If someone cannot be woken after GHB or GBL, call 112 (999 in the UK, 911 in the US) and stay with them. An unconscious person is in danger even when they seem to be sleeping: the tongue can block the airway, and they can choke on vomit or stop breathing. The steps below follow the order of the decision tree.
In short. Try to wake them. Not waking: call 112. Not breathing normally: start CPR with the operator's help. Breathing normally: recovery position and keep watching. Never leave them alone.
Out is not asleep
Regular users sometimes call it a "G-nap". The Nationale Drug Monitor is clear that people in that state are unconscious, and that this can lead to brain damage, choking on the tongue or vomit, or breathing that stops (Nationale Drug Monitor). Trimbos describes going out as a coma-like sleep from which the person cannot be woken, which leaves them very vulnerable (DRUGSinfo, going out).
Signs that someone is going under or is already out:
- they do not respond when you say their name loudly or tap their shoulders
- breathing is slow, irregular, noisy or gasping
- they vomit while drowsy
- twitching or jerking of the arms, legs or face, or a seizure
- they feel cold; a low body temperature was one of the most common findings in serious GHB cases in Dutch emergency data (Monitor Drugsincidenten 2024)
- blue lips or fingertips
Not breathing normally: call and start CPR
Check breathing for no more than 10 seconds: tilt the head back, lift the chin, look at the chest, listen and feel for breath on your cheek. St John Ambulance warns that slow, noisy gasps in someone who does not respond are no normal breathing (St John Ambulance, primary survey).
- Call 112, or 999 in the UK. Say that the person is unresponsive and not breathing normally.
- Put the phone on speaker and follow the operator, who can talk you through chest compressions.
- Keep going until the ambulance crew takes over. If there is a defibrillator (AED) nearby, send someone to get it.
Breathing but not waking: call and use the recovery position
Someone who breathes normally but cannot be woken still needs an ambulance. Call 112 first, or let someone else call while you start. Then turn them into the recovery position, which keeps the airway open and lets vomit drain away (St John Ambulance, recovery position):
- Kneel next to them and straighten their legs. Take off glasses and remove bulky things from their pockets.
- Place the arm nearest to you at a right angle to the body, elbow bent, palm up.
- Bring the other arm across the chest and hold the back of their hand against the cheek nearest to you.
- With your other hand, pull the far knee up until the foot is flat on the floor.
- Pull on that knee to roll them towards you onto their side. Bend the top leg at a right angle.
- Tilt the head back gently and lift the chin so the airway stays open.
- Keep checking their breathing until help arrives. If it stops or turns into gasping, call back and start CPR.
Keep them warm with a coat or blanket, especially outdoors or in wet clothes. Trimbos' first-aid advice for GHB names the same steps: clear the airway, lay the person on their side and call 112 straight away (Drugs & Uitgaan, first aid).
Awake but drowsy or confused
Someone who responds can still drift off again, especially if more was taken or alcohol is involved. Trimbos points out that a person coming round can feel sick and vomit before they are awake enough to turn onto their side.
- Stay with them. FRANK says: do not leave them alone, even for a moment (FRANK, emergencies).
- Keep them on their side or sitting up, never flat on their back.
- Call 112 if they cannot be woken, if their breathing changes, if they have a fit or if you are in doubt.
- Give them nothing: no alcohol, no other drugs and no more GHB.
- Someone stays awake next to them. A person who seems fine at midnight can be out at one.
Waking up can be rough
People often come out of a GHB coma quite suddenly. A clinical study describes patients who stayed deeply unconscious for a long time and then woke up within about half an hour (Van Sassenbroeck et al. 2007). Some wake confused or agitated and may lash out (Busardò and Jones 2015). Speak calmly, keep space around them and let the ambulance crew take over.
What does not help
- Coffee, a cold shower or a cold bath. FRANK and the NHS both advise against them; cold water adds the risk of getting too cold, falling or losing consciousness in the water (NHS, alcohol poisoning).
- Waiting to see whether it passes. There is no antidote for GHB; what keeps someone safe is an open airway, watching their breathing and medical care.
What to tell the ambulance crew
Tell them what was taken, when, and whether alcohol or other drugs were involved. FRANK advises to give any leftover drugs to the crew because it helps them; a bottle helps too.
In the Netherlands, Trimbos notes that you can get help without legal consequences for the user, because using GHB is no offence under Dutch law (Drugs & Uitgaan). Possession is a separate matter. In the UK, FRANK says that in most cases ambulance staff will not tell the police. In all cases, the person's life comes first.
Before next time
Three things make going out more likely, according to the sources on what GHB is: a liquid of unknown strength, more taken on top of the first amount, and a mix with alcohol or other downers. A reagent test shows whether GHB is probably in a bottle; it cannot show how strong it is. Read what a test can tell.
