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Commonly known as ‘Liquid X’, ‘Fantasy’ or Liquid G’, GHB is well- defined as a ‘date rape’ or ‘club drug’ narcotic. Its chemical name is Gamma Hydroxybutyrate, and it acts as a depressant in the central nervous system. It is a naturally-occurring metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) found in the brain. Xyrem (sodium oxybate) a brand-name prescription drug was approved by the Food and Drug Administration (FDA) in 2002 for the treatment of narcolepsy, a sleep disorder that causes excessive sleepiness and recurring daytime sleep attacks. It is the sodium salt of gamma Hydroxybutyrate. Xyrem is a highly regulated drug in America, a Schedule III controlled substance, and requires patient enrollment in a restricted access program.
GHB is particularly dangerous for its potential for loss of consciousness as well as amnesia, making it the perfect ‘date rape’ drug. In this context, it is usually found in the rave party circuit, as well as parties and club events. It is usually placed in alcoholic or other beverages, and the unwitting victim can feel the effects within 20 minutes or less, often rendering them incapacitated and extremely vulnerable. The immediate effects are loss of inhibitions, tranquility, euphoria and increased sex drive. Some of the negative side effects include sweating, nausea, and again, loss of consciousness (reported by nearly two-thirds of users). It is commonly available as a colorless, odorless compound that is easy to mix, particularly with alcohol. Aside from its popularity as a date-rape drug, GHB has also been put forward to have anabolic effects due to protein synthesis, and has been used by body-builders for muscle building and reducing fat. Another factor that increases its popularity as a recreational drug is the difficulty in measuring it in drug tests. Roughly 95 percent of GHB is metabolized in the liver, and its half-life ranges from 30 to 60 minutes. Only five percent of the parent drug is excreted via the kidneys. Detection of GHB in the urine may be difficult after 24 hours due to this short half-life.
GHB is acquired on the streets or over the Internet in liquid form or as a white powdered substance for illegal use. It is taken orally and is regularly combined with alcohol. Much of the GHB found on the streets or over the Internet is produced in illegal labs. GHB may be mixed with questionable contaminants that may increase its toxicity. The production of GHB typically entails the use of lye or drain cleaner mixed with GBL, a chemical cousin of GHB and an industrial solvent often used to strip floors…a great thing to put in your body.
In 1990, the Food and Drug Administration (FDA) delivered an advisory pronounce GHB use hazardous and illegal except under FDA-approved, physician-supervised protocols. In March 2000, GHB was sited in Schedule I of the Controlled Substances Act. The sodium salt of GHB, the brand product Xyrem, is a Schedule III drug when prescribed and used legally in a patient restricted-access program. Xyrem is not available at regular retail pharmacies, and if it is trafficked it’s as a recreational drug, and therefore the status transfers to Schedule I and it becomes an illegal drug.
GHB can be addictive if used repeatedly. Withdrawal effects may include insomnia, anxiety, tremors, and sweating. Withdrawal can be brutal and debilitating. Combined use with alcohol, other sedatives or hypnotics (such as barbiturates or benzodiazepines) and other drugs that possess CNS depressant activity may result in nausea, vomiting and aspiration, and dangerous CNS and respiratory depression.
High doses of GHB, even without other illicit substances or alcohol, may produce overwhelming sedation, seizures, coma, severe respiratory depression and even death. Emergency department incidents associated to the use of club drugs typically entail the use of multiple substances, such as marijuana, cocaine, and other club drugs, such as methamphetamine, ecstasy and/or Rohypnol. Again, GHB recognition processes for emergency room use are not readily available. Emergency room physicians may be unaware that GHB has been abused when a patient enters the hospital. Due to the short half-life of the drug, discovery in the urine may be tricky. Supportive care and keeping airways open are the principal procedures used in the emergency overdose situation.
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