine use (76%), was prevalent. ICU transfer occurred in 4.6% of cases, delirium in 8.1%, and 60.9% of cases completed treatment as planned. Conclusions: Detoxification of GHB/GBL-using pharmaceutical GHB titration appeared feasible and safe in this naturalistic cohort with low rates of ICU transfer and delirium that are consistent with prior reports. The retrospective design precludes inferences, prospective studies are needed to confirm advantages over benzodiazepine-based detoxification.