From GHB

Figure 4.2 The number of emergency room cases resulting from GHB use has increased significantly since the early 1990s. As can be seen on this graph, the number of emergency room reports more than doubled in the course of two years (1998 and 2000). Although fewer cases were reported in 2001 than 2000, GHB use is still a problem.

The number of deaths from GHB overdoses in the United States has been relatively small, amounting to fewer than 75 between 1994 and 2003. During the same period, trends in emergency room cases attributed to GHB overdose have varied from a low of 56 in 1994 to a high of 4,969 in 2000. In the two most recent years for which data were available, the number of such cases had dropped to 3,340 in 2001 and 3,330 in 2002. 

GHB (gamma hydroxybutyrate) was originally developed as an anesthetic, but was withdrawn due to unwanted side effects. GHB holds several U.S. patents for use in the treatment of sleep disorders such as narcolepsy and insomnia, and as a muscle relaxant. GHB is used as a fast-acting anesthetic in small animals. The compounds and compositions made from GHB are useful in the treatment of Parkinson s disease, schizophrenia, and other dopamine-related disorders. 

More people are overdosing on GHB than ecstasy. In 2000, 2,482 GHB users visited the emergency room for an overdose, compared with 1,742 ecstasy users. There also are more deaths from GHB. According to the DEA, 73 people have died from taking GHB since 1995, compared to 27 ecstasy-related deaths from 1994 to 1998. 

GHB and related products are popular with high school and college students. More than 60% of GHB abusers are between the ages of 18 and 25 years. Of the 72 individuals known to have died from GHB since 1995, 40% were between the ages of 15 and 24 years, and 27% were between the ages of 25 and 29 years. According to DAWN statistics, 60% of GHB-related emergency room visits are in patients age 25 and under. 

Figure 3.2 This graph indicates the alarming increase in emergency room visits due to overdoses of GHB. The number of visits resulting from GHB usage more than doubled between 1998 and 2000.

Taken for recreational use as an intoxicant, typical acute effects described by misusers are euphoria, relaxation, and increased sexuality (Galloway et al. 1997 Miotto et al. 2001). On the street, GHB is taken in capfuls or teaspoons of a salty/sour liquid, which because of variations in concentration, may range in dose from 0.5 to 5.0 g. Common side effects are nausea, headache, itching, and vomiting (Borgen et al. 2003). Doses of 10—20 mg/kg of GHB typically... 

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

Although the evidence base for this relatively rare disorder is not well developed, patients who are dependent on GHB appear to benefit from cognitive and motivational psychosocial therapies and from support of recovery in a manner similar to alcohol-dependent patients. However, because of the high likelihood of amnesia and cognitive dysfunction during the acute and subacute phases of GHB withdrawal, psychosocial interventions should, when possible, include significant others who can review and reinforce with the patient the negative consequences of GHB dependence. 

Other drugs, like GHB and Rohypnol , can interact directly with the neurotransmitter receptors to either enhance or block the effects of the brain s own neurotransmitters. Still other drugs can alter the metabolic breakdown or clearance of certain neurotransmitters after they are released from the synaptic terminal, thereby altering how long the neurotransmitter affects the activity of other nearby neurons. 

GHB, short for its chemical name gamma hydroxybutyrate, is a potent sedative and a depressant of the central nervous system. GHB was first synthesized in the 1920s, although it was not specifically designed to mimic another existing drug. In the 1960s, GHB was developed for possible use as an anesthetic. However, the makers of GHB later withdrew it from consideration for approval by the U.S. FDA because of severe side effects reported by patients. 

GHB powder easily dissolves in water or alcohol, and GHB is usually in this liquid form when it is distributed to the user. A standard dose of GHB costs anywhere from 5- 25. The liquid has a salty taste, much like baking soda, thus its nickname salty water. The presence of chemicals other than GHB itself causes the taste to become very bitter and... 

GHB has also been reported to have other medical benefits, such as a sleep aid for people suffering from temporary insomnia and for treating alcohol withdrawal and alcoholism. However, the risks and dangers of taking GHB, especially in combination with alcohol, have prohibited the FDA from approving its use for conditions other than narcolepsy. 

GHB is eliminated rapidly from the body, so in the binge GHB user, symptoms of withdrawal may begin within a few hours of the last dose. Despite being eliminated from the body quickly, the withdrawal symptoms may persist for weeks or months. 

Figure 7.3 Gamma-hydroxybutyrate (GHB) is manufactured in illicit home laboratories. The chemicals above were confiscated from a GHB lab in Germany.

Chloral hydrate, glutethimide, and methaqualone also produce a depressant effect. Chloral hydrate is dangerous to use as an anesthetic, but it has been used to treat persons undergoing withdrawal from heroin, GHB, and alcohol. A mixture of chloral hydrate and alcohol is termed a Mickey Finn and has been used as a date rape drug. 

GHB can be formed from GABA and is found naturally in human tissues. In non-GHB users, however, GHB is usually not detected in blood or urine samples. Also, since GHB appears to form in blood postmortem, a finding of GHB is not indicative of use unless there is evidence of oral intake. Because of its short half-life, GHB is not found in blood 8 hours after use or in urine after 24 hours. However, lack of GHB after these intervals is not indicative that GHB was not used in an alleged rape. There are many reports of GHB being involved in overdoses, motor vehicle accidents, and deaths. 

Abbreviations FDA, Food and Drug Administration GBL, gamma-butyrolactone GHB, gamma-hydroxybutyrate. Source From Ref. 52. 

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