Fact Sheet 1 – GHB Triage: “Deep Sleep” and Possible Emergencies

Objective
Help the clinician (and, indirectly, peer supporters / relatives) to distinguish between:

• a situation to be monitored closely

• and an emergency to be referred immediately (call 15 / 112)

• when GHB/GBL is involved (voluntary use or possible chemical submission).

• When to use it?

  • Consultation where the person reports:

  • Discussions with:

    • peer supporters, community group teams (CAARUD, festive associations, etc.)

    • worried relatives of someone who uses or has used GHB/GBL

  • Indicative duration of use: 3–5 minutes.

• Content of the sheet

  • 5 key questions to ask (breathing, rousability, vomiting, context, mixtures).

  • Warning signs that should warrant a call to 15/112.

  • Reminder of basic actions : recovery position, do not induce vomiting, stay with the person.

  • Possible formulations to explain these reference points to the patient.

The 5 key questions to ask

Objective: understand immediate severity + context.

1. Breathing

   • “When the person is asleep or 'unconscious', how is their breathing? Normal? Very slow, very irregular? Do they have long pauses, or unusually loud snoring?”

2. Rousability

   • “When you stimulate them strongly (speak loudly, shake the shoulder), do they open their eyes, talk, defend themselves? or do they barely react?”

3. Vomiting / risk of choking

   • “Have they vomited? Are they lying on their back with vomit in their mouth, or are they coughing / seem to be choking?”

4. Context and quantity

   • “How many doses of GHB/GBL, over what period of time? Is this a habit, or rather recent / after a long break? Medical history (heart, breathing, epilepsy)?”

5. Mixture of substances

   • “Was there also alcohol, benzos (Valium®, Xanax®…), opioids (methadone, heroin, tramadol, codeine…) or other drugs?”

Warning signs = call 15 / 112

Call 15 (SAMU) or 112 immediately if:

1. Consciousness / rousability

   • Does not react to a loud voice + vigorous shoulder stimulation.

   • Responses only consist of groans / weak movements, impossible to keep them awake.

   • Major confusion, incoherent speech that does not improve.

2. Breathing / color

   • Very slow breathing (≤ 8/min) or with long pauses. PMC+1

   • Noisy breathing, feeling that they are “choking” or “swallowing their tongue”.

   • Lips or face turning bluish or very pale.

3. Vomiting and position

   • Repeated vomiting + inability to sit or stand.

   • Person lying on their back, vomiting, and does not turn onto their side on their own.

4. Convulsions / trauma

   • Seizures (jerky movements, loss of consciousness). RACGP+1

   • Fall / blow to the head with loss of consciousness, even brief.

5. Other worrying factors

   • Significant mixtures with alcohol, benzos, opioids or other depressants. RACGP+1

   • Voluntary or uncertain overdose (“we don't know how much they took”).

   • Person alone, without the possibility of close supervision.

Simple rule: in case of doubt about the level of consciousness or breathing → call.

Reminder of basic actions

If the person is unconscious but breathing:

• Place them in the recovery position (lateral safety position) : on their side, head slightly tilted downwards, mouth clear. BNF

• Regularly check that they are breathing and that the chest rises.

• Remove anything that could obstruct breathing (tight scarf, closed collar…).

What NOT to do:

❌ Do not induce vomiting : risk of choking.

❌ Do not give anything to drink or eat until they are fully awake.

❌ Do not leave them alone, even “just for 5 minutes”.

❌ Avoid forcing them to walk, taking a cold shower, or “waking them up” using violent methods.

What is useful to do:

• Stay with the person, speak calmly, stimulate them gently.

• Note (if possible): time of the last dose, products consumed, known history.

• In a festive / community setting: inform the reference team, secure the environment (noise, crowd, risk of falling).

Possible formulations to explain these reference points to the patient / relatives

a) To explain the risk of GHB/GBL

• “G is not just about 'sleeping deeply'. At certain doses, it can put the brain as if on 'pause', with breathing that slows down too much. That is what can become dangerous.”

• “We are especially worried when we can no longer wake the person up or if they are breathing very slowly or strangely.”

b) To explain when to call 15 / 112

• “If one day you see someone on G who is barely waking up, or breathing very slowly, this is not something to monitor: you have to call 15 or 112 right away.”

• “You do not need to be sure it is serious to call. If you hesitate, you call, and you simply explain what you see.”

c) To reassure without downplaying

• “Most G comas resolve with time, but we cannot tell by eye which ones are going to cause a respiratory problem. Hence these simple reference points: waking, breathing, vomiting, seizures.”

d) To equip peer supporters / community teams

• “When in doubt, use your three questions: is he/she breathing well? can we wake him/her up? is he/she vomiting or risking choking? If one of these points worries you → you put them in the recovery position and you call 15/112.”