Gamma-Butyrolactone (GBL) is a recreational drug, whose use has increased in recent years. However, it is highly addictive and when consumed in excessive amounts, physical and psychological dependence can develop.

High profile deaths, including the death of a young medical student, have increased the public's awareness of GBL. However, in spite of this and a change in UK law (2009) to make the once legal high a class C drug, the number of patients presenting to emergency departments with GBL overdose has continued to rise. There is significant anxiety amongst professionals working in acute medicine and psychiatry when it comes to managing these difficult presentations, which combine symptoms of a frightening psychosis with marked physical compromise, which can ultimately lead to coma and death. There is also a lack of medical literature concerning GBL.

To discuss a case that presented at Chelsea and Westminster Hospital, highlighting:

1. The signs and symptoms of GBL intoxication and withdrawal.

2. The importance of managing the psychosis alongside the physical symptoms.

3. Where these patients should be managed.

24-year-old patient, brought to A+E after police received reports about a gentleman in an underground station exhibiting ‘erratic, unusual behaviour’.

This case highlights the need for an integrated approach to the management of substance misuse in acute hospital settings. GBL is a substance that most practising doctors have not been taught about. Education on the topic, and other emerging recreational drugs, should be an important part of our continuing professional development.