GHB street drug

19 Feb 2017
GHB
Overnight in Melbourne more than 30 people were taken to emergency department suffering effects of GHB intoxication.  In this post we refresh what this recreational drug is and look at its effects.

Gamma-hydroxybutyrate, (GHB) is naturally occurring neurotransmitter.  It is the precursor to GABA in our brain and has many functions.  Principally, it is used as a central nervous system (CNS) depressant .
In the 70s and 80s GHB was synthetically manufactured and used as a pharmaceutical to induce sleep and sedation and to provide peri operative pain relief in painful procedures.  It was a complete disaster.
Today, isn't used clinically; it was found, to be ineffective as an analgesic and dangerous.  Dosing proved to be unpredictable and with  high incidence of seizure, unconsciousness and hyperemesis, you have the perfect storm.  Vomiting , seizure and ALOC is a recipe for litigation and coronial inquests.

GHB did not disappear, however, and instead has become popular in the black market.  Athletes began taking supplements laced with GHB due to its ability to stimulate human growth hormone, a hormone known to increase muscle mass and reduce body fat.

Where it really gained popularity was the nightclub, rave party and sleazy date rape scene of the 1990s.  Like some benzodiazepines and alcohol, GHB was used for its euphoric and sedative effects.  Dangerously synergistic with these drugs, it is also commonly combined with Meth (Ice) or its cousin MDMA (Ecstasy) to prolong and enhance the effects of both.

Due to its tasteless, odourless and potent property to produce unconsciousness and disinhibition, the sinister use of GHB slipped into drinks facilitated its use as a date rape drug.

GHB is unpredictable.  Profound unconsciousness with fitting and vomiting , is a massive airway risk, and when paramedics arrived to more than 30 people all affected, it must have stretched resources of the prehospital crews and the local EDs.

From ingestion to symptom onset is between 15 and 20 minutes.  Effects last 1 to 6 hours.  When used along with other intoxicating substances, such as alcohol and methamphetamine, the effects are unpredictable and longer lived.  This makes recreational doses difficult to gauge.  In its cleanest and pure state, safe doses between 1-2 grams, produce serum concentrations between 80 and 100mg/L.
 On the street there is no way for users to tell what dose they are getting when they get GHB illegally.
Common signs of GHB use and intoxication include:
Relaxation / drowsiness
Euphoria, high
Lowered inhibitions
Dizziness/ ataxic /uncoordinated
Confusion loss of time line
Memory loss / amnesia
Nausea vomiting
Slurred speech.
Hallucinations.

When daily users of GHB are stopped abruptly. Discontinuation or withdrawal symptoms can begin in 12- 24 hours and last as long as 3 weeks.  They mimic alcohol or antidepressant withdrawal syndromes.  Common signs of GHB withdrawal include:
Fever
Extreme fatigue.
Anxiety / mood swings
Paranoia, hallucination (like Delirium tremens)
Insomnia and vivid dreams
Tremors
Confusion, irritation, aggitation.

In OD the margin separating a tolerable amount of drug and a potentially fatal dose is very low.  Accidental overdose is very common.

Expect
Vomiting with unconsciousness
Loss of a gag reflex.
Seizures
Double incontinence
Shaking, tremors,
Sternal rubs (not that they are acceptable) are less effective because GHB causes absence of pain response, even in conscious patients).
Nystagmus (rapid side-to-side eye movements)
Bradypnoea
Profuse sweating but hypothermic (T>35)

Treatment of OD
What kills these patients is airway and breathing compromise.  A secondary issue is electrolyte imbalance.
Priority is ABCD.
Airway secured, vent if needed.
Antiemetics, NG tube.
Fluids and watch gases and electrolytes
Supportive care.
#ECT4Health
Hope you enjoyed the timely read on GHB.