GHB (Gamma-hydroxybutrate)

Slang
Grievous Bodily Harm, Fantasy, Liquid ecstasy, GBH, Liquid E, G-riffic, Goop, Liquid G, Sodium oxybate. Date rape drug, Blue nitro

How it is taken
Snorted
Smoked
Injected
Orally (most commonly it is taken as a capful from a bottle or mixed into drinks such as water or alcohol)

Common effects

  • euphoria
  • drowsiness
  • nausea
  • increased confidence
  • dizziness

What it is
GHB is a clear odourless liquid (usually mixed with alcohol) or a white powder usually made into tablets or capsules. GHB as a white powder contains GHB's sodium salt called sodium oxybate. The most commonly abused form is the liquid. It is usually sold as liquid by the dose (one capful from a bottle or as drops).

GHB has a number of precursors that metabolise into GHB when in your body. These include gamma-butyrolactone (GBL) a solvent commonly used as a paint stripper, 1,4-butandiol (1,4-B) a chemical used in the production of plastics and adhesives, and gamma-aminobutyric (GABA) a chemical that naturally occurs in the brain.

GHB is classed as a depressant drug that contains sedative, and at higher doses anaesthetic, properties. GHB was first manufactured in 1960 and was internationally used as an anthesthetic agent prior to surgery, and as a treatment for narcolepsy (uncontrolled periods of deep sleep). Furthermore GHB was trialled as an aid to alcohol and opiate withdrawal. Body builders in the 1980's used GHB for its apparent growth hormone.

GHB then became more commonly used as recreational intoxicant. For many users GHB is a pleasant alcohol replacement. Because GHB is often kept as a clear liquid and even in drinking bottles, accidental ingestions are common.

Short-term effects
The effects of GHB vary each time a person uses it and it affects each person differently. Usually within 15 minutes of taking GHB the user experiences an initial feeling of euphoria and relaxation. The immediate effects may last up to 3 hours depending on dosage. However after the initial feeling some negative effects can occur which include:

  • nausea, dizziness and drowsiness
  • visual disturbances
  • increased confidence
  • increased sociability
  • enhancement of senses, especially touch.

An increase in dosage can significantly alter the short-term effects. Feelings of euphoria are replaced by sedative effects which can last up to 48 hours. If the user commonly takes GHB this period may be followed by withdrawal effects. Effects of increased amounts include:

  • confusion
  • agitation
  • seizures
  • vomiting and nausea
  • stiffening of the muscles
  • disorientation
  • impairment of speech and body functioning
  • convulsions
  • sleepiness, unconsciousness or short-term coma
  • respiratory collapse.

It is difficult to predict a person's reaction to GHB as it is produced in secret labs leading to wide variance in the purity and strength of doses.

Hospitalisations have been reported worldwide after heavy use of GHB, with some resulting in death. Death is common in users who overdose because vomiting commonly occurs resulting in the user choking. It is important recognise that the effects of GHB are significantly heightened when it is combined with other drugs, especially alcohol or other depressants. The likelihood of overdose and death also increases when these drugs interact.

Long-term effects
Apart from the potential to develop both physical and psychological dependence there has been little research conducted regarding the effects of long-term use on user's health and social environment.

Dependence, addiction, and overdose risk
GHB can become both physically and psychologically addictive. Regular users report that they often feel like they need a little GHB to feel normal.

If people suddenly stop using GHB symptoms of withdrawal will occur including anxiety, inability to sleep and irregular heartbeat. Many heavy users report being able to taper off their use to zero by reducing their intake slowly over a two week period.

Many people find GHB to be a pleasant alcohol replacement. Unfortunately, because it is often kept as a clear liquid and even in drinking bottles, it is difficult to judge the concentration and accidental ingestions leading to overdose are common.

GHB has a very steep sleep dose-response curve, meaning that there is only a small difference between the amount required to provide the 'desired effect' and the amount required for a sleep aid or an overdose. Also, the same dose may affect different people in different ways.

If overdose occurs:

  • check breathing
  • turn on side to prevent choking on vomit
  • call for help
  • find out if the user has combined drugs.

Once users overindulge in GHB the effects act as a sleep aid and there is the potential for vomiting, blocked airways, and severe respiratory depression.

Withdrawal effects may include hallucinations, insomnia, anxiety, tremors, sweating, edginess, chest pains and tightness, muscle and bone aches, sensitivity to sounds and colours and mental blocks. These side effects will generally subside between two and 21 days depending on usage.

The New Zealand context
In 2000 the availability of GHB was pronounced in New Zealand. A number of people were hospitalised with respiratory depression, high levels of sedation and coma after using GHB and precursor substances. On 1 April 2000 the media reported the first fatality from a GHB related substance in New Zealand, and this was followed by numerous admissions to hospital of patients presenting with severe respiratory depression and coma after taking these substances. Along with international obligations, this provided great rational for the classification of GHB and in March 2001 the Expert Advisory Committee (EACD) produced a recommendation that GHB be scheduled as a controlled drug under the Misuse of Drugs Act 1975.

This was in line with the United Nations Commission on drugs which voted to classify GHB under the United Nations Drug Classification Framework in 2001. New Zealand holds certain obligations under this framework and therefore, as recommended by the EACD, GHB and its related substances gamma-butyrolactone (GBL), 1,4-butandiol (1,4-B) and gamma-aminobutyric (GABA) were scheduled as Class B1 under the Misuse of Drugs Act 1975 on 31 May 2002.

New Zealand's experience of GHB and its precursor substances supports the World Health Organisation's assessment of GHB as a significant risk to health.

The context of GHB use in New Zealand is similar to that worldwide. The World Health Organisation noted that GHB's most current mode of use worldwide has been for its subjective, hypnotic, euphoric and hallucinogenic effects, especially in the context of the dance culture.

The Misuse of Drugs Act 1975 does not allow for the medicinal use of GHB.

Statistics
Auckland Hospital's Department of Critical Care Medicine (DCCM) reported that there were 27 admissions to the DCCM with poisoning due to GHB and its precursors between 21 October 1999 and 29 April 2001. Out of these, four admissions occurred in 1999, eight occurred in 2001and in the last four months of 2001 there were 15 admissions.

The first death in New Zealand attributable to GHB and its precursors was reported by the media in 2001.

Findings from the Hallucinogen Module of the Illicit Drug Monitoring System in 2005 reports that in 2005, the median price for GHB was $5.00 per millilitre.

The law and penalties
Due to the availability of GHB in New Zealand, and as a temporary measure in 2000, sodium oxybate (GHB's sodium salt) was scheduled under the Medicines Act 1981.

GHB is scheduled under the Misuse of Drugs Act 1975 as a Class B drug under part 2. Penalties include up to 14 years imprisonment for importation, manufacture, or supply of GHB, up to 10 years imprisonment for conspiracy to commit an offence and up to three months imprisonment or a $500 fine, or both, for possession of GHB.

Safe use
Dosages of GHB are difficult to judge, especially when in liquid form. Because the concentration of GHB may be unknown there is also a very fine line between the amount required to achieve the desired effect and the amount which leads to a coma.

More than the recommended dosage should never be taken. The recommended dosage is commonly measured as a capful, but purity will vary depending on the manufacturing. Extreme care should be taken, and use avoided if there is any doubt or uncertainty.

GHB should not be combined with any other drugs, especially alcohol and other depressants. It is just not worth the risk. Combining drugs intensifies the effects and places the user at a higher risk of respiratory collapse and vomiting. If vomiting or convulsions occur immediate medial attention must occur and emergency staff must be promptly informed of what the user has ingested.

The Expert Advisory Committee on Drugs has produced key messages for those who use GHB:

  • people who have taken the drug should not drive a vehicle, operate heavy machinery, or engage in water-related activities
  • people should not take these substances alone, or with strangers
  • people should not take drinks from strangers, or leave their glasses unattended because someone might spike their drink.

Additional precautions include that GHB is kept in a container that cannot be mistaken for a drinking container or most importantly a water bottle. People have been known to colour their GHB with blue food colouring (hence the term blue nitro) to distinguish it from water. It is also recommended that those using GHB write ˜G" or ˜GHB" on their hand so that if trouble occurs others, including medical staff, will be aware of what has been ingested.

How to get help
There are a number of treatment organisations that can help. If you feel that you or anyone you know needs help, then you can call these services in strict confidence.

If you are faced with an emergency, call 111 immediately.

To talk to someone about your or someone else's drug use, call the Alcohol Drug Helpline - 0800 787 797.

You can also get contact details for your local alcohol and other drug counsellor or treatment provider by calling the helpline or by visiting www.addictionshelp.org.nz.

Special section
GHB and sexual assault
GHB (and its related compounds) is well known as the date rape drug because large doses can be easily mixed with liquids including water. GHB by itself has a soapy or salty taste but when mixed with a drink it can be very difficult for a victim to detect by sight or smell.

Low doses may increase libido, euphoria, suggestibility, passivity, and amnesia which can make victims more susceptible to sexual assault. Higher doses can induce a sleep like coma where the victim is in an unconscious state and very vulnerable to sexual assault.

A potential further public health consequence of increased libido or loss of inhibitions caused by GHB and its related compounds is the risk of unsafe sexual practices. This leads to an increased risk of transmitting diseases such as hepatitis B or HIV/AIDS and other sexually transmitted infections. It also increases the risk of unplanned pregnancies.

The extent to which GHB is used as a date rape drug in New Zealand is unknown, largely due to the short life of the drug in the body and the fact that routine toxicology tests do not detect GHB and related compounds.

Links

A report from SHORE into Hallucinogens and other illicit drug trends in New Zealand, published 2005, which contains some information about LSD in New Zealand.

Expert Advisory Committee on Drugs advice on: Gamma-Hydroxybutyric acid and related substances (fantasy). December 2001.

Cameron S. 2001. Toxicity, Gamma Hydroxybutyrate from Emergency Medicine/Toxicology.