Gamma-hydroxybutyrate (GHB) is a naturally occurring short-chained fatty acid produced endogenously within the mammalian brain. This drug has found legal uses as an anesthetic agent and in the treatment of narcolepsy. GHB has been used for alcohol withdrawal syndrome and long term treatment of alcohol addiction. In Italy this drug can be used for the treatment of alcoholism under the supervision of a physician. Research into the nature of these interactions is incomplete and often contradictory. There is evidence that the mechanism in which the 2 drugs interact may be synergistic in nature, such that, when low doses of GHB and alcohol are combined, the resulting effects of the drug combination are markedly greater than the predicted effects based upon each drug administered alone.a patient under long-term treatment with GHB for alcohol addiction who was found dead for choking. The toxicological analysis showed a blood alcohol concentration of 2.6 g/L indicating a condition of acute intoxication and GHB concentration in peripheral blood as 9.85 μg/ml. We show autopsy and toxicological data and briefly discuss the possible pathophysiological mechanisms underlying the interaction.