Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is unclear. The law and abuse
GHB was sold in health food stores as a performance enhancing booster until the Food and Drug Administration banned it in 1990. It is currently marketed in some European countries as an adjunct to anesthesia.
GHB is abused for its ability to produce euphoric and hallucinogenic states and for its alleged function as a growth hormone that releases agents to stimulate muscle growth.
Common street-names of GHB
Blue nitro
Cherry fX bombs
Cherry meth
Easy lay
Everclear
Firewater
Gamma G
Georgia homeboy
GHB
G.H. revitalizer
Gib
Goops
Great hormones at bedtime
Grievous bodily harm
G-riffick
Growth hormone booster
Insom-X
Invigorate
Lemon fX drops
Liquid ecstasy
Liquid E
Liquid X
Longevity
Natural sleep-500
Nature's quaalude
Orange fX rush
Organic quaalude
Oxy-sleep
Poor man's heroin
Remforce
Revivarant
Salty water
Scoop
Soap
Somatomax PM
Somsanit
Vita-G
Water
Wolfies
Zonked
Incidence
GHB is often ingested with alcohol by young adults and teens at nightclubs and parties. It is used as a pleasure enhancer that depresses the central nervous system and induces intoxication.
Several researches have shown that annual GHB use by secondary school students in 2000 ranged from
%26bull; 1.1% among 10th graders
%26bull; 1.2% among 8th graders
%26bull; 1.9% among 12th graders
In 2001, estimates of annual GHB use ranged from 1.0% among 10th graders to 1.1% among 8th graders and 1.6% among 12th graders.
Production of GHB
GHB can be easily manufactured. In the United States, GHB is produced in laboratories with no guarantee of quality or purity, making its effects less predictable and more difficult to diagnose.
Abusers have figured out that this drug can be manufactured with inexpensive ingredients and using recipes on the Internet. There are some substances such as Gamma butyrolactone (GBL) and 1,4-butanediol which represent the analogs of GHB and can be substituted for it. Once ingested, these analogs convert to GHB and produce the identical effects. The FDA has issued warnings for both GBL and 1,4-butanediol, stating that the drugs have a potential for abuse and are a public health danger.
Medical used of GHB
From the date it was synthesized it has been used as a general anesthetic, and a hypnotic in the treatment of insomnia. GHB has also been used to treat clinical depression, and improve athletic performance. Food and Drug Administration have permitted the use of GHB under the trade name Xyrem in patients with narcolepsy, a form of sleep disorder. GHB is also used in the treatment of alcoholism. It is used to treat both, acute alcohol withdrawal and medium to long term detoxification.
The use and effects of GHB
%26bull; The appearance
GHB is usually taken orally, and in most cases it is sold as a light-colored powder that easily dissolves in liquids. It can also be found as a pure liquid packaged in vials or small bottles. In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink.
%26bull; The costs
GHB is typically consumed by the capful or teaspoonful at a cost of $5 to $10 per dose.
%26bull; The effects
Several studies have shown that the average dose is 1 to 5 grams. In most cases it produces effects in 15 to 30 minutes and the effects last from 3 to 6 hours. It is proven that consumption of:
o Less than 1 gram of this drug produce relaxing effects, causing a loss of muscle tone and reduced inhibitions.
o 1 to 2 grams causes a strong feeling of relaxation and slows the heart rate and respiration.
o 2 to 4 grams, pronounced interference with motor and speech control occurs. A coma-like sleep may be induced, requiring intubation to wake the user.
When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory depression, unconsciousness, coma, and overdose.
%26bull; Side effects
Side effects associated with GHB may include:
o nausea,
o vomiting,
o delusions,
o depression,
o vertigo,
o hallucinations,
o seizures,
o respiratory distress,
o loss of consciousness,
o slowed heart rate,
o lowered blood pressure,
o amnesia,
o coma
Mechanism of GHB action
Experts are still researching the exact mechanism of GHB effects because they are still not fully understood. GHB clearly has at least two sites of action, stimulating the:
%26bull; GHB receptor
%26bull; The GABAB.
Some researches tried to prove that GHB is nothing more then a neurotransmitter, which in high concentrations can also reach to the GABAB receptor causing the sedative effects.
GHB and cases of rape
The drug-facilitated rape is defined as a sexual assault made easier by the offender's use of an anesthetic-type drug that renders the victim physically incapacitated or helpless and unable to consent to sexual activity.
According to several researches, GHB is the most common substance used in drug-facilitated sexual assaults because it can mentally and physically paralyze an individual. Victims may not seek help until days after the assault, in part because the drug impairs their memory and in part because they may not identify signs of sexual assault. Even when they do seek help, GHB is only detectable in the system for a limited amount of time and the opportunity to detect the drug can quickly pass.
Dangers of usage
%26bull; Mixing GHB with alcohol is extremely dangerous and has caused many deaths due to respiratory failure.
%26bull; Passing out on GHB by itself is also dangerous and potentially life-threatening.
%26bull; Driving a car while on GHB could be extremely dangerous! It is proven that only one dose can impair motor coordination by as much as six drinks of alcohol.
%26bull; Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms.
%26bull; GHB is illegal and possession can result in long prison terms.
Withdrawal from GHB
Patients with a history of around-the-clock use of GHB (every 2 to 4 hours) exhibit withdrawal symptoms including:
%26bull; anxiety,
%26bull; insomnia,
%26bull; tremors,
%26bull; episodes of tachycardia
%26bull; delirium
%26bull; agitation
Because GHB has a short duration of action and quickly leaves the user's system, withdrawal symptoms may occur within 1 to 6 hours of the last dose. These symptoms may last for many months.
Other signs and symptoms of acute GHB abstinence syndrome may include
%26bull; Anorexia, abdominal cramps
%26bull; Nightmares
%26bull; Impaired concentration, memory, and judgment
%26bull; Increased sensitivity to sounds and tactile sensations
%26bull; Delusions
%26bull; Tonic-clonic activity (it is unclear if actual seizures occur during GHB withdrawal)
%26bull; Elevated temperature
%26bull; Dehydration
Therapy of GHB dependence
Benzodiazepines
Benzodiazepines such as Lorazepam (Ativan%26reg;, Temesta%26reg;), chlordiazepoxide (Librium%26reg;, Mitran%26reg;, Poxi%26reg;), and diazepam (Valium%26reg;, T-Quil%26reg;), are useful in relieving some of the signs and symptoms of GHB withdrawal.
Big doses of oral or intravenous benzodiazepines do not decrease the likelihood of withdrawal delirium, but are important for controlling psychotic agitation. The big problem is that most patients in GHB withdrawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal. Such large benzodiazepine doses require close medical attention and the application of continuous pulse oximetry to monitor for oxygen desaturation.
Barbiturates
Barbiturates in combination with benzodiazepines have been used successfully to improve withdrawal symptoms. Pentobarbital, a short acting barbiturate, can be titrated intravenously in 100-200 mg increments to symptoms.
Sedating Agents
Propofol is an anesthetic agent used for sedation which has been reported to provide relief for the psychotic agitation in patients with severe GHB withdrawal symptoms.
Antihypertensive Medications
It is not uncommon for patients to request medications such as beta-blockers for the treatment of minor autonomic hyperactivity such as elevated heart rate, elevation of blood pressure, sweating, tremor, or panic attacks. Beta-blockers used to control vital sign abnormalities via peripheral beta-blockade, without central nervous system sedation, may be detrimental.
Haloperidol and Other Antipsychotic medications
Clinicians have reported using large doses of antipsychotic medication in an attempt to control GHB withdrawal psychosis and they provided limited control of symptoms. Neuroleptics may also increase the risk of neuroleptics malignant syndrome and malignant hyperthermia.
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