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| − | == Also known as ==
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| − | [[File:skull.jpg]]
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| − | Liquid Ecstasy, geebs, GBH, GHB, liquid ecstasy, liquid e, liquid X, blue nitro
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| − | == Classification ==
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| − | Depressant
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| − | == Overview ==
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| − | GHB (gammahydroxybutrate) and GBL (gammabutyrolactone), are closely related, dangerous drugs with similar sedative and anaesthetic effects.
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| − | GBL is converted to GHB shortly after entering the body. Both produce a feeling of euphoria and can reduce inhibitions and cause sleepiness.
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| − | But both can kill and are particularly dangerous when used with alcohol and other depressant or sedative substances.
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| − | When they are sold as drugs they are usually sold as an odourless, colourless, oily liquid in small bottles or capsules and they both taste slightly salty. A teaspoon or a capful is a normal dose although the strength of GHB varies so it can be very difficult for people to know how much they're taking, making it easy to overdose.
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| − | There is a form of GHB (called iGHB) that does come in powder form but is rare. Prices can vary from region to region, on average a 30ml plastic container of GHB costs about £15.
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| − | GHB has a medical use in the treatment of narcolepsy, while GBL has a legitimate use as a stain remover, rust remover, alloy cleaner, superglue remover and as a paint stripper <ref name="1a">'''GHB''', 2016, http://www.talktofrank.com/drug/ghb</ref>.
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| − | At room temperature GBL is a colourless, slightly oily liquid that is clear to semi-opaque. It has a distinctive taste that some users have described as being distinctly chemical, like a solvent, nail varnish or paint stripper <ref name="12a"/>.
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| − | GHB is a [[Terminology|CNS]] depressant used as intoxicant. It is a naturally occurring substance found in the human central nervous system, as well as in wine, beef, small citrus fruits, and in small amounts in almost all animals. GHB has been used in a medical setting as a general anaesthetic, to treat conditions such as insomnia, clinical depression, narcolepsy, and alcohol withdrawal, and to improve athletic performance <ref name="2a">'''GHB''', 2017, https://wiki.tripsit.me/wiki/GHB</ref>.
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| − | == What does it look like? ==
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| − | GBL is a liquid, available in some countries in the form of an industrial solvent for cleaning metal or removing spray paint from vandalised buildings <ref name="3a">'''GHB/GHL''', 2017, http://www.drugscience.org.uk/drugs/depressants/ghbgbl/</ref>.
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| − | GHB is a white crystalline powder. The powder is rarely sold on at street or club level. Instead the salt is mixed with water to produce a clear liquid - often sold in small platic bottles.
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| − | GHB can be easiliy manufactured from GBL which is typically sold in plastic bottles, sometimes labelled but often unmarked <ref name="4a">'''GHB (and GBL)''', 2017, http://www.release.org.uk/drugs/ghb-and-gbl</ref>.
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| − | == Source ==
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| − | GHB is mostly manufactured and distributed illicitly via mail order, unless manufactured pharmaceutically for the medical industry <ref name="5a">'''GHB''', 2014, http://www.dan247.org.uk/Drug_GHB.asp</ref>.
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| − | GHB is mostly manufactured and distributed illicitly. UK sources may originate in Europe or further afield. GBL is currently found in a number of products including stain and glue removers, and industrial solvents. Most of the GBL currently used in the UK is sold in this form.
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| − | GBL is a pro-drug and converts in the body to GHB. Alternatively it is converted to GHB by processing with Sodium Hydroxide. GBL is also present, in small quantities, in some food and drinks as a natural product. It is present, in low levels, in many wines <ref name="6a">'''GHB (Gamma HydroxyButyrate)''', 2016, http://www.kfx.org.uk/drug_facts/drug_facts_ghb.php</ref>.
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| − | == Prevalence ==
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| − | There is very little statistical evidence relating to the prevalence of GHB, GBL and 1,4-BD in the UK. The drugs do not feature in any of the major national surveys of recreational drug use, such as the British Crime Survey Drug Misuse Declared bulletin.
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| − | Anecdotal evidence suggests that use of the drugs is fairly widespread on the UK club scene, particularly in gay clubs, but have yet to become significant players among the general drug-taking population <ref name="7a">'''GHB/GBL''', 2016, http://www.drugwise.org.uk/ghb/</ref>.
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| − | == Street price ==
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| − | Widely variable; large bottles of GBL sell for around £40 for 250ml <ref name="6a"/>. Prices can vary from region to region, on average a 30ml plastic container of GHB costs about £15 <ref name="1a"/>.
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| − | == Why take it? ==
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| − | === Sought after effects ===
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| − | * uninhibited,
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| − | * mild euphoria,
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| − | * relaxed feeling,
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| − | * aids sleep,
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| − | * a supplement for body building <ref name="4a"/>.
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| − | === Undesired effects ===
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| − | * loss of body control - effects similar to alcohol which can last for several hours,
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| − | * feeling sick and being sick,
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| − | * numb muscle and disorientation,
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| − | * seizures and collapse,
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| − | * psychosis and severe agitation,
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| − | * tachycardia,
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| − | * delirium,
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| − | * auditory and visual hallucinations,
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| − | * paranoia <ref name="4a"/>,
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| − | * dizziness,
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| − | * short-term memory loss <ref name="5a"/>.
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| − | == How long do its effects last? ==
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| − | === Onset of effects ===
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| − | - oral - 10 - 30 minutes <ref name="8a">'''GHB''', 2017, https://psychonautwiki.org/wiki/GHB</ref>.
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| − | - all [[Terminology|ROA]]'s - 20 - 60 minutes <ref name="9a">'''GHB''', 2017, http://drugs.tripsit.me/ghb</ref>.
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| − |
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| − | === Peak ===
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| − | - oral - 45 - 90 minutes <ref name="8a"/>.
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| − | === Offset ===
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| − | - oral - 15 - 30 minutes <ref name="8a"/>.
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| − | === Duration of effects ===
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| − | - oral - 1.5 - 2.5 hours <ref name="8a"/>.
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| − | - all [[Terminology|ROA]]'s - 1.5 - 2.5 hours <ref name="9a"/>.
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| − | === After-effects ===
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| − | - oral - 2 - 4 hours <ref name="8a"/>.
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| − | - all [[Terminology|ROA]]'s - 2 - 4 hours <ref name="9a"/>.
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| − | == Pharmacology ==
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| − | GBL is not active in its own right; its mechanism of action stems from its identity as a prodrug of GHB.
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| − | It is rapidly converted into GHB by lactonase enzymes found in the blood. GBL is more lipophilic (fat soluble) than GHB, and so is absorbed faster and has higher bioavailability; the paradox is that this can mean that GBL has a faster onset of effects than GHB itself, even though it is a prodrug.
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| − | The levels of lactonase enzyme can vary between individuals, meaning that first-time users can show unpredictable results, even from small doses. In many this manifests as slow onset of effects, followed by headaches, semi-consciousness which is distinct from GBL sleep in normal users. If the user decides to try again at a later date, they appear to be able to enjoy the effects normally. Because of these pharmacokinetic differences, GBL tends to be more potent and faster-acting than GHB, but has a shorter duration; whereas the related compound 1,4-butanediol (1,4-B) tends to be slightly less potent, slower to take effect but longer-acting than GHB <ref name="10a">'''GBL''', 2016, https://psychonautwiki.org/wiki/GBL</ref>.
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| − | GHB has an interesting but still greatly undiscovered pharmacology. It was created with the intention to produce an analogue of (or a related compound to) the inhibitory neurotransmitter [[Terminology|GABA]] and thought to act via [[Terminology|GABA]] receptors (mainly GABAB). However, we now know that it stimulates its own distinct GHB receptor, that it is endogenously (naturally) present in the brain, and that GHB actually has a low affinity (ability to bind) for the [[Terminology|GABA]] receptors.
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| − | GHB also interacts with the dopaminergic system, and can alter levels of dopamine. In some areas of the brain, it increases, and in others it decreases the levels of dopamine. It is also though to act on serotonergic and opioidergic systems. Interestingly, naloxone and naltrexone has shown to reverse the effects GHB (and GBL) on dopamine release. Much of the research requires further investigation.
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| − | GBL is converted into GHB in the body. GBL is more lipophilic (mixes with fat/lipids easily) than GHB, and therefore is absorbed faster in the body than GHB. This means that, paradoxically, GBL can have a faster onset than GHB <ref name="4a"/>.
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| − | === Dopamine rebound ===
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| − | GHB will reduce dopamine levels in high amounts, but increase dopamine levels in the brain in low amounts <ref name="11a">Hechler, V. and Gobaille, S. and Bourguignon, J. J. and Maitre, M., '''Extracellular events induced by gamma-hydroxybutyrate in striatum: a microdialysis study''', ''Journal of Neurochemistry'', 1991, 56, 3, 938-944, https://www.ncbi.nlm.nih.gov/pubmed/1847191</ref>. This leads to what is known as dopamine rebound among users. Users can experience strong wakefullness about 4 hours after the last dose was consumed. This is often strong enough to wake the user up from sleep, and may be accompanied by a strong redose compulsion. The longer and higher the dose of GHB used, the more pronounced the effect may become <ref name="2a"/>.
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| − | == Mode of use ==
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| − | GBL is mainly taken orally. Due both to its unpleasant taste and to it being a skin irritant, most users dilute it with juice or other liquid. IV use is strongly advised against; one user reported that this lead to ''the most horrific pain you can think of...the tiny amount of GBL that was on the outside of the needle was enough to make me cry'' <ref name="12a">'''Druglink factsheet 2014 - GBL''', 2014, http://www.drugwise.org.uk/wp-content/uploads/Factsheet-GBL.pdf</ref>.
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| − | Most illicit GHB is sold in the form of a clear, odourless, nearly tasteless liquid - though it can be somewhat salty tasting. It is often sold or found in a variety of containers such as water bottles, eyedroppers and/or vitamin bottles. Ingestion is usually achieved by mixing the solution with a beverage, usually water or various alcoholic drinks. Like other drugs (e.g., ecstasy, marijuana) the chemical composition of GHB is highly variable, and sold in a wide range of concentrations. As a result, there is no definitive way for users to know how strong a particular form of GHB is, thereby increasing the risk of an overdose. Powder forms of GHB are not as prevalent as liquid forms, yet the method of use is nearly identical <ref name="13a">'''GHB''', 2013, http://www.cesar.umd.edu/cesar/drugs/ghb.asp</ref>.
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| − | GHB and GBL is most commonly taken orally in liquid form; the powder is not commonly snorted, but dissolved in fluid.
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| − | * '''Swallowed''' - small capful provides an 'average' dose. It can take up to an hour for the effects to be fully felt.
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| − | GBL is converted to GHB in the body, appears in the same liquid form and produces equivalent effects to GHB <ref name="4a"/>.
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| − | Orally, usually in small doses such as a teaspoon (5ml) at a time <ref name="5a"/>.
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| − | GHB is usually swallowed, but sometimes it's injected or inserted anally <ref name="14a">Hillebrand, J. and Olszewski, D. and Sedefov, R., '''GHB and its precusor GBL: An emerging trend case study''', European Monitoring Centre for Drugs and Drug Addiction, 2008, 32, http://www.emcdda.europa.eu/system/files/publications/505/TP_GHB_and_GBL_107300.pdf, ISBN number: 978-92-9168-314-7</ref>, <ref name="15a">Dore, G., '''How to treat - Party drugs''', 2009, http://www.australiandoctor.com.au/cmspages/getfile.aspx?guid=9be78a1b-dc64-4f9e-a191-15aeb295ba78</ref>.
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| − | == Effects ==
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| − | GHB and GBL produce essentially the same effects - feelings of euphoria, reduced inhibitions and drowsiness. The effects start after about 10 minutes to an hour and can last for up to seven hours or so <ref name="1a"/>.
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| − | '''There is no safe level of drug use'''. Use of any drug always carries some risk. It's important to be careful when taking any type of drug <ref name="16a">'''GHB facts''', 2016, http://www.druginfo.adf.org.au/drug-facts/ghb</ref>.
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| − | GHB affects everyone differently, based on -
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| − | * the amount taken,
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| − | * the strength of the drug (varies from batch to batch),
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| − | * size, weight and health,
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| − | * whether the person is used to taking it,
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| − | * whether other drugs are taken around the same time <ref name="16a"/>.
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| − | === Short-term effects ===
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| − | The following effects may begin within 15 to 20 minutes of taking GHB and may last for around 3 to 4 hours <ref name="16a"/>.
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| − | * euphoria,
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| − | * drowsiness,
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| − | * decreased anxiety,
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| − | * confusion,
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| − | * memory loss,
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| − | * hallucinations,
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| − | * excited and aggressive behaviour,
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| − | * nausea,
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| − | * vomiting,
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| − | * unconsciousness,
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| − | * seizures,
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| − | * slowed heart rate and breathing,
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| − | * lower body temperature,
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| − | * coma,
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| − | * death <ref name="17a">'''Commonly Abused Drugs Charts''', 2016, https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts</ref>.
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| − | === Long-term effects ===
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| − | Little is known about the long-term effects of GHB use. However, it is known that regular use can lead to tolerance and dependence, which means larger amounts of GHB are needed to get the same effect <ref name="16a"/>.
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| − | * unknown <ref name="17a"/>.
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| − |
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| − | === Physical effects ===
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| − | * physical euphoria,
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| − | * stimulation,
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| − | * motor control loss,
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| − | * respiratory depression,
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| − | * sedation,
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| − | * dehydration,
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| − | * dizziness,
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| − | * nausea <ref name="8a"/>.
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| − |
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| − | === Cognitive effects ===
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| − | * cognitive euphoria,
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| − | * empathy, love, and sociability enhancement,
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| − | * increased libido,
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| − | * increased music appreciation,
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| − | * amnesia,
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| − | * anxiety suppression,
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| − | * disinhibition,
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| − | * information processing suppression,
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| − | * thought deceleration <ref name="8a"/>.
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| − |
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| − | === Positive effects ===
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| − | * relaxation,
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| − | * increased sociability,
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| − | * positive mood changes,
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| − | * euphoria,
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| − | * [[Terminology|empathogenic]],
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| − | * enhanced sensuality <ref name="2a"/>.
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| − |
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| − | === Neutral effects ===
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| − |
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| − | * dizziness <ref name="2a"/>.
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| − |
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| − | === Negative effects ===
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| − | * nausea,
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| − | * restlessness,
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| − | * unconsciousness,
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| − | * amnesia <ref name="2a"/>.
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| − | === Overdose ===
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| − | GBL can be fatal. It is very easy to overdose on it, both because the strength can vary from bottle to bottle and because the doses involved are measured in such small quantities. These risks are greatly increased by mixing GBL with alcohol or other sedative, depressant drugs or drugs such as ketamine. Mixing with alcohol is particularly dangerous as this can trigger instant collapse or an overdose reaction. GHB and GBL have been found to reduce the efficiency of some HIV medication and have also been implicated in sexual assaults or 'date rapes' <ref name="12a"/>.
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| − | There is a particularly high chance of accidental overdose with GHB and GBL, because an extra half-millilitre of GBL or half-gram of GHB on top of a moderate dose can make you fall into a deep sleep where you could potentially choke to death on your own vomit. Knowledge of the recovery position and how to clear an airway could save lives. Slightly higher quantities can cause coma-like unconsciousness from which the user cannot be woken. Breathing becomes shallow, slow, and irregular or stops. This respiratory depression can easily kill or cause brain damage, (although most people who overdose will recover without lasting consequences). Large overdoses can also cause seizures, and interfere with or stop the heartbeat. Getting medical help fast is essential if you suspect that you or someone else has taken an overdose, or you find that someone cannot be woken.
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| − | The drugs may take a while to kick in compared to expectations and factors like stomach contents make this time variable. This means someone who takes a second dose without having waited for the effects to reach their peak could be taking a big risk. Second or third doses can have much bigger effects than the first dose because of the 'steep dose-response curve' of these drugs. To reduce risk of overdose users should only take smaller doses after their first dose, having given enough time to feel the effects reach their peak <ref name="3a"/>.
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| − | The chemical composition of GHB is highly variable. It's very easy to take too much GHB: the difference between the amount needed to get high and the amount that causes an overdose can be hard to judge <ref name="16a"/>.
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| − | Symptoms of a GHB overdose include -
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| − | * vomiting,
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| − | * sweating,
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| − | * irregular or shallow breathing,
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| − | * confusion, irritation and agitation,
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| − | * hallucinations,
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| − | * blackouts and memory loss,
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| − | * unconsciousness that can last for 3 to 4 hours,
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| − | * seizures,
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| − | * death <ref name="14a"/>, <ref name="16a"/>.
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| − |
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| − | === Listed effects ===
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| − | The listed effects will rarely (if ever) occur all at once, but heavier doses will increase the chances and are more likely to induce a full range of effects. Likewise, adverse effects become much more likely on higher doses and may include injury or death <ref name="10a"/>.
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| − |
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| − | === Physical effects ===
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| − | * stimulation and sedation - At lower dosages, GBL is physically stimulating, encouraging movement and wakefulness. At higher dosages, however, it becomes physically sedating, encouraging sleep and lethargy.
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| − | * respiratory depression - In cases of GBL overdoses, many reportedly experience an abnormal pattern of breathing characterised by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnoea.
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| − | * euphoria,
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| − | * nausea - This effect is more common with GBL than GHB.
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| − | * stomach pain - This effect is more common with GBL than GHB due to its properties as a mucous membrane irritant. The most effective way to reduce this is to dilute it with a large meal or drink.
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| − | * stomach cramps,
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| − | * motor control loss,
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| − | * dizziness,
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| − | * dehydration,
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| − | * muscle cramps,
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| − | * muscle pain,
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| − | * [[Terminology|optical sliding]] <ref name="10a"/>.
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| − |
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| − | === Cognitive effects ===
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| − | * empathy, love, and sociability enhancement - Unlike alcohol which merely increases sociability through disinhibition, GBL presents strong entactogenic effects which are prominent and well defined although weaker than that of MDMA.
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| − | * disinhibition,
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| − | * information processing suppression,
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| − | * thought deceleration,
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| − | * amnesia,
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| − | * euphoria,
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| − | * anxiety suppression,
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| − | * suggestibility enhancement,
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| − | * increased libido,
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| − | * increased music appreciation <ref name="10a"/>.
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| − |
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| − | === Onset and duration of effects ===
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| − | Onset varies between individuals and can depend on a number of factors (including when the user last ate), but effects can be felt approximately 10 - 30 minutes after ingestion. 45 minutes to 11⁄2 hours later the effects begin to level off and decrease, depending on tolerance to the drug its effects can be felt for 2 - 4 hours. After-effects like grogginess and sleepiness can be felt for as little as two hours or as long as twelve hours after use, although some users find a sense of increased well-being the following day <ref name="12a"/>.
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| − | == Risks ==
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| − | Taking GHB and/or GBL does involve risks. Here's what it could do to you -
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| − | * Both GHB and GBL can cause unconsciousness, coma and death
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| − | * Even experienced users are at risk of death.
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| − | * Because GHB and GBL can really knock you out, they've been linked to drug assisted sexual assault.
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| − | * When mixed badly, it can really burn the mouth <ref name="1a"/>.
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| − |
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| − | === Short-term ===
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| − | * overdose,
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| − | * convulsions,
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| − | * coma,
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| − | * respiratory collapse <ref name="5a"/>.
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| − | == Purity ==
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| − | The strength of GHB and GBL varies widely from bottle to bottle. At present there is little reliable evidence to determine the purity of GBL <ref name="1a"/>.
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| − | Highly variable; as GHB is illegally manufactured strength can vary widely from brand to brand and batch to batch. Likewise, concentrations of GBL can vary massively <ref name="6a"/>.
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| − | == Addiction ==
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| − | === Can you get addicted ===
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| − | Yes, repeated use is now known to cause dependence in some people.
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| − | Very severe withdrawals with delirium have been reported - especially in unplanned detoxifications when people have been unable to get GHB or GBL <ref name="1a"/>.
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| − |
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| − | GHB and GBL can be addictive, typically when the drugs are used regularly for a sustained period <ref name="3a"/>.
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| − |
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| − | === Dependence ===
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| − | Regular use of GBL builds tolerance, meaning users need to take more to feel the same effects. GBL is physically addictive and stopping it without medical supervision can be fatal; sudden withdrawal poses dangerous health risks and can require an in-patient detox. Clinical presentation of withdrawal may include anxiety, confusion, agitation, tremor, cramps, insomnia, aggression, delirium, delusions, paranoia with hallucinations, tachycardia (racing heart), low blood pressure and occasionally a schizophrenic-like state <ref name="12a"/>.
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| − | Taking GHB or GBL every day results in increased tolerance and users may become dependent on it. Those dependent on GHB and GBL usually suffer from cravings, anxiety, low mood, and have trouble sleeping if they do not re-dose every few hours <ref name="3a"/>.
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| − | Regular and frequent use of GHB can lead to physical dependency, with severe withdrawal symptoms akin to those from Alcohol or Benzodiazepines. These could include shakes, tremors, spasms, panic, hallucinations or delusions. While such dependency will not develop with infrequent users, anyone using GHB for a sustained period of time should seek expert drugs advice before discontinuing use abruptly <ref name="6a"/>.
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| − | Prolong use of GHB can result in the user developing a tolerance, requiring larger doses to achieve the desired effects. As doses and frequency of its use increases the user is at great risk of developing an physical and psychological dependency to the drug. When stopping the use of GHB abruptly the user will experience withdrawal symptoms that can be painful and overwhelming <ref name="18a">'''GHB (Gamma- HydroxyButyrate): Uses, Symptoms, Signs and Addiction Treatment''', 2017, http://addictionlibrary.org/prescription/ghb-gamma-hydroxybutyrate.html</ref>.
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| − |
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| − | === Signs of addiction ===
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| − |
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| − | * intentionally misusing medication,
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| − | * unable to stop its use,
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| − | * experiencing withdrawal symptoms,
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| − | * cravings,
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| − | * loss of interest in usual activities,
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| − | * trouble at work, school and home,
| |
| − | * difficulties in personal relationships,
| |
| − | * financial hardship,
| |
| − | * health effects due to GHB (gamma- hydroxybutyrate) abuse <ref name="18a"/>.
| |
| − |
| |
| − | == Dangerous interactions ==
| |
| − |
| |
| − | * depressants,
| |
| − | * dissociatives,
| |
| − | * stimulants <ref name="8a"/>.
| |
| − |
| |
| − | == Withdrawal ==
| |
| − |
| |
| − | Giving up GHB after using it for a long time is challenging because the body has to get used to functioning without it. This is why it's important to speak to a health professional when planning to stop using GHB.
| |
| − |
| |
| − | Withdrawal symptoms usually start about 12 hours after the last dose and can continue for about 15 days.
| |
| − |
| |
| − | Sudden withdrawal from high doses can result in bowel and bladder incontinence and blackouts <ref name="19a">Galloway, G. and Frederick, S. and Staggers, F. and Gonzales, M. and Stalcup, S. and Smith, D., '''Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence''', ''Addiction'', 1997, 92, 1, 89-96</ref>, <ref name="16a"/>.
| |
| − |
| |
| − | * insomnia,
| |
| − | * anxiety,
| |
| − | * tremors,
| |
| − | * sweating,
| |
| − | * increased heart rate and blood pressure,
| |
| − | * psychotic thoughts <ref name="17a"/>.
| |
| − | * confusion and agitation,
| |
| − | * panic,
| |
| − | * feelings of doom and paranoia,
| |
| − | * restless sleep,
| |
| − | * muscle cramps,
| |
| − | * sweating,
| |
| − | * hallucinations <ref name="16a"/>.
| |
| − |
| |
| − | == Legality ==
| |
| − |
| |
| − | GHB and GBL are both Class C drugs - but GBL is available for legitimate use in industry, but if someone supplies or possesses them knowing or believing that they will be swallowed and ingested, they are committing an offence.
| |
| − |
| |
| − | Possession can get you up to two years in prison and/or an unlimited fine.
| |
| − |
| |
| − | Supplying someone else, even your friends, can get you 14 years in jail and/or an unlimited fine <ref name="1a"/>.
| |
| − |
| |
| − | === Did you know? ===
| |
| − |
| |
| − | * A conviction for a drug-related offence could have a serious impact. It can stop you visiting certain countries - for example the United States - and limit the types of jobs you can apply for.
| |
| − | * Like drinking and driving, driving while impaired from using GHB and/or GBL is illegal - you can get a heavy fine, be disqualified from driving or even go to prison.
| |
| − | * Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises.
| |
| − | * The Sexual Offences Act 2003 states that it is an offence to administer a substance, like GHB and GBL, to a person with intent to overpower that person to enable sexual activity with them. This is punishable by up to 10 years imprisonment <ref name="1a"/>.
| |
| − |
| |
| − | == Mixing with other drugs ==
| |
| − |
| |
| − | GBL/GHB are particularly dangerous when used with alcohol <ref name="1a"/>.
| |
| − |
| |
| − | * '''GHB + alcohol or benzodiazepines''' - chance of overdose is greatly increased.
| |
| − | * '''GHB + amphetamines or ecstasy''' - enormous strain on the body and risk of seizures <ref name="20a">Miotto, K. and Roth, B., '''GHB Withdrawal Syndrome''', 2001, https://www.erowid.org/chemicals/ghb/ghb_addiction2.pdf</ref>.
| |
| − |
| |
| − | == Harm reduction ==
| |
| − |
| |
| − | The strength of GHB varies a great deal. It is therefore advisable to take a small amount at first in order to avoid unexpectedly taking more than intended. After use, there is likely to be a lack of energy for hours or even days.
| |
| − |
| |
| − | The doses of GHB and GBL are different, and should be thoroughly considered. The same dose has different effects on different people. What may be a normal dose for one user could be a dangerous overdose to another user, tolerance can develop very quickly and it is dangerous to mix either drug with alcohol or any CNS depressant.
| |
| − |
| |
| − | GHB has recently been associated with 'date rape'.
| |
| − |
| |
| − | Taken in strong doses or with alcohol, the effects of GHB can be physically disabling. GHB is difficult to detect in a strongly flavoured alcoholic drink. These qualities have led people to 'spike' alcoholic drinks with GHB, with the intention of committing a sexual assault against the 'disabled' victim.
| |
| − |
| |
| − | The risk of having your drink spiked with GHB should not be exaggerated. American research has shown that alcohol alone is implicated in over 90% of sexual assaults. However, it is a risk of which you should be aware.
| |
| − |
| |
| − | To avoid being a victim of any date rape drug, the best advice is not to accept a drink unless you have seen it being prepared and not to leave your drink unattended.
| |
| − |
| |
| − | You should be careful about accepting any form of drug (including alcohol) from someone who is not known to you.
| |
| − |
| |
| − | Symptoms of having been 'spiked' could include extreme drowsiness, slight nausea and paralysis of the limbs, blurred vision and audio/spatial disorientation.
| |
| − |
| |
| − | If you think you may have been 'spiked', it is best to stay with a trusted friend (not someone you have just met) and go to a safe place (your home/hospital/police station) <ref name="4a"/>.
| |
| − |
| |
| − | * always measure your dose using a dropper and start with a small amount (0.3 - 0.5ml),
| |
| − | * wait until effects are felt and don't re-dose for at least 2 hours,
| |
| − | * always dilute in water and add a food colouring to avoid accidental drinking,
| |
| − | * always use in a safe place with friends and with someone who is 'straight' as it is common to become unconscious with GHB/GBL,
| |
| − | * avoid frequent use. GHB/GBL is very physically addictive,
| |
| − | * avoid mixing with other downers especially alcohol which increases the risk of overdose <ref name="21a">'''GBL/GHB''', 2017, http://www.mycrew.org.uk/drugs-information/gblghb</ref>.
| |
| − |
| |
| − | * the dosage curve of GHB is very steep, recreational doses being very close to doses which will cause a period of unrousable sleep, which are again relatively close to doses which may cause coma or death through respiratory depression,
| |
| − | * the only way to know the concentration of liquid GHB is to know and trust information provided by the source. Users should be extremely careful about GHB dosages as even small overdoses can result in temporarily unrousable sleep,
| |
| − | * avoid driving and operating heavy machinery,
| |
| − | * don't mix it with alcohol, or other depressants,
| |
| − | * 2 - 3 uses a week should be the maximum,
| |
| − | * high addiction potential <ref name="2a"/>.
| |
| − |
| |
| − | === How much are you taking? ===
| |
| − |
| |
| − | Extreme caution should be used when measuring doses. Pipettes are often used. GHB, when sold as a solution varies in concentration, so it is very important to know how strong the solution is, although you should not rely on it being the strength you have been told. Always start with a very small amount and work up. People have ended up coming round in hospital after swigging from the bottle directly. Different people will be more or less sensitive to the effects, just as with alcohol. If you buy or are given a pre-prepared solution of any of these drugs, the risks of accidentally taking too much is especially high. Taking an unmeasured dose of an unknown solution is very risky, even if it seems like a small amount. Measuring out doses millilitre by millilitre using a pipette, and starting with a small dose, reduces the risk <ref name="3a"/>.
| |
| − |
| |
| − | === Are you taking GHB or GBL on its own? ===
| |
| − |
| |
| − | A very little alcohol combined with GBL can have a powerful and negative effect. A high proportion of those who collapse after taking GBL have also been drinking, or using other sedating drugs <ref name="3a"/>.
| |
| − |
| |
| − | === Are you taking responsibility over the risks you face? ===
| |
| − |
| |
| − | These drugs may be carried in quantities enough for several overdoses, so it may be safest to prepare in advance the quantity you wish to take in one session so that when intoxicated, you can only take up to an arranged limit.
| |
| − |
| |
| − | Friends should always look out for each other - if someone is suffering bad effects, then seek medical assistance immediately. If they cannot be roused, put them in the recovery position until you can get help <ref name="3a"/>.
| |
| − |
| |
| − | === Health implications ===
| |
| − |
| |
| − | There have been fatalities related to the use of GHB but usually where alcohol has been consumed as well. Users run the risk of becoming unconscious; breathing may stop or be prevented by aspirating vomit. Users may enter a coma-like state for several hours <ref name="6a"/>.
| |
| − |
| |
| − | == Paraphernalia ==
| |
| − |
| |
| − | GHB is usually sold in small plastic bottles, containing around 40ml <ref name="5a"/>.
| |
| − |
| |
| − | == History ==
| |
| − |
| |
| − | Synthesis of the chemical GHB was first reported in 1874. GHB was re-investigated in France more than 50 years ago as a possible anaesthetic and introduced into medicine between 1960 - 63 when it was discovered as a naturally occurring chemical in the human brain and scientists noted its effect on the neurotransmitter GABA. Throughout much of the 1960's it was held likely to have considerable anaesthetic properties, but was abandoned by doctors following discoveries of its limited clinical analgesic effects and its very short duration of action. In the 1970's, GHB was recommended for the treatment of narcolepsy/cataplexy, though it was again found to be flawed, primarily due to its euphoric side effects.
| |
| − |
| |
| − | During the 1980's it was marketed as a fat burner and muscle developer and interest was stirred in the body-building/steroid using community to enhance the body's production of growth hormone. It became adopted by 'rave' culture during the late 1980's and early 1990's, particularly because of its euphoric and aphrodisiac properties. It is occasionally used in the treatment of alcoholism. Its effects have been noted in clubs with incidents reported of people losing consciousness and the use of the drug as a 'spiking' agent in sexual assaults. These have contributed to wariness of the drug, and it has waned in popularity across the last 10 years. It was made a class C drug in June 2003.
| |
| − |
| |
| − | GBL and 1,4-BD are chemicals that have widespread legitimate uses (for example, in nail polish, paints and as industrial solvents) but are also misused. They are pro-drugs of the Class C drug gamma-hydroxybutyrate (GHB), meaning that when either substance is ingested it is rapidly converted to GHB. The effects and risks associated with their misuse are unconsciousness, a risk of death by intoxication and a dependence syndrome if used regularly. The risks are increased if combined with alcohol or other depressant substances. GBL and 1,4-BD have therefore been controlled as Class C drugs <ref name="4a"/>.
| |
| − |
| |
| − | GHB was synthesised and introduced into medicine in 1960 and in 1963 discovered as a naturally occurring chemical in the human brain <ref name="22a">Graeme, K.A., '''New Drugs of Abuse''', ''Pharmacologic Advances in Emergency Medicine'', 2000, 18, 625-636</ref>. Throughout much of the 1960's it was a popular anaesthetic, but was abandoned by doctors following discoveries of its poor analgesic effects <ref name="23a">Teter, C. J. and Guthrie, S. K., '''A Comprehensive Review of MDMA and GHB: Two Common Club Drugs''', ''Pharmacotherapy'', 2001, 21, 12, 1486-1513, https://www.ncbi.nlm.nih.gov/pubmed/11765302</ref>. In the 1970's, GHB was recommended for the treatment of narcolepsy, though it was also found to be an ineffective and unpopular form of treatment primarily due to its euphoric side-effects. Use began to intensify in the 1980's when it was marketed as a fat burner and muscle developer. However, in 1990, based on more than 30 reports of GHB-linked illness, the [[Terminology|FDA]] declared the chemical unsafe and ordered it to be removed from store's shelves, thus limiting a user's ability to purchase the product. Following the [[Terminology|FDA]] ban, many producers of GHB began to switch their ingredients to GBL and BD and sold those drugs as muscle enhancers and sleep aids. On January 21, 1999, the [[Terminology|FDA]] began to ask manufactures of GBL to stop producing it and to recall products containing GBL because it was never approved for human consumption. Around this same time GHB gained in popularity among 'party drug' users for its euphoric and [[Terminology|aphrodisiac]] effects <ref name="24a">Dillon, P. and Degenhardt, L., '''Ketamine and GHB: New Trends in Club Drug Use?''', ''Journal of Substance Use'', 2001, 6, 1, 11-15, http://dx.doi.org/10.1080/146598901750132045, http://www.tandfonline.com/doi/abs/10.1080/146598901750132045</ref>, <ref name="25a">'''GHB''', 2013, http://www.cesar.umd.edu/cesar/drugs/ghb.asp</ref>.
| |
| − |
| |
| − | Synthesis of this chemical was first reported in 1874 by Alexander Zaytsev. But the first major research in humans was conducted in the early 1960's by Dr. Henri Laborit to use in studying the neurotransmitter [[Terminology|GABA]].
| |
| − |
| |
| − | Throughout most of the 1960's it was a popular anaesthetic, then was abandoned by doctors, following discoveries of its poor analgesic effects. In the 1970's was recommended for the treatment of narcolepsy, though the euphoric side of GHB made that unfavourable.
| |
| − |
| |
| − | GHB was widely used in France, Italy, and other European countries for several decades as a sleeping agent and an anaesthetic in childbirth, but problems with its abuse potential and development of newer drugs have led to a decrease in the medical use in recent times.
| |
| − |
| |
| − | In the 1980's It was marketed for a short time as a fat burner and muscle developer. However, in 1990, based off many reports of GHB-linked illness, the [[Terminology|FDA]] declared GHB unsafe, and ordered it to be removed from stores shelves. Following this, many users switched to GBL and 1 4-butanediol.
| |
| − |
| |
| − | GHB (Xyrem) was approved by the [[Terminology|FDA]] in 2002 for use in the treatment of narcolepsy/Cataplexy <ref name="2a"/>.
| |
| − |
| |
| − | ----
| |
| − |
| |
| − | == References ==
| |
| − |
| |
| − | <references />
| |