Wednesday, 24th May 2017

Research Articles

Gamma Hydroxy Butyrate Usage, Effects and UK Prices

 

Gamma hydroxy butyrate (GHB) usually appears as an odorless, colorless, tasteless liquid - in proprietary form as a 20% solution, but can also be found as a powder, or capsule. GHB is a neurotransmitter which occurs naturally at low concentrations in mammalian brains acting as a central nervous system depressant.

GHB was originally described as an anaesthetic and widely-used in Italy, particularly for obstetric operations, maxillofacial or laryngial surgery Lane considered GHB to be a "valuable and safe paediatric anaesthetic". However, GHB is not currently licenced for medical use in the UK.

Recreational use of GHB has become popular among clubbers and as a dietary supplement by bodybuilders, it has also been cited as a "date-rape" drug. GHB is not currently controlled under ths Misuse of Drugs Act, the Advisory Council on the Misuse of Drugs has not recommended inclusion under the Act despite having considered the issue on three separate occasions, leaving control of manufacture and supply in the hands of the Medicines Control Agency.

 

Recreational GHB use in the UK - IDMU survey results.

Each year since 1997, IDMU conducts surveys of over 1000 drug users monitoring consumption patterns and prices, using anonymous questionnaires distributed at pop festivals and similar large events. GHB was added to the list of named drugs in 1999, as it had been one of the more commonly-reported "other" (write-in) drugs during previous years. However, less than 3% of all drug users in our surveys conducted during 1999 and 2000 (2173 + 2352 = 4525 total respondents) admitted ever having used GHB.

The maximum quantity used was 250ml per month in 1999, and 500ml per month in 2000, with average spending of £21 in 1999 and £8 in 2000. However as both surveys involved only small samples of current GHB users, the levels of use reported may not be representative of usage patterns among other GHB users. Internet resources warn of the addictive qualities of GHB.

 

Frequency of GHB Use

Frequency of Use

Count

% of GHB Users

% of Total

Experimental

69

52%

1.52%

Occasional

16

12%

0.35%

Regular

3

2%

0.07%

Daily

1

1%

0.02%

Ex-users

43

33%

0.95%

Total Used

132

100%

2.92%

Sample size

4525

100%

 

The vast majority of those who had used GHB had done so experimentally or had stopped using the drug. Fifteen individuals stated they continued to use occasionally or more often, three on a regular and one on a daily basis. The drug was not popular among users as a whole, with a low subjective rating (2.45 on a scale of 0 to 10).

GHB is not normally a drug used by naive drug users, most users will have tried many other drugs before experimenting with GHB, the peak ages of initiation falling in young adulthood.

 

GHB

 

The relatively wide spread of initiation ages is consistent with the relatively recent arrival of GHB on the club-scene. Very few individuals had used the drug prior to 1993.

Fig 2

 

ghb

 

Effects of GHB

At low doses, GHB encourages a reduction of social inhibitions, similar to alcohol, euphoria, and increased libido. Higher doses lead to feelings of sedation, and can cause symptoms including vomiting, drowsiness, dizziness, vertigo, and seizures. After excessive use, some users have experienced loss of consciousness, irregular and depressed respiration, tremors, or coma. Cole reported intravenous dosages of 60-70mg/kg to be sufficient to induce anaesthesia in healthy patients, whereas up to 200mg/kg are needed in laboratory animals. Greenblatt reported "GHB is being marketed in England as an anti-aging medicine which allegedly increases the libido, decreases body fat, aids alcohol withdrawal, and induces sleep." Gallimberti reported therapeutic uses for the treatment of alcohol withdrawal.

A number of deaths have been attributed to recreational GHB use. A total of 69 poisonings and one death were reported in New York & Texas by the Centre for Disease Control (CDC). One 17 year old girl who died of cardiac arrest was found to have 27mg/l of GHB in her blood. "Of the 56 reports from the poison control centers, 34 involved males; 10 reports involved teenagers aged 16-18 years. Nineteen persons were treated in and re-leased from hospital EDs, and 25 were admitted to intensive-care units with severe clinical symptoms, including coma (15), respiratory depression (three), and agitation (one); six required intubation. Of the 56 reports, 12 included ingestion of both alcohol and GHB, and three included the use of GHB with other drugs." They also warned of the dangers of illicit GHB preparations "Improper preparation of GHB can result in a mixture of GHB and sodium hydroxide that can be severely toxic because of the combined effects of the GHB and the direct caustic effects of sodium hydroxide."

Vayer et al reported the symptoms of acute GHB toxicity to include "coma, seizures, respiratory depression, and vomiting... amnesia and hypotonia (associated with doses of 10 mg/kg body weight); a normal sequence of rapid eye movement (REM) and non-REM sleep (doses of 20-30 mg/kg body weight); and anesthesia (doses of approximately 50 mg/kg body weight). Doses of >50 mg/kg body weight can decrease cardiac output and produce severe respiratory depression, seizure-like activity, and coma." A Hungarian paper reported respiratory paralysis, whereas Miglani et al reported a case of GHB withdrawal delirium.