GHB overdose

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. 

Patients with ethanol or sedative-hypnotic overdose may be euphoric and rowdy ("drunk") or in a state of stupor or coma ("dead drunk"). Comatose patients often have depressed respiratory drive. Depression of protective airway reflexes may result in aspiration of gastric contents. Hypothermia may be present because of environmental exposure and depressed shivering. Ethanol blood levels greater than 300 mg/dL usually cause deep coma, but regular users are often tolerant to the effects of ethanol and may be ambulatory despite even higher levels. Patients with GHB overdose are often deeply comatose for 3-4 hours and then awaken fully in a matter of minutes. 

Users of GHB are warned that it should never, under any circumstances, be mixed with alcohol or other nervous system depressants. Combining even a low GHB dose with alcohol can trigger the overdose reaction and a state of unresponsive unconsciousness and depressed breathing. GHB has been linked to 70 deaths in the United States, most often attributed to its ingestion with alcohol. About a third of those deaths have been tied to GHB overdose alone. 

Other nervous system depressants that could trigger a GHB overdose reaction are benzodiazepines (mild tranquilizers such as Valium and Xanax), phenothiazines (potent tranquilizers like Thorazine and Stellazine), various painkillers (barbiturates and opiates), anticonvulsants (Dilantin and phenobarbital), and even many over-the-counter allergy and sleep remedies. 

The case was watched closely by authorities, and in response to public outcry over Samantha Reid s death, Congress banned the substance in April 2000. At the same time, President Clinton signed the Hillary J. Farias and Samantha Reid Date Rape Drug Prohibition Act into law. The law also commemorates Farias, a 17-year-old high-school senior from La Porte, Texas, who died from a GHB overdose after someone slipped it into her soda. 

There are no definitive numbers available on GHB abuse and overdoses, but various agencies have started tracking this information. The DEA reports more than 7,100 GHB overdoses and encounters with law enforcement between 1990 and 2001. Over that same time period, 65 GHB-related deaths, mainly from respiratory depression, have been documented. The Drug Abuse Warning Network (DAWN) listed 20 emergency room episodes in 1992, and the number of episodes has climbed steadily since then to 2,973 in 1999. That number leaped to 4,969 in 2000. 

GHB overdose is usually characterized by a strong drowsy feeling followed by a temporarily unrousable sleep (sometimes characterized as a type of coma or a blackout ) for one to four hours. During this blackout period, the user or victim is physically incapacitated or helpless, and is unable to consent to or reject sexual advances. Victims of GHB-facilitated rape may not seek help until days after a date rape incident, if at all, in part because the drug impairs memory, causing anterograde amnesia. 

With the increasing popularity of GHB as both a recreational and date rape drug, the number of overdoses seen in emergency rooms in the United States has also been rising. Reports of methods to treat GHB overdoses have been surfacing in scientific and medical literature. 

Respiratory support with oxygen may be required for respiratory depression associated with Rohypnol ingestion. A benzodiazepine antagonist can reverse respiratory depression and coma caused by overdose but is not routinely recommended because it can precipitate withdrawal symptoms and seizures. There is no antidote to GHB overdose. Ventilator respiratory support, seizure control, and supportive care may be required. Symptoms often resolve within 3-4 h. Abuse of both rohypnol and GHB can cause withdrawal symptoms. Long-term use of Rohypnol can cause seizures, tremors, and anxiety. Long-term abuse of GHB withdrawal can last from days to weeks. GHB withdrawal includes anxiety, tremors, disorientation, hallucinations, and insomnia. 

After Samantha Reid died of a GHB overdose, Congress passed the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000. Hillory Farias was another teenage girl who died after GHB was slipped into her drink. President Clinton signed the legislation on February 18,2000. 

III. Clinical presentation. Patients with acute GHB overdose commonly present... 

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