Verve and jolt: Deadly new Internet drugs

As regulatory agencies have increased restrictions on the sale and marketin g of gamma-hydroxybutyrate (GHB), they have been frustrated by the appearan ce of precursor molecules such as gamma-butyrolactone (GBL) that have becom e widely available over the Internet. These dangerous precursors are vigoro usly marketed to adolescents and young adults as dietary supplements that i ncrease muscle mass and enhance sexual performance with seductive names suc h as Verve and Jolt, both easily recognizable teen icons. We present the ca se of an adolescent who ingested both of these GBL products 2 weeks apart, resulting in life-threatening respiratory depression and emergent intubatio n on both occasions. The GBL toxidrome, necessary acute interventions, and public health implications are reviewed. We urge all health care providers to report similar cases immediately to the FDA MedWatch system.