sodium-oxybate and Substance-Related-Disorders

Over the past decades gamma-hydroxybutyrate (GHB) has emerged as a popular drug with high potential of (ab)use due to its euphoric and relaxing effects. An overview of different populations using GHB is urgently needed, since this would enable development of adequate prevention and treatment policies to diminish the risks associated with GHB use. We systematically reviewed literature on different GHB using populations, comparing demographic characteristics, GHB use patterns, psychosocial aspects and psychiatric comorbidity.. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Rayyan software. Original studies published from January 1997 up to October 2019 on GHB use were included. Out of 80 full-text articles, 60 articles of 51 unique studies were included. Most studies included people using GHB 1) presenting at emergency departments (n = 22), 2) recruited from the general population (n = 11), or 3) presenting at addiction care (n = 8).. Three main sub-populations of people using GHB are described in the literature: people using GHB recreationally without adverse effects; people using GHB recreationally with adverse effects, and people with dependence on GHB. These groups show considerable overlap in gender, age range, and comorbid substance use, as well as amount of GHB use per occasion. Differences are related to frequency and function of GHB use, the number of comas experienced, as well as work status, and psychiatric comorbidity.. Policy interventions should aim at preventing the transition from recreational substance use to GHB use, as most users are experienced recreational substance users prior to starting GHB use. When people use GHB regularly, interventions should aim at reducing the level of GHB use and preventing GHB use-related harm. Longitudinal studies and population-based probability sampling are required for more insight in the dynamics of GHB use in different sub-populations, and the transition from one group to the other, ultimately leading to dependence on GHB.

Topics: Coma; Drug Users; Humans; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is a central nervous system depressant primarily used as a recreational drug of abuse, but also for the treatment of narcolepsy with cataplexy in adult patients and as an adjuvant for control of alcohol withdrawal syndrome. The main aim of this review is to summarise updated knowledge about GHB pharmacokinetics and pharmacodynamics, acute poisoning, and clinical features of GHB withdrawal syndrome, its diagnosis and medical treatment. The most common clinical signs and symptoms of acute poisoning include sleepiness to deep coma, bradycardia, hypotension, and respiratory failure. Therapy is essentially supportive and based on continuous monitoring of vital signs. GHB withdrawal syndrome shares patterns with other withdrawal syndromes such as alcohol withdrawal and is sometimes difficult to distinguish, especially if toxicological tests are GHB-negative or cannot be performed. There are no official detoxification protocols for GHB withdrawal syndrome, but its therapy is based on benzodiazepine. When benzodiazepine alone is not effective, it can be combined with barbiturates or antipsychotics. Information about abuse and distribution of GHB and its precursors/analogues among the general population is still limited. Their prompt identification is therefore crucial in conventional and non-conventional biological matrices, the latter in particular, to clarify all the issues around this complex molecule.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Illicit Drugs; Male; Middle Aged; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Sexual violence is a universal phenomenon without restriction to sex, age, ethnicity or social class that causes devastating effects in the physical and mental health spheres, in the short-term and long-term, such as pregnancy, sexually transmitted infections (STI) and greater susceptibility to psychiatric symptoms, especially depression. Some cases of sexual assault and rape are based on the use of so-called drug-facilitated sexual assault (DFSA), which cause victims' loss of consciousness and inability to defend, making them vulnerable to violence. Thus, this article aimed to review the literature on gender violence and the drugs used to facilitate sexual assault, addressing their mechanism of action and pharmacokinetics, as well as drug detection times in human body and types of forensic identification. It is understood that the knowledge of these drugs and their pharmacological and diagnostic mechanisms should be widely disseminated, especially about sensitivity tests and the time the drug remains in the body, which would validate the promotion of evidence to prove abuse, and, thus, being able to give a promising outcome to cases of aggression, which is extremely beneficial for women.

Topics: Adjuvants, Anesthesia; Alcohol Drinking; Anesthetics, Dissociative; Benzodiazepines; Crime Victims; Female; Gender-Based Violence; Humans; Ketamine; Molecular Structure; Poisoning; Sex Offenses; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Unconsciousness

γ-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths.. The aim of this review is to assist clinical and forensic practitioners with the interpretation of γ-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons.. The information sources used to prepare this review were PubMed, Scopus, and Web-of-Science. These databases were searched using keywords γ-hydroxybutyrate (GHB), blood, urine, alternative specimens, non-conventional biological matrices, saliva, oral fluid, sweat, hair, vitreous humor (VH), brain, cerebrospinal fluid (CSF), dried blood spots (DBS), breast milk, and various combinations thereof. The resulting 4228 references were screened to exclude duplicates, which left 1980 articles for further consideration. These publications were carefully evaluated by taking into account the main aims of the review and 143 scientific papers were considered relevant. Analytical methods: The analytical methods used to determine γ-hydroxybutyric acid in blood and other biological specimens make use of gas- or liquid-chromatography coupled to mass spectrometry. These hyphenated techniques are accurate, precise, and specific for their intended purposes and the lower limit of quantitation in blood and other specimens is 0.5 mg/L or less. Human pharmacokinetics: GHB is rapidly absorbed from the gut and distributes into the total body water compartment. Only a small fraction of the dose (1-2%) is excreted unchanged in the urine. The plasma elimination half-life of γ-hydroxybutyric acid is short, being only about 0.5-0.9 h, which requires timely sampling of blood and other biological specimens for clinical and forensic analysis. Endogenous concentrations of GHB in blood: GHB is both an endogenous metabolite and a drug of abuse, which complicates interpretation of the laboratory results of analysis. Moreover, the concentrations of GHB in blood and other specimens tend to increase after sampling, especially in autopsy cases. This requires the use of practical "cut-off" concentrations to avoid reporting false positive results. These cut-offs are different for different biological specimen types. Concentrations of GHB in clinical and forensic practice: As a recreational drug GHB is predominantly used by young males (94%) with a mean age of 27.1 years. The mean (median) and range of concentrations in blood from apprehended drivers was 90 mg/L (82 mg/L) and 8-600 mg/L, respectively. The concentration distributions in blood taken from living and deceased persons overlapped, although the mean (median) and range of concentrations were higher in intoxication deaths; 640 mg/L (280 mg/L) and 30-9200 mg/L, respectively. Analysis of GHB in alternative specimens: All biological fluids and. Body fluids for the analysis of GHB must be obtained as quickly as possible after a poisoned patient is admitted to hospital or after a person is arrested for a drug-related crime to enhance chances of detecting the drug. The sampling of urine lengthens the window of detection by 3-4 h compared with blood samples, but with longer delays between last intake of GHB and obtaining specimens, hair strands, and/or nails might be the only option. In postmortem toxicology, the concentrations of drugs tend to be more stable in bladder urine, VH, and CSF compared with blood, because these sampling sites are protected from the spread of bacteria from the gut. Accordingly, the relationship between blood and urine concentrations of GHB furnishes useful information when drug intoxication deaths are investigated.

Topics: Adult; Female; Forensic Toxicology; Humans; Illicit Drugs; Male; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Young Adult

Sexualised drug use (SDU) refers to the use of drugs in a sexual context. This includes 'Chemsex'- the use of drugs (specifically crystal methamphetamine, GHB/GBL and mephedrone) before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience. Here we aimed to synthesise available UK prevalence data for Chemsex, SDU and the use of Chemsex drugs in an undefined context (CDU) in men who have sex with men (MSM).. Papers published between January 2007 and August 2017 reporting Chemsex, SDU and/or Chemsex drug use (CDU) prevalence in MSM were identified through PubMed. Citations were searched for further eligible publications. We also conducted a review of national surveillance data, extracting prevalence data for Chemsex, SDU or CDU. Synthesized data were then assessed to determine the time at which these drugs were taken, in this case just prior to or during sexual activity (event-level).. Our search identified 136 publications, of which 28 were included in the final data synthesis. Three of the four surveillance systems assessed provided SDU or CDU data in MSM. Few publications included event-level data for Chemsex (n = 4), with prevalence estimates ranging from 17% among MSM attending sexual health clinics (SHC) to 31% in HIV-positive MSM inpatients. Prevalence estimates for SDU (n = 7 publications) also varied considerably between 4% in MSM receiving HIV care to 41% among MSM attending SHC for HIV post-exposure prophylaxis (PEP). Eighteen publications provided data for CDU.. Prevalence estimates varied considerably due to differences in the definition used and population assessed. Standardised definitions and studies with representative national samples of MSM are required to improve our understanding of the extent of Chemsex and its associated risks. Longitudinal event-level data for SDU and Chemsex are needed to monitor impact of interventions.

Topics: 4-Butyrolactone; Humans; Illicit Drugs; Methamphetamine; Sexual and Gender Minorities; Sodium Oxybate; Substance-Related Disorders; United Kingdom; Unsafe Sex

Drug-facilitated sexual assault (DFSA) is a sexual act in which the victim is unable to give or rescind consent due to intoxication with alcohol and/or drugs that have been self-administered (opportunistic DFSA) or covertly administered by the perpetrator (predatory DFSA). The drugs that are most commonly associated with DFSA are flunitrazepam and gamma-hydroxybutyric acid (GHB). They cause sedation and amnesia, are readily dissolved in beverages and are rapidly eliminated from the system. However, drugs such as amphetamine and cocaine, which are central nervous system (CNS) stimulants, have also been encountered in DFSA cases. This paper critically evaluates trend data from cohort studies, identifying drugs that have been detected in DFSA cases and reports on the differences in drugs used between opportunistic and predatory DFSA. This is the first time that a critical multifactorial review of drugs used in DFSA has been conducted. The pharmacology of each identified group of drugs is presented, showing why these compounds are of interest and used in the perpetration of DFSA. Furthermore, the pharmacology and mechanisms of action are described to explain how the drugs cause their effects. It is also apparent from this study that if meaningful data is to be exchanged between law enforcement agencies then it is necessary to agree on protocols for the collection of evidence and the drugs for which analysis should be performed and indeed on the analytical methods used.

Topics: Analgesics, Opioid; Antidepressive Agents; Barbiturates; Benzodiazepines; Cannabis; Central Nervous System Stimulants; Cocaine; Crime Victims; Dose-Response Relationship, Drug; Forensic Toxicology; Half-Life; Histamine Antagonists; Humans; Sex Offenses; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

γ-Hydroxybutyrate (GHB) is a common drug of abuse and poses important health risks to users in the form of respiratory, cardiovascular, mental, or traumatic adverse events. GHB has non-dose-proportional effects and pharmacologic effects such as sedation and retrograde amnesia, which can incapacitate people targeted for assault. It has Krebs cycle metabolism, rapid clearance, relative hydrophilicity, and unique drug interactions. Promptly seeking medical attention during intentional or inadvertent overdose is critical to survival, as is prompt supportive care once medical personnel are alerted. People drugged before assault also need to promptly notify authorities because the period to detect the drug in the urine or blood is brief and the ultimate metabolites are carbon dioxide and water. After acute treatment has passed, withdrawal could be severe in chronic abusers that could harm the patient directly or drive them back into reuse.

Topics: Anesthetics, Intravenous; Animals; Drug Overdose; Humans; Illicit Drugs; Rape; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

The misuse of γ-hydroxybutyrate (GHB) for recreational purposes has resulted in an increase in GHB-related problems such as intoxications, dependence and withdrawal in several countries in Europe, Australia and the US over the last decade. However, prevalence rates of misuse of GHB and its precursor, γ-butyrolactone (GBL), are still relatively low. In this qualitative review paper, after a short introduction on the pharmacology of GHB/GBL, followed by a summary of the epidemiology of GHB abuse, an overview of GHB dependence syndrome and GHB/GBL withdrawal syndrome is provided. Finally, the existing literature on management of GHB detoxification, both planned and unplanned, as well as the available management of GHB withdrawal syndrome, is summarized. Although no systematic studies on detoxification and management of withdrawal have been performed to date, general recommendations are given on pharmacological treatment and preferred treatment setting.

Topics: 4-Butyrolactone; Animals; Humans; Inactivation, Metabolic; Secondary Prevention; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

x03B3;-Hydroxybutyrate (GHB) has gained popularity as a drug of abuse. In the Netherlands the number of patients in treatment for GHB dependence has increased sharply. Clinical presentation of GHB withdrawal can be life threatening. We aim, through this overview, to explore the neurobiological pathways causing GHB dependency and withdrawal, and their implications for treatment choices.. In this work we review the literature discussing the findings from animal models to clinical studies focused on the neurobiological pathways of endogenous but mainly exogenous GHB.. Chronic abuse of GHB exerts multifarious neurotransmitter and neuromodulator effects on x03B3;-aminobutyric acid (GABA), glutamate, dopamine, serotonin, norepinephrine and cholinergic systems. Moreover, important effects on neurosteroidogenesis and oxytocin release are wielded. GHB acts mainly via a bidirectional effect on GABAB receptors (GABABR; subunits GABAB1 and GABAB2), depending on the subunit of the GIRK (G-protein-dependent ion inwardly rectifying potassium) channel involved, and an indirect effect of the cortical and limbic inputs outside the nucleus accumbens. GHB also activates a specific GHB receptor and β1-subunits of α4-GABAAR. Reversing this complex interaction of neurobiological mechanisms by the abrupt cessation of GHB use results in a withdrawal syndrome with a diversity of symptoms of different intensity, depending on the pattern of GHB abuse.. The GHB withdrawal symptoms cannot be related to a single mechanism or neurological pathway, which implies that different medication combinations are needed for treatment. A single drug class, such as benzodiazepines, gabapentin or antipsychotics, is unlikely to be sufficient to avoid life-threatening complications. Detoxification by means of titration and tapering of pharmaceutical GHB can be considered as a promising treatment that could make polypharmacy redundant.

Topics: Animals; Brain; Humans; Neurons; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Experimental studies on the impairing effects of drugs of relevance to driving-related performance published between 1998 and 2015 were reviewed. Studies with on-the-road driving, driving simulators, and performance tests were included for benzodiazepines and related drugs, cannabis, opioids, stimulants, GHB, ketamine, antihistamines, and antidepressants. The findings in these experimental studies were briefly discussed in relation to a review of epidemiological studies published recently. The studies mainly concluded that there may be a significant psychomotor impairment after using benzodiazepines or related drugs, cannabis, opioids, GHB, or ketamine. Low doses of central stimulants did not seem to cause impairment of driving behavior.

Topics: Analgesics, Opioid; Antidepressive Agents; Benzodiazepines; Cannabis; Central Nervous System Stimulants; Dose-Response Relationship, Drug; Driving Under the Influence; Forensic Toxicology; Histamine Antagonists; Humans; Ketamine; Sodium Oxybate; Substance-Related Disorders

Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4-butanediol (1,4-BD) use extracted from the UK's National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%); young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0-6500; SD 758)mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.

Topics: 4-Butyrolactone; Butylene Glycols; Female; Humans; Male; Sodium Oxybate; Substance-Related Disorders; United Kingdom

The illicit recreational drug of abuse, γ-hydroxybutyrate (GHB) is a potent central nervous system depressant and is often encountered during forensic investigations of living and deceased persons. The sodium salt of GHB is registered as a therapeutic agent (Xyrem®), approved in some countries for the treatment of narcolepsy-associated cataplexy and (Alcover®) is an adjuvant medication for detoxification and withdrawal in alcoholics. Trace amounts of GHB are produced endogenously (0.5-1.0 mg/L) in various tissues, including the brain, where it functions as both a precursor and a metabolite of the major inhibitory neurotransmitter γ-aminobutyric acid (GABA). Available information indicates that GHB serves as a neurotransmitter or neuromodulator in the GABAergic system, especially via binding to the GABA-B receptor subtype. Although GHB is listed as a controlled substance in many countries abuse still continues, owing to the availability of precursor drugs, γ-butyrolactone (GBL) and 1,4-butanediol (BD), which are not regulated. After ingestion both GBL and BD are rapidly converted into GHB (t½ ~1 min). The Cmax occurs after 20-40 min and GHB is then eliminated from plasma with a half-life of 30-50 min. Only about 1-5% of the dose of GHB is recoverable in urine and the window of detection is relatively short (3-10 h). This calls for expeditious sampling when evidence of drug use and/or abuse is required in forensic casework. The recreational dose of GHB is not easy to estimate and a concentration in plasma of ~100 mg/L produces euphoria and disinhibition, whereas 500 mg/L might cause death from cardiorespiratory depression. Effective antidotes to reverse the sedative and intoxicating effects of GHB do not exist. The poisoned patients require supportive care, vital signs should be monitored and the airways kept clear in case of emesis. After prolonged regular use of GHB tolerance and dependence develop and abrupt cessation of drug use leads to unpleasant withdrawal symptoms. There is no evidence-based protocol available to deal with GHB withdrawal, apart from administering benzodiazepines.

Topics: Animals; Drug Interactions; Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adolescent Behavior; Adolescent Medicine; Amphetamines; Flunitrazepam; Hallucinogens; Humans; Illicit Drugs; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; United States

The use of novel psychoactive substances ('legal highs' or 'designer drugs') is increasing worldwide. Patients misusing such substances have been reported to experience severe or prolonged side effects requiring admission to acute or critical care wards. These complications can be life threatening if misdiagnosed or mismanaged. As physicians have traditionally had less involvement with the management of such patients compared with their colleagues in emergency departments an update in the management of such patients is indicated. Here we present a summary of the management of those novel substances with the potential for serious complications based on a review of current literature.

Topics: Alkaloids; Cannabinoid Receptor Agonists; Designer Drugs; Humans; Piperazine; Piperazines; Psychotropic Drugs; Sodium Oxybate; Substance-Related Disorders

Topics: Adult; Electroencephalography; Humans; Male; Neurons; Neurotoxicity Syndromes; Sodium Oxybate; Substance-Related Disorders; Video Recording

The drug abusing patient can provide a management dilemma for health care providers including nurses, obstetrician, anesthesiologist, and pediatrician. Certain illicit drugs may mimic other diseases of pregnancy and result in inappropriate treatment for the mother and child. Pain management may be challenging in such patients because of increasing drug tolerance and increased sensitivity to pain. This article highlights the clinical presentation in a pregnant patient who may have recently used some of the more commonly abused drugs. The ability to identify such a patient is crucial so that the appropriate screening and treatment can occur.

Topics: Amphetamines; Cocaine; Ethanol; Female; Humans; Inhalant Abuse; Labor, Obstetric; Opioid-Related Disorders; Pain Management; Pregnancy; Pregnancy Complications; Sodium Oxybate; Substance-Related Disorders

Topics: Alkaloids; Anesthetics, Dissociative; Anesthetics, Intravenous; Butylene Glycols; Central Nervous System Stimulants; Humans; Illicit Drugs; Ketamine; Primary Health Care; Referral and Consultation; Sodium Oxybate; Substance-Related Disorders

In several countries, including the Netherlands, the use of GHB seems to be rising. GHB is regarded by recreational users as an innocent drug without any side effects. Recently, the number of patients in treatment due to GHB addiction sharply increased. In addition, various studies report incidents following risky GHB use or GHB overdosing. Other sedative drugs, like ketamine and alcohol have been shown to result in unintended neurotoxic harm at the level of memory and cognitive function. As outlined in the present review, GHB and ketamine have a common mode of action, which suggests that GHB may also lead to similar neurotoxicity as ketamine. GHB overdosing, as well as binge drinking (and high ketamine doses), induce profound coma which is probably neurotoxic for the brain especially in the maturing brain of young adults. It is therefore advocated to investigate possible long-term neurotoxic effects in recreational GHB users e.g. by studying the residual effects on cognition and memory.

Topics: Alcoholism; Anesthetics; Anesthetics, Dissociative; Animals; Central Nervous System Depressants; Cognition Disorders; Coma; Drug Overdose; Ethanol; Glutamic Acid; Humans; Illicit Drugs; Ketamine; Neurotoxicity Syndromes; Oxidative Stress; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Succinate-Semialdehyde Dehydrogenase

Gammabutyrolactone is included in the solvent such as wheel cleaners, pesticides, cosmetics, drugs. After ingestion GBL is converted to gamma-hydroxybutyrate. Both substances are classified as so called "club drugs" and their action is characterized by euphoria, sedation, and induction of retrograde amnesia of events. These activities were basis for the use of GHB and its lactone as rape pill. Acute poisoning with these compounds causes confusion, agitation, ataxia, nausea, vomiting, nystagmus, dyskinesia, hallucinations, coma, irregular breathing, hypothermia, bradycardia, hypotension, convulsions, respiratory paralysis and thus respiratory arrest. These substances carry a risk of development of physical addiction of the hard proceeding of abstinence syndrome. In the USA there is a ban on the sale and promotion of these compounds. In Poland despite the fact that GHB is a controlled substance, there is no regulation of GBL trading. The aim of this paper is to summarize current knowledge regarding the pharmacology, impact on the human body, toxicity, and the effects of chronic abuse of these substances.

Topics: 4-Butyrolactone; Acidosis; Amnesia, Retrograde; Drug Overdose; Euphoria; Humans; Sodium Oxybate; Solvents; Substance Abuse Detection; Substance-Related Disorders

γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention.

Topics: Adolescent; Adult; Female; Humans; Illicit Drugs; Male; Middle Aged; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; United States; Young Adult

Gamma-hydroxybutyric acid (GHB, "liquid ecstasy") and its legal prodrugs gamma-butyrolactone and 1,4-butanediol are gaining importance as recreational drugs in Germany. Because of the wide availability of GHB and its prodrugs physicians are increasingly being confronted with cases of intoxication. The effect of GHB intoxication is comparable with those of alcohol and/or benzodiazepines. Likewise, symptoms of withdrawal may occur. In this review, we summarise current data regarding the history, pharmacodynamics and pharmacokinetics of the drug as well as the relevant symptoms of intoxication or withdrawal as they pertain to neurology and psychiatry.

Topics: Adolescent; Germany; Humans; Illicit Drugs; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

Designer drugs belong to a group of legally or illegally produced substances that are structurally and pharmacologically very similar to illicit drugs. In the past, designer drugs were often used during all-night dance parties, but they are now consumed in multiple settings from college bars to parks to private house parties. Most of these club drugs can be bought on legal websites and home-delivered for private parties. Recently, legal highs have once again become a burning media issue across the world. Our review will focus on GHB and synthetic cathinones. Literature searches were conducted for the period from 1975 to July 2010 using PubMed, EMBASE, PsycInfo, Internet underground and governmental websites using the following keywords alone or in combination: designer drugs, club drugs, party drugs, GHB, synthetic cathinones, mephedrone, methylone, flephedrone, MDAI, and MDVP. Available epidemiological, neurobiological, and clinical data for each compound are described. There is evidence that negative health and social consequences may occur in recreational and chronic users. The addictive potential of designer drugs is not weak. Non-fatal overdoses and deaths related to GHB/GBL or synthetic cathinones have been reported. Clinicians must be careful with GBL or synthetic cathinones, which are being sold and used as substitutes for GHB and MDMA, respectively. Interventions for drug prevention and harm reduction in response to the use of these drugs should be implemented on the Internet and in recreational settings. Prevention, Information, Action, and Treatment are the main goals that must be addressed for this new potentially addictive problem.

Topics: Alkaloids; Animals; Designer Drugs; Humans; Illicit Drugs; Indans; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is naturally present in the human body, but may also be used as an intoxicating drug. Information from several sources has suggested its increased availability and use in Norway. There have also been reports of an increasing use of the chemical precursor gamma-butyrolactone (GBL).There is currently a need for knowledge on symptoms, addictiveness and overdoses, as well as targeted preventive measures.. The article is based on a discretionary selection of articles resulting from a literature search in PubMed, as well as reports from Norwegian and European authorities and research institutions.. An intake of small amounts of GHB produces an intoxicating effect, whereas higher doses can result in poisoning. Deaths have been reported. The effect may be variable, due to a steep dose-response curve and interaction with alcohol and other intoxicants. Treatment of poisoning is symptomatic and supportive. Treatment of abstinence is also supportive, while delirium may be treated as delirium tremens.. Preventive measures should be tailored specifically to potential user-groups.

Topics: 4-Butyrolactone; Citric Acid Cycle; Drug Overdose; Europe; Humans; Illicit Drugs; Norway; Sodium Oxybate; Solvents; Substance Withdrawal Syndrome; Substance-Related Disorders

Although being a relatively old phenomenon, drug-facilitated crime has been well described over the past 20 years as being the administration without the knowledge of the victim of a psychoactive substance in criminal purposes (rape, robbery, theft, money extortion, even murder). Drug-facilitated crime involves also mistreatment of older people or children treated by their parents in order to obtain sedation. Drug-facilitated crimes are often difficult to solve mainly due to analytical issues. Since 10 years, we developed and improved specific methods using LC-MS/MS (benzodiazepines, neuroleptics) and GC-MS/MS (GHB, cannabis) to detect the drugs involved in such crimes. After the intake of a low dosage of a particular drug, those methods allow to detect the analyte of interest up to 3-5 days in blood, 10-15 days in urine, and more than 1 year in hair. In drug-facilitated crime cases, blood and urine are frequently collected too late, more than 12 h after the drug intake and in some cases with a delay greater than 48 h after the event. Thus, the most used molecules are undetectable by the techniques classically used in a laboratory of biology. Moreover, a "good" compound that can be used to commit a drug-facilitated crime usually possesses a short elimination half-life and amnesic properties, so that the victim is less able to accurately recall the circumstances under which the offence occurred. The recent progress in analytical toxicology, particularly for laboratories working in the field of forensic toxicology, permits to elucidate many cases of drug-facilitated crimes. Heaven to the introduction of the sequential analysis of hair and the use of sophisticated analytical techniques such as tandem mass-spectrometry for the toxicologist to bring the scientific proof to the applicant authorities in the description of the criminal act and to confuse the offender. The author presents the results of 583 presumed cases of drug-facilitated crimes analyzed by his laboratory specialized in forensic toxicology. One hundred and seventy of those cases were confirmed by the analyses of the blood and/or the urine and/or hair, in which molecules frequently encountered, were identified.

Topics: Crime; Dose-Response Relationship, Drug; Forensic Medicine; France; Hair; Humans; Pharmaceutical Preparations; Saliva; Sodium Oxybate; Substance-Related Disorders

In recent years, there has been a notable increase in the number of reports of drug-facilitated crimes (DFCs). Usually, individuals report that they were robbed or assaulted while incapacitated by drugs. Most often, these cases have involved drugs that have the ability to produce an effect that leaves the victim in a semiconscious or unconscious state. It is reasonable to assume that the purpose of drug-induced incapacitation is probably largely unchanged with time. This covers the full range of property offences (particularly theft) and crimes against the person. What have changed are the drugs themselves: the number; type; their accessibility; effects and detection. The purpose of this review is to explore the different aspects related to the involvement and use of ethanol, sedative-hypnotics drugs, gamma-hydroxybutyrate (GHB) and ketamine in DFCs or offences, which may help people working in this field to expand their knowledge for better understanding of the nature of these crimes or offences.

Topics: Alcohol Drinking; Anesthetics, Dissociative; Crime; Humans; Hypnotics and Sedatives; Ketamine; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyric acid (GHB) is a neurotransmitter that occurs naturally in the brain and is increasingly being used as a 'party drug' because of its relaxing and euphoria-inducing effects. GHB has a limited medical use in the treatment of narcolepsy. GHB-intoxications occur often in non-medical use, and generally result in a coma of short duration. GHB use several times a day can lead to tolerance and dependence. After sudden cessation or reduction of intensive GHB use, a severe withdrawal syndrome may occur with symptoms varying from tremor, anxiety and agitation to autonomic instability, hallucinations and delirium. Treatment of the GHB withdrawal syndrome consists of supportive care and benzodiazepines, often in high doses. The controlled detoxification of GHB using pharmaceutical GHB in an adjusted dose is currently being investigated in the Netherlands. There is no literature concerning the treatment of patients following GHB intoxication or after detoxification.

Topics: Adjuvants, Anesthesia; Coma; Drug Tolerance; Humans; Narcolepsy; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Six criteria described in the New Zealand Misuse of Drugs Act and used by the Expert Advisory Committee on Drugs (EACD) for determining the risk of a drug to public health were examined in relation to ethanol, using gamma-hydroxybutyric acid (GHB) as a comparator drug. GHB is an ideal candidate for use as a comparator because it is a sedative substance very similar to ethanol and has been previously investigated by the EACD using these six criteria. GHB was subsequently classified as a Class B1 drug under the Misuse of Drugs Act, that is, as a prohibited drug of high risk to public health. The dangerousness level of ethanol was found to be at least similar to that of GHB in this analysis. This highlights a major discrepancy in public policy.

Topics: Central Nervous System Depressants; Ethanol; Government Regulation; Humans; Legislation, Drug; New Zealand; Public Health; Risk Assessment; Risk Factors; Sodium Oxybate; Substance-Related Disorders

There is an increasing interest in studying the role of GABAergic medications in the treatment of alcohol dependence. The GABAergic drug gamma-hydroxybutyric acid (GHB) has been investigated in Europe as a possible treatment for alcohol dependence. In some European Countries, GHB has been approved as a treatment for alcohol dependence. However, this drug has also shown addictive properties, therefore raising questions about its safety in treating alcohol-dependent subjects. More recent research is focusing on the possibility of identifying alcohol-dependent subtypes without risk of developing GHB abuse. Finally, GHB and naltrexone combined together represent a possible approach deserving future investigations.

Topics: Alcoholism; Animals; Clinical Trials as Topic; Humans; Risk Factors; Sodium Oxybate; Substance-Related Disorders

There are distinct differences in the accessibility, purity, dosing, and misuse associated with illicit gamma-hydroxybutyrate (GHB) compared to pharmaceutical sodium oxybate. Gamma-hydroxybutyrate sodium and sodium oxybate are the chemical and drug names, respectively, for the pharmaceutical product Xyrem (sodium oxybate) oral solution. However, the acronym GHB is also used to refer to illicit formulations that are used for non-medical purposes. This review highlights important differences between illicit GHB and sodium oxybate with regard to their relative abuse liability, which includes the likelihood and consequences of abuse. Data are summarized from the scientific literature; from national surveillance systems in the U.S., Europe, and Australia (for illicit GHB); and from clinical trials and post-marketing surveillance with sodium oxybate (Xyrem). In the U.S., the prevalence of illicit GHB use, abuse, intoxication, and overdose has declined from 2000, the year that GHB was scheduled, to the present and is lower than that of most other licit and illicit drugs. Abuse and misuse of the pharmaceutical product, sodium oxybate, has been rare over the 5 years since its introduction to the market, which is likely due in part to the risk management program associated with this product. Differences in the accessibility, purity, dosing, and misuse of illicit GHB and sodium oxybate suggest that risks associated with illicit GHB are greater than those associated with the pharmaceutical product sodium oxybate.

Topics: Chemistry, Pharmaceutical; Humans; Illicit Drugs; Narcolepsy; Rape; Risk Management; Sodium Oxybate; Substance-Related Disorders

The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as it's physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists.. In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment.. High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death.. Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.

Topics: 4-Butyrolactone; Acute Disease; Adolescent; Anesthetics, Intravenous; Antipsychotic Agents; Benzodiazepines; Butylene Glycols; Child; Critical Care; Delusions; Diagnosis, Differential; Drug Interactions; Humans; Psychoses, Substance-Induced; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

This study reviewed the cumulative postmarketing and clinical safety experience with sodium oxybate (Xyrem), a treatment approved for cataplexy and excessive daytime sleepiness in narcolepsy. Study objectives were to investigate the occurrence of abuse/misuse of sodium oxybate since first market introduction in 2002, classify cases using DSM-IV criteria for substance abuse and dependence, and describe specific characteristics of these cases.. We retrospectively reviewed postmarketing spontaneous adverse event (AE) reports from 15 countries for all cases containing reporting terminology related to abuse/misuse to determine its occurrence. All death cases independent of causality were reviewed to identify associated risk factors.. Approximately 26,000 patients worldwide received sodium oxybate from first market introduction in 2002 through March 2008. Of those 26,000 patients, 0.2% reported > or = 1 of the events studied. These included 10 cases (0.039%) meeting DSM-IV abuse criteria, 4 cases (0.016%) meeting DSM-IV dependence criteria, 8 cases (0.031%, including 3 of the previous 4) with withdrawal symptoms reported after discontinuation of sodium oxybate, 2 confirmed cases (0.008%) of sodium oxybate-facilitated sexual assault, 8 cases (0.031%) of overdose with suicidal intent, 21 deaths (0.08%) in patients receiving sodium oxybate treatment with 1 death known to be related to sodium oxybate, and 3 cases (0.01%) of traffic accidents involving drivers taking sodium oxybate. During this period, approximately 600,000 bottles of sodium oxybate were distributed, and 5 incidents (0.0009%) of diversion were reported.. Cumulative postmarketing and clinical experience indicates a very low risk of abuse/misuse of sodium oxybate.

Topics: Accidents, Traffic; Central Nervous System Depressants; Disorders of Excessive Somnolence; Drug Overdose; Drug Utilization; Drug-Related Side Effects and Adverse Reactions; Humans; Product Surveillance, Postmarketing; Rape; Risk; Sodium Oxybate; Substance-Related Disorders

Reported incidences of drug-facilitated sexual assault (DFSA) are on the increase worldwide. These cases represent a particular challenge for the forensic toxicologist due to the difficulty in obtaining adequate evidence of drug administration. Primarily, this is due to the nature and diversity of the drugs involved, their pharmacology and sampling timescales. Evaluating whether a drug has been administered to a victim for the purpose of sexual assault can often be difficult, if not impossible. This review draws attention to this burgeoning crime and focuses on the unique challenges DFSA cases present in terms of evidential analysis. Current analytical methodologies for investigating DFSA are highlighted and discussed along with developments in improving analytical procedures. In particular, enlarging detection windows by adopting emerging LC-MS techniques is also discussed. This review also highlights the use of cutting-edge technologies such as ultra-HPLC and the use of alternative matrices for addressing the problem of improved retrospective drug detection.

Topics: Female; Flunitrazepam; Forensic Toxicology; Humans; Hypnotics and Sedatives; Male; Sex Offenses; Sodium Oxybate; Substance-Related Disorders

The discovery of gamma-hydroxybutyrate (GHB) over 40 years ago led to its immediate use as a general anesthetic agent. Subsequent research demonstrated that GHB is an endogenous compound in the mammalian brain and current research suggests that GHB is a probable neurotransmitter. In the United States, reports of anabolic effects lead to its misuse among body builders during the 1980's while the intoxicating properties of the drug lead to its popularization as a substance of abuse during the 1990's. GHB became associated with reports of drug-facilitated sexual assault and cases of physical dependence and withdrawal. Efforts to ban GHB caused increased use of GHB analogues and pro-drugs. Against this backdrop, GHB was being developed for the treatment of narcolepsy, leading to the approval of Xyrem (sodium oxybate) oral solution in 2002 for the treatment of cataplexy in patients with narcolepsy. A risk management program permits the safe handling and distribution of the approved product, minimizes the risk for diversion, provides professional and patient education about the risks and benefits of sodium oxybate, and includes physician and patient registries. Post-marketing surveillance indicates sodium oxybate has an acceptable safety profile and presents minimal risk for the development of physical dependence.

Topics: Anesthetics, Intravenous; Clinical Trials as Topic; Drug Design; History, 20th Century; Humans; Product Surveillance, Postmarketing; Risk Management; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is a drug of abuse that causes euphoria, anxiolysis, and hypnosis. The recent rise in the recreational intake of GHB, as well as its association with 'drug rape', has turned the attention to GHB in acute hospital settings. Acutely admitted GHB intoxicated patients may display various levels of sedation or coma, but may also show paradoxical agitation, combativeness, or self-injurious behaviors. The symptoms can be nonspecific and the definite diagnosis therefore normally relies on the detection of GHB in blood or body fluids, which is an analysis that may not be promptly available. As a basis for understanding the clinical features of GHB intoxication and abuse, we here review the pharmacological and neurophysiological knowledge about GHB, which stems from decades of clinical and basic GHB research. In addition, we discuss the latest discoveries in the quest for distinct GHB receptors in the brain, and their possible implications for future therapies of GHB abuse.

Topics: Adjuvants, Anesthesia; Brain; Humans; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is a short fatty acid and physiologic neurotransmitter. Initially, it was synthesized as a GABA agonist and used as a narcotic agent, because it rapidly induces sleep without major cardiovascular or respiratory side effects. Recently, a specific GHB receptor was identified, but while the clinical use of GHB as an anaesthetic was reduced due to putative pro-convulsive effects, it now is used to treat alcohol withdrawal and sleep disorders. Furthermore, GHB was postulated to be a regulator of energy metabolism, and tissue-protective effects were demonstrated in different animal models. Besides its clinical use, GHB (also called "liquid ecstasy") is increasingly consumed in the disco scene because of its mild sedative and euphoric effects. Intoxication from GHB is common with GHB users. For this reason and because GHB is not easy to detect, it is important to be aware of the symptoms of GHB intoxication. Moreover, some recent case reports document the danger of GHB dependence.

Topics: Alcohol Withdrawal Delirium; Anesthetics, Intravenous; Brain; Humans; Neurotransmitter Agents; Sleep Wake Disorders; Sodium Oxybate; Substance-Related Disorders; Treatment Outcome

The recreational use of gamma hydroxy butyrate (GHB) has gained popularity over the last decade. GHB was initially sold as a safe body building and fat burning compound. It is now also widely abused by body builders and young ravers. GHB attracts young people due the euphoria that it initially produces, and the claimed increase in sociability and sexual function (it is also known as liquid Ecstasy). Over the last few years, there has been an increase in the number of cases of GHB intoxication, dependence and severe withdrawal, as reported in medical literature. The situation is complicated by the use of GHB analogues, other toxic chemicals that are easily converted into GHB. GHB has recently been classified as a class 'C' drug in the UK, but no provisions were made in relation to GHB analogues. GHB has been increasingly used in rape cases due to its capacity to produce intoxication and amnesia. The management of patients dependent on GHB is rather complicated due to the high doses of medication that they require to control withdrawal symptoms.

Topics: Adult; Anabolic Agents; Anesthetics, Intravenous; Humans; Male; Rage; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Four different "club drugs" are reviewed: MDMA (methylenedioxymethamphetamine, "Ecstasy"), GHB (gamma-hydroxybutyrate), ketamine, and Rohypnol (flunitrazepam). The neurobiology, clinical pharmacology, and treatment issues for each are discussed.

Topics: Adjuvants, Anesthesia; Anesthetics, Dissociative; Dancing; Flunitrazepam; GABA Modulators; Hallucinogens; Humans; Illicit Drugs; Ketamine; N-Methyl-3,4-methylenedioxyamphetamine; Recreation; Sodium Oxybate; Substance-Related Disorders

The use of "club drugs" such as MDMA, ketamine, and GHB appears to have increased in Western countries over the last 20 years, and Australia is no exception to that trend. While levels of use appear to be relatively low in the general population, among users of these drugs a number of adverse health and psychological problems, including dependence, have been reported. MDMA or ecstasy is the third most commonly used illicit drug in Australia, and relatively more information is available on its use in Australia than of drugs such as GHB or ketamine. Although there are no population level data available, levels of ketamine use in the general population appear to be lower than those of MDMA. In addition, the harms reported by recreational users are not excessive and the mortality rate is low. At the individual level, many of those who experiment find the effects aversive and do not persist. The harms that require further investigation are the association between ketamine and unsafe sex and injecting behaviors, the neurotoxic effects, and use in situations where there is a heightened risk of accidental death when the user's cognition is grossly impaired. In contrast, while least is known of the epidemiology of GHB use, there is mounting evidence suggesting significant acute and long-term risks associated with the use of this drug. This suggests an urgent need for international research on the patterns of use, health, and psychosocial consequences of GHB use. In order to address public health issues associated with a range of club drug use, there is a need for research to identify the trends in population prevalence of these drugs. This could be most easily achieved by the inclusion of MDMA, ketamine, and GHB in household surveys that are currently collected routinely in a number of countries.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Anesthetics, Dissociative; Australia; Cognition Disorders; Female; Hallucinogens; Humans; Ketamine; Male; N-Methyl-3,4-methylenedioxyamphetamine; Prevalence; Recreation; Risk Factors; Risk-Taking; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders

Drug abuse affects a significant number of individuals of all ages. Health care practitioners must be knowledgeable about both the physiological effects of such drugs and the impact of drug-seeking behavior on their patients.

Topics: 4-Butyrolactone; Catha; Designer Drugs; Dibenzothiazepines; Diterpenes; Diterpenes, Clerodane; DOM 2,5-Dimethoxy-4-Methylamphetamine; Drug and Narcotic Control; Flunitrazepam; Hallucinogens; Humans; Illicit Drugs; Ketamine; Lysergic Acid Diethylamide; Methamphetamine; Motivation; N-Methyl-3,4-methylenedioxyamphetamine; Phencyclidine; Phenylpropanolamine; Piperazines; Psilocybin; Quetiapine Fumarate; Sodium Oxybate; Substance-Related Disorders; United States

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug over-dose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Topics: Anesthetics, Dissociative; Drug Overdose; Flunitrazepam; Hallucinogens; Humans; Ketamine; Leisure Activities; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

To examine the clinical course of gamma-hydroxybutyrate (GHB) withdrawal and generate management guidelines.. Review and analysis of all published reports of GHB or GHB precursor withdrawal identified from electronic searches.. In total, 38 cases of GHB (n = 28) or GHB precursor (n = 10) withdrawal were identified, 36 of which were from the US. A rapidly deteriorating course into delirium (53% of cases) was typical for heavily dependent users. Symptoms were broadly similar to alcohol withdrawal but often occurred earlier in usage with delirium being associated with severe dependence as determined by more frequent ingestion. High dose benzodiazepines were effective in pharmacological management of GHB withdrawal. In benzodiazepine refractory cases withdrawal responded to other sedative agents, mainly pentobarbital or chloral hydrate. No withdrawal seizures but one death was recorded.. GHB withdrawal is potentially life threatening and requires vigorous clinical management, preferably as an inpatient for severe cases. A management algorithm is proposed.

Topics: Female; Humans; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

gamma-Hydroxybutyrate (GHB) is a GABA-active CNS depressant, commonly used as a drug of abuse. In the early 1990s, the US Drug Enforcement Administration (DEA) warned against the use of GHB and restricted its sale. This diminished availability of GHB caused a shift toward GHB analogues such as gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) as precursors and surrogates. Both GBL and 1,4-BD are metabolically converted to GHB. Furthermore, GBL is commonly used as a starting material for chemical conversion to GHB. As such, the clinical presentation and management of GBL and 1,4-BD intoxication shares a great deal of common ground with that for GHB. This similarity exists not only for acute intoxication but also for withdrawal in those patients with a history of extended high-dose abuse. This review examines the history of GHB analogue abuse as well as the clinical presentation and management of acute intoxication and withdrawal associated with abuse of these compounds.

Topics: 4-Butyrolactone; Body Temperature Regulation; Butylene Glycols; GABA Modulators; Humans; Illicit Drugs; Seizures; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

gamma-Hydroxybutyrate (GHB) is endogenous inhibitory transmitter that, when administered in pharmacological doses, has sedative-hypnotic properties. It is used in anaesthesia for the treatment of narcolepsy/catalepsy and in alcohol/opioid detoxification treatment regimens. Based on its purported anabolic effects, GHB use became established among bodybuilders. As the euphorigenic effects of GHB became publicised, attendees at dance clubs and rave parties began to use it alone or in combination with other psychoactive drugs. Following the ban of GHB in 1990, several precursor products (e.g. gamma-butyrolactone, butanediol) became widely used as replacement drugs until their ultimate proscription from lawful use in 2000. GHB and its precursors, like most sedative-hypnotic agents, can induce tolerance and produce dependence. Although many GHB users will experience a mild withdrawal syndrome upon drug discontinuation, those with chronic heavy GHB use can experience severe withdrawal. This syndrome clinically resembles the withdrawal syndrome noted from alcohol and other sedative-hypnotic drugs (e.g. benzodiazepines). Distinct clinical features of GHB withdrawal are its relatively mild and brief autonomic instability with prolonged psychotic symptoms. Patients with fulminant GHB withdrawal require aggressive treatment with cross-tolerant sedative hypnotics, such as benzodiazepines.

Topics: 4-Butyrolactone; Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: 4-Butyrolactone; Adjuvants, Anesthesia; Administration, Oral; Anesthetics, Intravenous; Brain; Humans; Illicit Drugs; Sodium Oxybate; Solvents; Substance-Related Disorders; Switzerland; Time Factors

This article summarizes the short-term physiological toxicity and the adverse behavioral effects of four substances (GHB, ketamine, MDMA, and Rohypnol) that have been used at latenight dance clubs. The two primary data sources were case studies of human fatalities and experimental studies with laboratory animals. A safety ratio was calculated for each substance based on its estimated lethal dose and its customary recreational dose. GHB (gamma-hydroxybutyrate) appears to be the most physiologically toxic; Rohypnol (flunitrazepam) appears to be the least physiologically toxic. The single most risk-producing behavior of club drug users is combining psychoactive substances, usually involving alcohol. Hazardous drug-use sequelae such as accidents, aggressive behavior, and addiction were not factored into the safety ratio estimates.

Topics: Alcohol Drinking; Animals; Behavior; Drug Interactions; Flunitrazepam; Hallucinogens; Humans; Illicit Drugs; Ketamine; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Ecstasy (MDMA), gamma-hydroxybutyrate (GHB), ketamine, and methamphetamine are 4 examples of club drugs that are increasing in popularity. Although the pharmacological classifications of these drugs vary, MDMA has structural similarities to both amphetamine and the hallucinogen mescaline. Ketamine and GHB are anesthetic agents and methamphetamine is a long-acting psychostimulant. Medical visits for club drug-related toxicity have sharply increased across the country. This article provides a brief review of the literature on club drugs.

Topics: Central Nervous System Stimulants; Humans; Ketamine; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Topics: Adolescent; Adolescent Behavior; Anxiety Disorders; Humans; Illicit Drugs; Ketamine; Methamphetamine; Muscle Cramp; N-Methyl-3,4-methylenedioxyamphetamine; Risk-Taking; Sodium Oxybate; Substance-Related Disorders

The abuse of methylenedioxymethamphetamine (MDMA), flunitrazepam, ketamine hydrochloride, and gamma-hydroxybutyrate (GHB) is discussed. Club drugs are chemical substances used recreationally in social settings. Use is increasingly frequent among young people, especially during all-night dance parties. All four agents have been classified as controlled substances. MDMA ("ecstasy") is available as a tablet, a capsule, and a powder; formulations may contain many adulterants. MDMA increases the release of neurotransmitters. The desired effects are euphoria, a feeling of intimacy, altered visual perception, enhanced libido, and increased energy. The most common adverse effects are agitation, anxiety, tachycardia, and hypertension. More serious adverse effects include arrhythmias, hyperthermia, and rhabdomyolysis. Flunitrazepam is a potent benzodiazepine. At higher doses, the drug can cause lack of muscle control and loss of consciousness. Other adverse effects are hypotension, dizziness, confusion, and occasional aggression. Ketamine is a dissociative anesthetic used primarily in veterinary practice. It may be injected, swallowed, snorted, or smoked. Like phencyclidine, ketamine interacts with the N-methyl-D-aspartate channel. Analgesic effects occur at lower doses and amnestic effects at higher doses. Cardiovascular and respiratory toxicity may occur, as well as confusion, hostility, and delirium. GHB, a naturally occurring fatty acid derivative of gamma-aminobutyric acid, was introduced as a dietary supplement. Increasing doses progressively produce amnesia, drowsiness, dizziness, euphoria, seizures, coma, and death. Flunitrazepam, ketamine, and GHB have been used to facilitate sexual assault. Supportive care is indicated for most cases of club drug intoxication. The increasing abuse of MDMA, flunitrazepam, ketamine hydrochloride, and GHB, particularly by young people in social settings such as clubs, should put health care professionals on guard to recognize and manage serious reactions.

Topics: Flunitrazepam; Humans; Illicit Drugs; Ketamine; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Gamma hydroxybutyric acid (GHB) is a naturally occurring analog of gamma-aminobutyric acid (GABA) that has been used in research and clinical medicine for many years. In the past decade it has become very popular as a dietary supplement and recreational drug. Acute overdose leads to profound alteration of mental status and variable amounts of respiratory depression. With proper management, most patients recover fully within six hours. However, respiratory arrest and death have been reported in severe GHB intoxication. In addition to acute overdose, there is a GHB withdrawal syndrome that is similar to sedative/hypnotic and ethanol withdrawal. Recently several congeners of GHB, gamma butyrolactone and 1,4-butanediol, have emerged as drugs of abuse and show toxidromes similar to GHB. Emergency physicians should be familiar with the presentation and management of GHB-related emergencies.

Topics: Anesthetics; Animals; Antidotes; Drug Interactions; Humans; Prodrugs; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

There has been increasing attention in the United States to problems of abuse of gamma-hydroxybutyrate (GHB), with some evidence for problems in other parts of the world as well. In vitro and animal research show that, while GHB shares some properties with abused central nervous system depressant drugs, it has unique aspects of its pharmacology as well, including actions at a specific neural receptor which probably mediates many of its effects. Abuse potential assessment of GHB using standard animal models has not yielded a picture of a highly abusable substance, but little human testing has yet been done. Very little systematic data exist on tolerance and dependence with GHB, but both have been seen in human users. Quantitative data on the prevalence of GHB abuse is incomplete, but various qualitative measures indicate that a mini-epidemic of abuse began in the late 1980s and continues to the present. GHB is often included with the group of 'club drugs', and can be used as an intoxicant. It also has been used as a growth promoter and sleep aid and has been implicated in cases of 'date rape', usually in combination with alcohol. Undoubtedly the easy availability of GHB and some of its precursors has contributed to its popularity. Recent changes in the control status of GHB in the US may reduce its availability with as yet unknown consequences for the scope of the public health problem. Drug abuse experts need to familiarize themselves with GHB as possibly representing a new type of drug abuse problem with some unique properties.

Topics: Adjuvants, Anesthesia; Prevalence; Sodium Oxybate; Substance-Related Disorders

Illicit drug use by young people has changed in the last decade, with the increasing use of "designer" or "club" drugs such as ecstasy. Keeping abreast of current trends in illicit drug use prepares the primary care clinician to recognize the clinical effects of drug use, to manage drug emergencies, and to detect addictive behavior. Today's widely used drugs, their street names, their effects, and how to manage overdoses are reviewed.

Topics: 3,4-Methylenedioxyamphetamine; Adolescent; Ephedrine; Flunitrazepam; Humans; Illicit Drugs; Ketamine; Methamphetamine; Sodium Oxybate; Substance-Related Disorders

This report reviews the pharmacology, toxicity and abuse pattern of gamma-hydroxybutyrate (GHB). The legislative changes pertaining to this substance are also addressed. Examples of abuse, driving under the influence and fatal intoxication are given. It is concluded that GHB is widely abused, particularly among the younger generation, and that further cases of severe intoxication are likely to occur as long as the substance is easily available from countless sources, including via the Internet. Despite the classification of GHB as a narcotic in Sweden and several other countries, continued problems are expected since the precursors gamma-butyrolactone (GBL) and 1,4-butanediol (BD) are widely--and legally--available.

Topics: 4-Butyrolactone; Accidents, Traffic; Adult; Butylene Glycols; Drug and Narcotic Control; Fatal Outcome; Forensic Medicine; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders

During the past decade, several new drugs of abuse have emerged as public health concerns in Connecticut. These include ketamine, gamma-hydroxybutyrate, methylphenidate (Ritalin), and "Illy." Two trends stand out when one looks at these new drugs of abuse. First, drugs that have legitimate medical indications are being increasingly diverted for illicit purposes. Second, much of the information needed to acquire, synthesize, and use these drugs can be found on the Internet. While none of these newer agents is abused to the extent of heroin or cocaine, all of them have the potential to cause serious morbidity, and occasionally death. The goal of this article is to make Connecticut physicians aware of these emerging drugs of abuse. Emphasis is placed on recognizing the signs and symptoms produced by these drugs and on managing the complications that are associated with their use.

Topics: Cannabis; Connecticut; Female; Humans; Incidence; Ketamine; Male; Methylphenidate; Risk Assessment; Sodium Oxybate; Substance-Related Disorders

Topics: Adolescent; Adult; Alcohol Drinking; Autopsy; Cause of Death; Female; Heart Arrest; Humans; Male; Postmortem Changes; Respiratory Insufficiency; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is an illicitly marketed substance that has recently gained popularity among body builders and party attendees as a drug of abuse. GHB is a depressant that acts on the central nervous system. It is purported as a strength enhancer, euphoriant and aphrodisiac and is one of several agents reported as being used as a "date rape" drug. Because of its central nervous system depressant effects, GHB can be lethal when combined with alcohol or other depressants. Currently, there is no accepted medical use for GHB, and the U.S. Food and Drug Administration has prohibited its manufacture and sale. Clinicians should be familiar with the typical clinical presentation of GHB and its adverse effects. In addition, patients should be warned of its potential toxicity and be cautioned to avoid the use of GHB.

Topics: Central Nervous System Depressants; Coma; Counseling; Drug Interactions; Humans; Male; Mass Screening; Middle Aged; Narcotics; Patient Education as Topic; Sodium Oxybate; Substance-Related Disorders; Teaching Materials

GHB, GBL, and 1,4-BD are prevalent drugs of abuse in the United States. Unfortunately, attempts to regulate GHB have been circumvented by clandestine trafficking through the Internet and marketing of "natural" chemical precursors . Despite repeated FDA warnings to the public about their dangers as well as recent federal scheduling of GHB and GBL, they remain accessible as "club drugs" on Internet websites, as natural dietary supplements in health food stores, and as illicit products manufactured at home or in clandestine laboratories. EDs and poison control centers nationwide will undoubtedly continue to manage GHB, GBL, and 1,4-BD toxicities.

Topics: 4-Butyrolactone; Adjuvants, Anesthesia; Adolescent; Butylene Glycols; Emergency Medical Services; Female; Humans; Lorazepam; Seizures; Sodium Oxybate; Structure-Activity Relationship; Substance-Related Disorders; Treatment Outcome

Topics: Amphetamines; Analgesics, Opioid; Anesthetics, Intravenous; Cocaine; Drug Overdose; Emergency Treatment; Heroin; Humans; Narcotics; Poisoning; Sodium Oxybate; Substance-Related Disorders

During the last six months, the Poison Control Centre at Bispebjerg Hospital, Copenhagen, Denmark, has observed an increasing number of patients intoxicated with GHB, a drug of abuse. The patients are often admitted to the emergency ward shortly after having taken the drug, unconscious or comatose. If younger patients present with these symptoms, intoxication with GHB should be seriously considered. The effects are seen within 15 to 30 minutes after oral ingestion of the drug. Spontaneous recovery usually occurs within three to five hours. The most common effects are mild euphoria, sedation, vomiting, somnolence, bradycardia, aggressive behaviour, apnoea, respiratory depression, and coma. Normally the patient breathes adequately, but insufficient respiration may occur and deaths have been described. The drug is often consumed together with alcohol and other drugs of abuse, which strengthens the effect of GHB. Treatment is symptomatic. A review of the literature with special emphasis on clinical effects included toxicology and treatment is given.

Topics: Central Nervous System Stimulants; Drug Overdose; Emergencies; Humans; Illicit Drugs; Poisoning; Sodium Oxybate; Substance-Related Disorders

gamma-Hydroxybutyric acid (GHB) is unfamiliar to many physicians in the United States but enjoys clinical use elsewhere for applications in resuscitation, anesthesia, and addiction therapy. Use within the United States is restricted to Food and Drug Administration-approved clinical trials for treatment of narcolepsy. Recently illicit use of GHB has emerged within the United States where it is distributed for purported euphoric and "fat-burning" metabolic effects. Clinical effects can be severe, progressing rapidly to respiratory arrest and death. We provide an updated comprehensive review of the literature with particular emphasis on toxicology, including GHB pharmacodynamics, clinical effects, and suggestions for overdose management. Recommended management of acute GHB intoxication includes prevention of aspiration, use of atropine for persistent symptomatic bradycardia, consideration of neostigmine as a reversal agent, and treatment for coingested substances. Emergency physicians are urged to become familiar with GHB because of its potential for severe morbidity as well as its potential use as a future resuscitative agent.

Topics: Adjuvants, Anesthesia; Animals; Drug Overdose; Humans; Sodium Oxybate; Substance-Related Disorders

Recreational drug use continues to be prevalent in many social settings. These drugs are alleged to enhance sociability and liberate inhibitions, allowing the user to experience feelings of euphoria. This article reviews recreational drugs that have gained notoriety in the 1990s including gamma-hydroxybutyrate (GHB), flunitrazepam, and amphetamine analogues such as 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethylamphetamine (MDEA). Topics discussed include history, drug use and misuse, clinical presentation and treatment, and laboratory analysis.

Topics: Amphetamine-Related Disorders; Flunitrazepam; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyric acid (GHB) is no longer used as an anaesthetic induction agent because of the high incidence of myoclonic seizures and vomiting. However, it is used occasionally in Europe for the treatment of narcolepsy, alcohol dependence and opiate dependence. Since the early 1990s, GHB has become a drug of abuse in youths for its euphoric, sedative and anabolic effects. Common adverse effects include a rapid onset of drowsiness, nausea, vomiting, myoclonic seizures and coma of short duration. Clinicians should be alert for these adverse effects and consider the possibility of GHB abuse in young adults with unusual clinical presentations in the emergency department.

Topics: Brain; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders

Topics: Acetaldehyde; Alcohol Withdrawal Delirium; Anesthesia, General; Blood Proteins; Carbon Dioxide; Catecholamines; Ethanol; Hemoperfusion; Humans; Opioid-Related Disorders; Oxygen; Pregnanediones; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) dependence is associated with a severe, potentially lethal, withdrawal syndrome and relapse rates as high as 60% within 3 months of detoxification. Baclofen has been shown to decrease self-administration of GHB in mice and reduce relapse in a case series of GHB-dependent patients. Controlled studies on the effectiveness of baclofen to prevent relapse in GHB-dependent patients are lacking.. The aim of this study was to assess effectiveness of baclofen in preventing relapse in GHB-dependent patients.. This was an out-patient, multicentre, open-label, non-randomized, controlled trial in GHB-dependent patients (n = 107) in the Netherlands. Treatment as usual (TAU, n = 70) was compared with TAU plus baclofen 45-60 mg/day for 3 months (n = 37). Outcome measures were rates of lapse (any use) and relapse (using GHB on average once a week or more), based on self-report. Side effects were monitored with a baclofen side-effects questionnaire. Treatment groups were compared using Chi square analyses, with both per-protocol (PP) and intention-to-treat (ITT) analyses.. GHB-dependent patients treated with baclofen after detoxification showed no reduced lapse rates, but reduced relapse and dropout rates, compared with patients receiving TAU only (24 vs 50%). While both ITT and PP analyses revealed similar results, the effectiveness of baclofen prescribed PP was slightly higher than in ITT analysis. Patients reported overall limited side effects, with the most frequently reported being feeling tired (28%), sleepiness (14%) and feeling depressed (14%). No serious adverse events were reported.. This study showed potential effectiveness of baclofen in preventing relapse in patients with GHB dependence after detoxification. Though promising, future studies with longer follow-up and a randomized double-blind design should confirm these findings before recommendations for clinical practice can be made.. Netherlands Trial Register with number NTR4528.

Topics: Adult; Ambulatory Care; Baclofen; Female; GABA-B Receptor Agonists; Humans; Male; Secondary Prevention; Sodium Oxybate; Substance-Related Disorders; Treatment Outcome

In the last decade, gamma-hydroxybutyrate (GHB) abuse and dependence have increased. It has been reported that GHB dependence has a high rate of relapse, serious complications of intoxication, and a potentially life-threatening withdrawal syndrome. Nevertheless, in clinical practice, there is no known medical treatment to support GHB relapse prevention. We describe a case series of patients who were supported through an off-label treatment with baclofen to avoid a relapse into GHB abuse, for a period of 12 weeks. Nine of 11 patients did not relapse while taking a dose ranging from 30 to 60 mg per day, one patient relapsed after 5 weeks, and one stopped after 7 weeks. Baclofen was well tolerated; patients reported mild side effects such as fatigue, nausea, dry mouth, excessive sweating, and depressive feelings. Although systematic evidence is still lacking, our practice-based experience suggests that treatment with baclofen to assist abstinence might be effective in patients with GHB dependence. Further systematic controlled studies are necessary to establish the exact efficacy and safety of baclofen as relapse prevention for GHB-dependent patients.

Topics: Adult; Anesthetics; Baclofen; Drug Administration Schedule; Female; GABA-B Receptor Agonists; Humans; Male; Secondary Prevention; Sodium Oxybate; Substance-Related Disorders; Young Adult

GHB dependence is a growing health problem in several western countries, especially the Netherlands. Attempts to stop using GHB are often followed by relapse shortly after successful detoxification. Craving for GHB use and co-morbid psychiatric symptom levels are thought to be the major factors contributing to the high relapse rates. Given its pharmacological profile, baclofen might prove an effective anti-craving agent for patients with GHB dependence. The aim of the current study is to assess the potential of baclofen as an anti-craving agent relapse prevention intervention in GHB dependent patients.. In an open label non-randomized trial treatment with baclofen to a maximum of 60 mg/day will be compared with treatment as usual (TAU) in recently detoxified GHB dependent patients (n = 80). The primary outcome measure will be the level of GHB use. Secondary outcome measures are craving levels, psychiatric symptom levels and quality of life. Questionnaires will be administered during 12 weeks of baclofen treatment and at follow-up (six months after the start of treatment).. It is hypothesized that baclofen treatment compared to TAU will be associated with significantly reduced GHB use. In addition, we hypothesize that baclofen treatment will be associated with decreased craving and anxiety levels, and higher quality of life. If results are in line with our hypotheses, further studies on the efficacy of baclofen using placebo controlled designs and long term follow-up are warranted.. The Netherlands Trial Register with number NTR4528 . Registered 19 April 2014.

Topics: Adult; Baclofen; Clinical Protocols; Craving; Female; GABA Agonists; Humans; Male; Quality of Life; Recurrence; Secondary Prevention; Sodium Oxybate; Substance-Related Disorders; Young Adult

Despite the increasing concern about gamma-hydroxybutyrate (GHB) toxicity in users, no studies have addressed GHB and other club drugs effects on the immune system under controlled administration. Lymphocyte subsets and functional responsiveness of lymphocytes to mitogenic stimulation were measured in 10 healthy male recreational users of GHB who participated in five experimental sessions within the framework of a clinical trial. The study was randomized, double blind, double dummy and cross-over. Drug conditions were: a single oral dose of GHB (40 mg/kg or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg) and placebo. Acute GHB produced a time-dependent immune impairment in the first 4 hours after drug administration associated with an increase in cortisol secretion. Although total leukocyte count remained unchanged, there was a significant decrease in the CD4 T/CD8 T-cell ratio, as well as in the percentage of mature T lymphocytes, probably because of a decrease in both the percentage and absolute number of T helper cells. A significant decrease was also observed in natural killer cells and in functional responsiveness of lymphocytes to mitogenic stimulation. Flunitrazepam administration did not produce any change in the immune system, while ethanol intake produced a decrease in B lymphocytes and in lymphocyte proliferative response to mitogens. These results provide the first evidence that GHB intake under a controlled environmental setting impairs the immunological status and confirms the alterations in the immune function caused by ethanol.

Topics: Adjuvants, Anesthesia; Adult; Alcoholic Intoxication; CD4-CD8 Ratio; Dose-Response Relationship, Drug; Double-Blind Method; Flunitrazepam; Humans; Hydrocortisone; Illicit Drugs; Immunity, Cellular; Immunocompetence; Killer Cells, Natural; Lymphocyte Activation; Lymphocyte Count; Lymphocyte Subsets; Male; Sodium Oxybate; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Helper-Inducer

Despite gamma-hydroxybutyrate (GHB) therapeutic uses and the increasing concern about its toxicity, few studies have addressed GHB dose-related effects under controlled administration and their relationship with its pharmacokinetics. The study design was double-blind, randomized, crossover, and controlled. As a pilot pharmacology phase I study, increasing doses of GHB were given. Single oral sodium GHB doses (40, 50, 60, and 72 mg/kg) were administered to eight volunteers. Plasma and urine were analyzed for GHB by gas chromatography-mass spectrometry. Physiological effects, psychomotor performance, and subjective effects were examined simultaneously. GHB produced dose-related changes in subjective effects as measured by questionnaires and VAS. GHB showed a mixed stimulant-sedative pattern, with initially increased scores in subjective feeling of euphoria, high, and liking followed by mild-moderate symptoms of sedation with impairment of performance and balance. Mean peak GHB plasma concentrations were 79.1, 83.1, 113.5, and 130.1 mug/L for 40, 50, 60, and 72 mg/kg, respectively. GHB-mediated physiological and subjective effects were dose dependent and related to GHB plasma concentrations. GHB urinary excretion was mainly related to administered doses. GHB-mediated subjective and physiological effects seem dose dependent and related to GHB plasma concentrations. Results suggest a high abuse liability of GHB in the range of dose usually consumed.

Topics: Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Male; Pilot Projects; Psychomotor Disorders; Sodium Oxybate; Substance-Related Disorders; Time Factors

The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression.. We examined recent trends in adverse effects related to ketamine use.. US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (. The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (. Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use-particularly with opioids or GHB-appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed.

Topics: Aged; Analgesics, Opioid; Benzodiazepines; Female; Humans; Ketamine; Male; Sodium Oxybate; Substance-Related Disorders; United States

Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia.. A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB.. There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%).. We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.

Topics: Ambulances; Communicable Disease Control; COVID-19; Cross-Sectional Studies; Humans; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Victoria

Topics: Humans; Sodium Oxybate; Substance-Related Disorders

Topics: Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

GHB (gammahydroxybutyrate) and its precursors are popular recreational drugs due to their sedative, anxiolytic and sexually stimulating effects. Their use has been steadily increasing in recent years. The detoxification process is complex and prone to high rates of complications while little is known about the pathophysiology. This study aims to elucidate the characteristics of GHB-addicted patients and to evaluate the risks and complications of GHB withdrawal treatment.. This observational study describes prospectively the socioeconomic status, clinical history and course of inpatient detoxification treatment of a group of 39 patients suffering from GHB substance use disorder. Detoxification treatment took place in a highly specialized psychiatric inpatient unit for substance use disorders.. GHB patients were characterised by being young, well-educated and by living alone. More than 50% of the patients had no regular income. The patients were male and female in equal numbers. Detoxification treatment was complicated, with high rates of delirium (30.8%) and high need for intensive care (20.5%).. In our sample, GHB users were young, well-educated people and male and female in equal number. Detoxification proved to be dangerous for GHB-addicted patients. The presence of delirium and the need for transfer to an intensive care unit during detoxification treatment was extraordinarily high, even with appropriate clinical treatment. The reasons for this remain unknown. Therefore an intensive care unit should be available for GHB detoxification treatment. Further studies are needed to evaluate the options for prophylactic treatment of delirium during detoxification.

Topics: Delirium; Female; Humans; Inpatients; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Gamma-Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood-concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB-concentrations in blood and urine were determined by gas chromatography-mass spectrometry (GC-MS) along with, in part, via enzymatic assay. GHB-concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB-levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty-four of the patients (72%) were male. The mean GHB-concentration in blood was 248 mg/L (range 21.5-1418 mg/L). Out of the group with detailed clinical information (n = 18), the comatose group (n = 10/18) showed a mean of 244 mg/L (range 136-403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% (n = 7) showed co-use of one or more substances, with the additional use of cocaine being the most frequently detected (n = 5). In conclusion, a moderate dose-effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB-intoxication cases, co-use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB-concentration in blood could support correct diagnosis of the cause of unconsciousness.

Topics: Coma; Drug Overdose; Humans; Male; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders

The COVID-19 pandemic is presumably having an impact on the consumption of psychoactive substances. Social distancing and lockdown measures may particularly affect the use of "party drugs" (e.g., stimulants, dissociatives, and GHB/GBL) through the absence of typical use settings. We aimed to analyse the use patterns of those substances and underlying motivations before and during the pandemic.. A subsample of 1,231 users of stimulants (amphetamine, methamphetamine, MDMA/ecstasy, cocaine), dissociative drugs (ketamine, dextromethorphan, PCP), and GHB/GBL was assessed from 30th April to 4th August 2020 as part of the Corona Drug Survey, a cross-sectional international online survey in five languages that included a total of 5,049 participants. The reported use of distinct substances and the underlying motivations were ascertained before (retrospectively) and during the pandemic. Furthermore, associations between drug use as a coping mechanism, pandemic-related stressors, and substance use were examined.. Regarding the reported frequency of use during the pandemic, 48.0-64.8% of the sample ceased or decreased, 11.9-25.5% maintained, and 23.6-29.1% increased their consumption. MDMA/ecstasy showed the strongest decrease and GHB/GBL and dissociatives the highest increase. Participants reported that price, quality, and supply were mostly unaffected by the pandemic. The most common motivations before and during the pandemic were mood-related factors, such as a desire to feel exhilarated, euphoric, high, or buzzed. The relevance of social purposes and mood-related motivators declined during the pandemic, whereas dealing with boredom increased. Overall, 16.4-35.6% perceived drug use as helpful for dealing with pandemic-related stressors, which were associated with an increased consumption frequency.. The early stage of the COVID-19 pandemic was associated with major changes in the use of "party drugs". Those who increased their level of drug use and perceived it as a coping strategy in particular might be targeted with adaptive preventive and therapeutic measures.

Topics: Communicable Disease Control; COVID-19; Cross-Sectional Studies; Humans; Pandemics; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders

We report a case of a young male with amphetamine toxicity initially obscured by concomitant use of gamma-hydroxybutyrate (GHB), and the sympathomimetic symptoms emerged after GHB's effects receded. A 24-year-old unconscious man presented to emergency department showed the following vital signs upon admission: blood pressure 136/58 mmHg; heart rate 79 bpm; SpO2 87% under ambient air; body temperature 36.1 °C; Glasgow Coma Scale score 3. The pupils were not dilated. Arterial blood gas test revealed respiratory acidosis (pH = 7.229, pCO2 = 64.4 mmHg, pO2 = 42.3 mmHg, HCO3 = 26.3 mmol/L). Intubation was performed and the patient was transferred to intensive care unit. The patient regained consciousness and became agitated in association with sinus tachycardia (heartrate 143 bpm; blood pressure 173/61 mmHg). A few hours later, he experienced abrupt desaturation (SpO2 65%) and profuse, pinkish, frothy sputum. Chest radiography revealed a bat-wing perihilar shadowing, and computed tomography showed bilateral ground-glass opacity and an alveolar pattern from acute pulmonary edema. A high dose of benzodiazepine with a midazolam pump at 50 mg/h was administered to relieve symptoms. The patient's friends confessed to concomitant use of amphetamine and GHB. The urine toxicology result was positive for amphetamine (≧500 ng/mL). The patient improved later and was extubated at 4 days after the mitigation of pneumonia and discharged uneventfully 8 days later. In our patient, amphetamine intoxication was initially masked by concomitant use of GHB but appeared as GHB's effect attenuated. We wish to remind clinicians of variable clinical presentations of polydrug abuse.

Topics: Adult; Airway Extubation; Eating; Glasgow Coma Scale; Humans; Male; Sodium Oxybate; Substance-Related Disorders; Young Adult

Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life.. La PrEP es una intervención biomédica eficaz en la prevención del VIH en personas con alto riesgo, entre ellas las personas que practican chemsex. De los 190 usuarios de PrEP seguidos en el Hospital Clínic de Barcelona hasta octubre de 2020, el 89% refirió utilizar drogas y el 63% en contexto de chemsex, iniciando el consumo el 64% durante el último año. El 21% refería policonsumo, siendo GHB/GBL, nitritos, sildenafilo y metanfetamina la combinación más prevalente. El 8% reportó slamming. El 41% describió haber tenido experiencias negativas y el 8% no recordaba la última vez que tuvo sexo sobrio. Metanfetamina, mefedrona, GHB/GBL y haber tenido relaciones abiertas, sexo en grupo, doble penetración y fisting fueron significativamente más frecuentes. El 49% refirió estar preocupado por la práctica de chemsex y el 18% necesitar ayuda. Un abordaje integral e interdisciplinar mejoraría el acompañamiento global de la sexualidad en estas personas.

Topics: HIV Infections; Homosexuality, Male; Hospitals; Humans; Male; Methamphetamine; Pre-Exposure Prophylaxis; Sexual and Gender Minorities; Sexual Behavior; Sodium Oxybate; Spain; Substance-Related Disorders

To characterize the prevalence of food insecurity among men who have sex with men (MSM) and assess its associations with sexual health measures and substance use, as compared to poverty status.. In 2017, 10,049 US MSM were recruited online and completed the American Men's Internet Survey. The survey assessed food insecurity, annual household income and past-year behaviors: condomless anal intercourse, exchange sex, any illicit substance use other than marijuana, use of methamphetamine, alkyl nitrites or gamma-hydroxybutyrate (GHB), HIV testing, and sexually transmitted infection testing and diagnosis. We tested associations between behavioral outcomes and food insecurity or poverty, controlling for demographic characteristics.. The prevalence of food insecurity among AMIS participants was 15.8%. Food insecurity nonresponse was 2.5% while income nonresponse was 19.0%. Food insecurity was significantly and positively associated with all behavioral outcomes, while poverty was significantly and positively associated only with exchange sex, any illicit substance use, methamphetamine, and GHB use. In models that included both food insecurity and poverty as exposures, food insecurity remained independently positively associated with all behavioral outcomes and the associations for poverty level were null for all outcomes except methamphetamine and GHB use.. Assessing food insecurity in sexual health and substance use survey research may provide a more robust indicator of economic deprivation and provide insight for HIV and STI prevention interventions.

Topics: Food Insecurity; HIV Infections; Homosexuality, Male; Humans; Male; Methamphetamine; Nitrites; Poverty; Risk-Taking; Sexual and Gender Minorities; Sexual Behavior; Sexual Health; Sexually Transmitted Diseases; Social Determinants of Health; Sodium Oxybate; Substance-Related Disorders; United States

The recreational use of gamma hydroxybutyrate (GHB) is associated with frequent overdoses, coma and the risk of developing GHB use disorder (GUD). Several studies suggest negative effects of GHB use or related comas on cognition. Since relapse rates are high in GUD and cognitive impairment has been associated with relapse in other substance use disorders, we aimed to (1) investigate the prevalence of cognitive impairment before and after detoxification, (2) analyse the relationship between GHB use, comas, and cognitive impairment, and (3) explore the association between cognitive impairment and relapse after detoxification in GUD patients.. In these secondary analyses of a prospective cohort study, a consecutive series of patients with GUD (n = 103) admitted for detoxification were recruited at six addiction care facilities in the Netherlands. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairments before and after detoxification. The follow-up duration for the assessment of relapse in GHB use was 3 months.. A substantial number of patients with GUD screened positive for cognitive impairment before (56.3%) and after (30.6%) detoxification. Impairment on the MoCA memory domain was most frequent (58.8%). Cognitive impairment was not related to the severity of GUD or number of GHB-induced comas. Logistic regression analysis showed that only the memory score independently predicted relapse.. Cognitive impairment seems highly prevalent among patients with GUD, possibly related to the risk of relapse. The absence of a relationship between the severity of GUD, level of GHB use, the number of GHB-induced comas, and cognitive impairment suggest that other factors may also contribute to the observed cognitive impairment.

Topics: Cognition; Coma; Humans; Prospective Studies; Recurrence; Sodium Oxybate; Substance-Related Disorders

To investigated the impact of the lockdown during the COVID-19 pandemic, since March 2020, on the occurrence and characteristics of recreational drug intoxications in the Emergency Department (ED), compared to previous years.. Retrospective cohort study METHOD: Patients ≥ 18 years old who presented to the ED of OLVG hospital in Amsterdam with recreational drug intoxication(s), with or without alcohol, were divided into the pre-COVID-19-period (January 2017 to February 2020), and the COVID-19-period (March to December 2020). An intoxication was registered by the treating physician, or retrospectively by researchers. Subgroup analysis was performed for foreign tourists, Dutch tourists and Amsterdam residents, as for the four most common drugs used.. A total of 3,881 patients (73.6% male, aged 32 (±12) years) were included, of whom 49.0% were tourists. During the COVID-19-period, a 53% decrease of intoxications was observed (1090.1 vs. 514.8 patients/year), with an 83% decrease of tourists (574 vs. 98.4 patients/year), 20% decrease in Dutch residents (516 vs. 416 patients/year) and 4,5% decrease in Amsterdam residents (354 vs.338 patients/year). Among Dutch patients, a significant decrease in cocaine (85.6 vs. 75.6 patients/years), MDMA (25.1 vs. 27.6 patients/year), and THC (108.6 vs. 76.8 patients/year) intoxications were observed. However, the amount of GHB/GBL related intoxications was comparable between groups (100.7 vs. 105.6 patients/year).. During the COVID-19-period, drug-related intoxications decreased by 53%. Among Dutch residents this decrease was 20%, with a significant decrease in cocaine, MDMA and THC intoxications. However, the amount of GHB/GBL related intoxications was comparable with the pre-COVID-19 period.

Topics: Adolescent; Cocaine; Communicable Disease Control; COVID-19; Dronabinol; Emergency Service, Hospital; Female; Humans; Illicit Drugs; Male; N-Methyl-3,4-methylenedioxyamphetamine; Pandemics; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders

Research addressing sexualised use of GHB to date has largely focussed on gay and bisexual men's GHB use in the context of chemsex, this research has highlighted risks and experiences associated with sexual violence. No studies have included people of diverse sexualities and genders and documented reported practices to ensure mutually gratifying and consensual sex in the context of sexualised drug use (SDU).. Semi-structured interviews were conducted with 31 people from sexuality and gender diverse communities living in Australia who reported three or more occasions of GHB use in the previous 12 months. Participants were asked about their use of GHB for sex, their experiences of GHB sex and their approaches to negotiating sexual boundaries. Data were analysed thematically.. Most participants valued the sexual possibilities enabled by disinhibitory components of GHB and were cognisant of respecting other's sexual boundaries in the context of GHB sex. Participants reported strategies to ensure communication prior to and throughout GHB sex. However, several participants narrated experiences of GHB sex that they felt were distressing and, in some circumstances, sexually violent. In most instances participant's resisted terminology of sexual violence or non-consent as descriptors of their experience and none reported accessing sexual violence services.. Positive strategies to facilitate sexual communication prior to and throughout GHB sex should be reflected in health promotion and service level responses to promote affirmative and continuous consent among people who use GHB for sex. Education initiatives to help people engaged in SDU to recognise and respond to sexual violence if it occurs ought to be prioritised.

Topics: Female; Gender Identity; Homosexuality, Male; Humans; Male; Sexual and Gender Minorities; Sexual Behavior; Sexuality; Sodium Oxybate; Substance-Related Disorders

Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway.. Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad.. Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37-7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18-2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20-3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53-1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33-1.19).. Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.

Topics: Cocaine; Cross-Sectional Studies; Gonorrhea; HIV Infections; Homosexuality, Male; Humans; Ketamine; Male; Methamphetamine; Sexual and Gender Minorities; Sexual Behavior; Sexually Transmitted Diseases; Sodium Oxybate; Substance-Related Disorders; Syphilis

The main objective was to examine sexual assertiveness and sexual satisfaction in people who have sex under the influence of alcohol and drugs, considering the type of substance consumed, the frequency of consumption, gender, and sexual orientation.. The sample consisted of 274 adults who had sexual relationships consuming substances. A questionnaire composed of sociodemographic, sexual history and substance use items, the Sexual Assertiveness Scale and the Global Measure of Sexual Satisfaction were administered.. Gender differences were found in sexual assertiveness and in the frequency of substance use. Women reported greater sexual assertiveness and greater alcohol consumption. Men reported greater consumption of different types of substances. Furthermore, bisexual participants showed greater assertiveness and STI prevention. Homosexual participants reported a higher frequency of the consumption of poppers, mephedrone, and GBL/GHB. Sexual assertiveness was associated with sexual satisfaction. Greater consumption of some types of substances was related to sexual assertiveness, STI prevention, and sexual satisfaction.. The association found between sexual assertiveness and sexual satisfaction in a specific context of substance use in sexual relationships corroborates the important role that these psychosexual variables have in sexual health, in view of the frequency and type of drug consumed, gender, and sexual orientation.

Topics: Adult; Assertiveness; Female; Humans; Male; Orgasm; Sexual Behavior; Sexually Transmitted Diseases; Sodium Oxybate; Substance-Related Disorders

COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD).. We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured.. Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose.. ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.

Topics: Adult; Alcoholism; Analgesics, Opioid; Buprenorphine; COVID-19; Delivery of Health Care; Feasibility Studies; Female; Health Services Accessibility; Humans; Ill-Housed Persons; Male; Marijuana Abuse; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Public Health; Quarantine; San Francisco; SARS-CoV-2; Sodium Oxybate; Substance-Related Disorders; Telemedicine; Telephone

Although the prevalence of gamma-hydroxybutyrate (GHB) use is relatively low globally, harms related to the drug appear to be increasing. Few existing studies present reliable, representative, population-level data on GHB-related harms. The aim of this study was to investigate trends in acute GHB-related harms within an ambulance database in Australia.. Cross-sectional, retrospective analysis of data on all GHB-related ambulance attendances in the state of Victoria, Australia during a 7-year period (January 2012-December 2018) MEASUREMENTS: Presentations were characterized based on patient demographics, transport to hospital, co-occurring substance use (i.e. GHB only, alcohol, methamphetamine, heroin, benzodiazepine and cannabis) and clinical presentation (e.g. symptoms of anxiety, psychosis, depression).. There were 5866 GHB-related ambulance attendances between 2012 and 2018, with the prevalence rate increasing from 8.8 per 100 000 population in 2012 to a maximum of 21.7 per 100 000 population in 2017. Methamphetamine [odds ratio (OR) = 6.23, P < 0.001] and benzodiazepine-related (OR = 1.43, P < 0.001) co-occurrences; ages between 18-29 (OR = 6.58, P < 0.001) and 30-39 years (OR = 2.02, P < 0.001); and male gender (OR = 1.23, P < 0.001) were significant predictors of GHB-related attendances.. There has been a 147% increase in the prevalence of GHB-related ambulance attendances in Victoria, Australia between 2012 and 2019, largely attributable to a growth in the proportions of people using gamma-hydroxybutyrate alone or concurrently with methamphetamine.

Topics: Adolescent; Adult; Ambulances; Cross-Sectional Studies; Datasets as Topic; Drug Overdose; Emergency Medical Services; Female; Humans; Male; Methamphetamine; Middle Aged; Prevalence; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Victoria; Young Adult

Topics: Ambulances; Humans; Sodium Oxybate; Substance-Related Disorders; Victoria

Post mortem gamma hydroxy butyric acid (GHB) concentrations should be interpreted with caution since GHB concentrations can increase after death. Post mortem concentrations after the intake of GHB ante mortem do overlap with concentration ranges in cases without known exposure to GHB and make an interpretation challenging. GHB is known to undergo intensive metabolism to related acids (glycolic acid (GA), succinic acid (SA), 2,4- and 3,4-dihydroxy butyric acid (2,4-OH-BA and 3,4-OH-BA)). GHB and these related acids were analyzed using a validated gas chromatographic mass spectrometric (GC-MS) method after liquid liquid extraction and trimethylsilylation. SA concentrations were not usable post mortem due to instability. Concentrations in cases without known exposure to GHB (urine: n = 80; femoral blood: n = 103) were: for GA 4.6-121 mg/L in urine and 1.6-11.2 mg/L in blood, for 2,4-OH-BA < LoD-25,3 mg/L in urine and < LoD-3.7 mg/L in blood and for 3,4-OH-BA < LoD-54,3 mg/L in urine and < LoD-5.3 mg/L in blood. In death cases involving GHB (n = 11) concentrations of GHB related acids were increased compared to these levels (for GA in 7/10 cases and up to 391 mg/L in urine, in 6/11 cases and up to 34 mg/L in blood; for 2,4-OH-BA in 9/10 cases and up to 144 mg/L in urine, in 11/11 cases and up to 9.1 mg/L in blood; for 3,4-OH-BA in 7/10 cases and up to 665 mg/L in urine, in 11/11 cases and up to 19 mg/L in blood). Therefore, the concentrations of these GHB related acids can aid in a more reliable differentiation of GHB exposure in post mortem toxicology. We recommend to add the analysis of 2,4-OH-BA, 3,4-OH-BA and GA in femoral blood for the diagnosis of a GHB intake post mortem. Post mortem femoral blood concentrations > 4 mg/L for 2,4-OH-BA, > 5 mg/L for 3,4-OH-BA and > 12 mg/L for GA give hints for a GHB intake.

Topics: Adult; Biomarkers; Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Glycolates; Humans; Hydroxybutyrates; Male; Middle Aged; Postmortem Changes; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Succinic Acid

Gamma-hydroxybutyrate (GHB) is a controlled substance that is often abused due to its euphoric, sexual and sedative effects. Both acute intoxication with and withdrawal from GHB are potentially lethal, and need to be treated in an in-patient environment. We report the case of a female patient who used GHB regularly during the first trimester of pregnancy. We subsequently describe available evidence on the impact of GHB on fetal development, and how existing guidelines for GHB detoxification differ in pregnant patients.

Topics: Adult; Antisocial Personality Disorder; Female; Humans; Hypnotics and Sedatives; Pregnancy; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Since the nineties, we note a diversification of recreational drugs and an increase in intoxications requiring medical care. From cannabis to cocaine through the New Psychoactive Substances, the aim of this article is to focus on Gamma-hydroxybutyrate (GHB), lysergic diethylamid acid (LSD) and 3,4-methylenedioxymethamphetamin (MDMA), three substances that we are confronted with in our emergency rooms and review the effective care to provide in case of intoxication.. Nous observons depuis les années 90 une diversification des drogues dites festives ou récréatives associée à une augmentation des intoxications admises dans les services d’urgences. Du cannabis à la cocaïne, en passant par les drogues émergentes, ou détournées de leur utilisation médicale, le but de cet article est de se concentrer sur le Gamma-hydroxybutyrate (GHB), l’acide lysergique diéthylamide (LSD) et la 3,4-méthylènedioxyméthamphétamine (MDMA), trois molécules déjà connues ayant fait leur réapparition ces dernières années dans les services d’urgences, et de revoir leur présentation clinique et leur prise en charge.

Topics: Cocaine; Humans; Illicit Drugs; Recreation; Referral and Consultation; Sodium Oxybate; Substance-Related Disorders

The routine analysis of driver specimens for gamma-hydroxybutyrate (GHB) is rarely performed by toxicology laboratories as the physical and chemical properties of GHB make it unamenable to the screening methods usually employed. The prevalence of the drug in driver populations has therefore only rarely been reported. This study outlines the results of the routine analysis for GHB in the blood of motor vehicle drivers in Queensland, Australia, over an eight-year period (2011-2018). The methodology for GHB analysis was updated over the course of the study; screening for GHB was conducted using GC/FID or GC/MS between 2011 and 2016 and by LC/MS/MS from 2017 onwards. Due to the endogenous nature of GHB, any specimens containing greater than 5mg/kg GHB were subjected to quantitative analysis by either; GC/MS after liquid-liquid extraction and derivatisation with BSTFA+1%TMCS (2011-2016), or by LC/MS/MS analysis after solvent precipitation from 2017 onwards. Of the 15,061 specimens analysed, 160 were positive for GHB (1.1% of all cases, range 0.4-1.8%). GHB positive drivers were 66.9% male (33.1% female) and had an average age of 32 years. The mean GHB concentration identified was 89mg/kg (range 6-354mg/kg). GHB was found to be closely associated with amphetamine type substances (ATS), particularly methylamphetamine. Though GHB was present in only 2.2% of all ATS positive specimens submitted to the laboratory, 91.2% of all GHB positive cases contained an ATS. Other drugs commonly co-administered with GHB were THC, cocaine, benzodiazepines and erectile dysfunction drugs. GHB was found to be more commonly identified in drivers from city areas and a geographical localisation of the use of the drug was identified in the Gold Coast region of Queensland.

Topics: Adult; Amphetamines; Australia; Benzodiazepines; Driving Under the Influence; Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Humans; Male; Narcotics; Phosphodiesterase 5 Inhibitors; Sildenafil Citrate; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Tadalafil

Outbreaks of shigellosis among men who have sex with men (MSM) have been reported since the late 1990s. HIV infection is an important risk factor. Since 2014, the global shigellosis epidemic has intensified. Whether chemsex (the use of crystal methamphetamine, γ-hydroxybutyrate or mephedrone to enhance sex) is a new risk factor has not been previously examined.. Seventy-five shigellosis cases were compared with 225 controls. High pVL (>100 000 copies/mL; adjusted OR (aOR): 4.9, 95% CI 1.4 to 16.9), gonorrhoea (aOR: 29.4, 95% CI 2.3 to 340.2) and syphilis (aOR: 4.3, 95% CI 1.6 to 11.6) were independent risk factors of shigellosis. Twenty shigellosis cases and 59 controls completed the questionnaire. Oral-to-anal sex (aOR: 15.5, 95% CI 3.6 to 66.7), chemsex (aOR: 5.6, 95% CI 1.4 to 22.7) and poppers use (aOR: 10.9, 95% CI 1.9 to 64.2) within 12 months were independent behavioural risk factors of shigellosis.. Chemsex is a new risk factor for shigellosis among MSM living with HIV, as identified in the 2015-2016 outbreak. Additional risk factors include poppers use, sexual risk behaviours and high pVL. Further studies on chemsex among MSM, which is a rising public health concern, are urgently required.

Topics: Adult; Case-Control Studies; Coinfection; Disease Outbreaks; Dysentery, Bacillary; Gonorrhea; HIV Infections; Humans; Logistic Models; Male; Methamphetamine; Multivariate Analysis; Odds Ratio; Risk Factors; Sexual and Gender Minorities; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders; Syphilis; Taiwan; Viral Load

Gamma-hydroxybutyrate (GHB) and its precursors have gained popularity over the last decade as a drug in the party and club scene; however, the clinical knowledge of these substances is low. In the literature there have been case reports of severe dependence and withdrawal but there is a lack of systematic knowledge about the clinical course and complications of detoxification treatment.. The aim of this article is to evaluate the prevalence, treatment course, complications and compliance of GHB patients seeking inpatient qualified detoxification treatment (QDT).. A retrospective evaluation of the hospital charts of all patients admitted to this clinic in 2017 for QDT of GHB. The Jewish Hospital in Berlin (Jüdisches Krankenhaus Berlin) provides specialized inpatient units for addictive diseases and a general intensive care unit. The control population came from a prospective study of all patients with addictive diseases who were treated in the same hospital in 2012.. In 2017 a total of 18 patients with GHB addiction were treated in this hospital. This corresponds to a 1‑year prevalence of 2.28% of all addictive diseases in this year. During detoxification treatment 52% of the GHB patients had to be temporarily transferred to the intensive care unit, 5% had to be temporarily mechanically ventilated and 26% suffered from withdrawal delirium. Of the patients 42% terminated treatment prematurely against medical advice.. Withdrawal treatment from GHB is a severe and potentially dangerous condition, the prevalence of complications was higher than for most other drugs and the rate of intensive care and withdrawal delirium was very high. Further studies are urgently needed with the aim of reducing the complication rates of GHB withdrawal and enhancing therapy adherence.

Topics: Berlin; Humans; Prospective Studies; Retrospective Studies; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

To describe the baseline characteristics, treatment and retention in patients electively admitted for gamma-hydroxybutyrate (GHB) withdrawal management.. All patients admitted between July 2010 to June 2016 who used GHB two or more times per week with a minimum duration of 3 months were identified and data extracted by file review.. Twelve cases satisfied the inclusion criteria, of whom 50% were female; 75% were using GHB daily, with an average daily amount of 16 ml. Average duration of use was 60 months. All subjects were using amphetamine type stimulants and nicotine. Psychiatric comorbidity and unintentional overdose were common; 50% completed treatment. Medications used included diazepam and neuroleptic. Two patients completed withdrawal with no medications. No subject using greater than 90 ml GHB in the preceding week completed treatment. Pattern of GHB use did not predict medication requirements during withdrawal management.. There were low numbers attending for elective treatment for GHB use. Heavier GHB use predicted poor treatment retention. Polysubstance use and psychiatric co-morbidities need consideration in treatment planning.

Topics: Adult; Female; Humans; Inpatients; Male; Middle Aged; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

Gamma-hydroxybutyrate acid (GHB) is a recreational drug with a high addictive potential. Severe side effects such as GHB-induced coma are common and linked to increased emergency room attendances. Task-based functional-imaging studies have revealed an association between the regular use of GHB and multiple GHB-induced comas, and altered neurocognitive function. However the effects of multiple GHB-induced comas and regular GHB-use on intrinsic brain connectivity during rest remain unknown. The study population consisted of 23 GHB-users with ≥4 GHB-induced comas (GHB-Coma), 22 GHB-users who never experienced a GHB-induced coma (GHB-NoComa) and 24 polydrug users who never used GHB (No-GHB). Resting-state scans were collected to assess resting-state functional-connectivity within and between the default mode network (DMN), the bilateral central executive network (CEN) and the salience network (SN). The GHB-NoComa group showed decreased rsFC of the right CEN with a region in the anterior cingulate cortex (p

Topics: Adult; Anesthetics, Intravenous; Cerebral Cortex; Coma; Connectome; Cross-Sectional Studies; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Male; Nerve Net; Sodium Oxybate; Substance-Related Disorders; Young Adult

Ethanol intake can increase the sedative effects of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), although the real clinical impact is unknown. We studied the clinical impact of the co-ingestion of ethanol in patients presenting to the Emergency Department (ED) with acute toxicity related to GHB/GBL use.. We performed a secondary analysis of the Euro-DEN Plus Registry (14 countries, 22 EDs) which includes 17,371 consecutive patients presenting to the ED with acute recreational drug toxicity over 39 consecutive months (October 2013 - December 2016). We compared the epidemiological and clinical characteristics and ED management of patients identified as presenting with acute toxicity related to lone GHB/GBL (Group A) or GHB/GBL combined with ethanol (Group B) without other concomitant drugs.. A total of 609 patients were included (age 32 (8) years; 116 women (19%); Group A: 183 patients and Group B: 426). The most common features were reduction in consciousness (defined as Glasgow Coma Score <13 points: 56.1%) and agitation/aggressiveness (33.6%). Those with ethanol co-ingestion were younger patients (Group A/B: 31.5/33.1 years, p = 0.029) and ethanol co-ingestion was associated with a lower frequency of bradycardia (23.5%/15.7%, p = 0.027) and more frequent arrival at the ED by ambulance (68.3/86.6%; p < 0.001), reduction in consciousness (58.9%/49.1%; p = 0.031), need for treatment in the ED (49.2%/60.4%; p = 0.011), use of sedatives (20.1%/12.8%; p = 0.034), admission to critical care units (22.4%/55.3%; p < 0.001), and longer hospital stay (stay longer than 6 h: 16.9%/28.4%; p = 0.003).. Co-ingestion of ethanol increases the adverse effects of patients intoxicated by GHB/GBL, leading to greater depression of consciousness, need for treatment, admission to the ICU and longer hospital stay.

Topics: 4-Butyrolactone; Adult; Aggression; Alcohol Drinking; Consciousness; Consciousness Disorders; Emergency Service, Hospital; Ethanol; Europe; Female; Humans; Illicit Drugs; Intensive Care Units; Length of Stay; Male; Patient Admission; Registries; Risk Factors; Sodium Oxybate; Substance-Related Disorders; Time Factors; Young Adult

Reports of sexualised drug taking (chemsex) have increased significantly in recent years. There is currently limited intelligence on chemsex outside of London. An anonymous survey was promoted via several sources including voluntary services and a sexual health clinic in order to establish the risks associated with chemsex, and how support services can best be tailored to meet the needs of those in Greater Manchester, UK. Quantitative and qualitative data were collected on demographics, drug use, sexual practices and barriers and facilitators to accessing support. Fifty-two men who have sex with men completed the online survey. Thirty-nine (75%) were HIV-positive and 11 (21%) were hepatitis C virus (HCV) positive, all of whom were HIV/HCV co-infected. The most commonly used drugs were mephedrone (81%) and gamma hydroxybutyrate/gamma butyrolactone (79%). Nineteen (37%) reported ever injecting drugs. High-risk sexual practices were reported by respondents. Barriers to accessing support included a fear of being recognised. Findings demonstrate those engaging in chemsex are participating in a number of high-risk sexual practices, taking substances with significant risks and administering these substances in potentially high-risk ways. Results demonstrate the need for promotion of existing services, with key areas to target where chemsex sessions are most commonly arranged. Results may be useful in other metropolitan cities, both for commissioning and tailoring of chemsex support services.

Topics: 4-Butyrolactone; Adult; Coinfection; Harm Reduction; Hepatitis C; HIV Infections; Homosexuality, Male; Humans; Internet; London; Male; Methamphetamine; Middle Aged; Risk-Taking; Sexual Behavior; Sexual Partners; Sodium Oxybate; Substance-Related Disorders; Surveys and Questionnaires; Unsafe Sex; Young Adult

Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM.. Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined.. The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected.. Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users.. Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.

Topics: Adult; Australia; Homosexuality, Male; Humans; Male; Middle Aged; Risk-Taking; Sexual and Gender Minorities; Sexual Behavior; Sexual Partners; Sodium Oxybate; Substance-Related Disorders; Young Adult

This case discusses a gay male participating in sexualised drug use. It raises several important issues and strengthens the case for routine screening for sexualised drug use in men who have sex with men so that healthcare professionals can provide better-informed and higher-quality health care to this population.

Topics: Adult; Diagnostic Tests, Routine; HIV Infections; Homosexuality, Male; Humans; Illicit Drugs; Male; Methamphetamine; Risk-Taking; Sodium Oxybate; Substance-Related Disorders

Recent developments in drug use patterns call for an investigation of current party-drug use and associated problems among college students, who appear to be an important target population for harm reduction interventions.. In addition to reporting on party-drug use prevalence, we investigated whether initial use and continuation of party-drug use among students was associated with demographic, personality and psychosocial factors.. An online questionnaire was administered to 446 students from a Dutch university, inquiring about party-drug use, demographic characteristics, social norms and personality (big five, impulsiveness, aggression). Univariate and multivariate bootstrapped linear regression analyses were used.. Of all students, 22.9% indicated having used party-drugs at least once, with a notable sex difference (39.2% of men vs. 16.2% of women). In contrast to the reported trends in Dutch nightlife, GHB was used rarely (lifetime 1.6%) and new psychoactive substances (NPS; 6.7%) appeared almost equally popular as amphetamines (7.6%) and cocaine (7%). Mild health/psychosocial problems (e.g., doing embarrassing things, feeling unwell) were common (65%), whereas serious problems (e.g., being hospitalized) were rare. Neuroticism, extraversion, conscientiousness and impulsiveness were associated with lifetime but not regular party-drug use. Of all predictors, lifetime and regular party-drug use were most strongly related to lenient injunctive and descriptive norms in friends, and a low motivation to comply with parents.. Our findings indicate that harm reduction/preventive interventions might profit from focusing on social norms, and targeting students who are highly involved in a pro-party-drug environment while experiencing less parental influence.

Topics: Adolescent; Adult; Amphetamines; Cocaine; Female; Friends; Humans; Linear Models; Male; Motivation; Multivariate Analysis; Netherlands; Parents; Personality; Prevalence; Sex Distribution; Social Norms; Sodium Oxybate; Students; Substance-Related Disorders; Surveys and Questionnaires; Universities; Young Adult

This article reports the concentrations of gamma-hydroxybutyrate (GHB) in femoral blood and bladder urine in a case series of drug intoxication deaths (N = 37). GHB was determined in blood (B-GHB) and urine (U-GHB) by a GC-FID-GBL method and 30 mg/L was used as a cut-off concentration for reporting positive results. The mean (median) and range of GHB concentrations in bladder urine were 2,818 mg/L (1,900 mg/L) and 120-13,000 mg/L, respectively. These concentrations were appreciably higher than those in femoral blood, 637 mg/L (260 mg/L) and 30-9,200 mg/L, respectively. Urine/blood ratios of GHB were highly variable (mean 8.99, median 5.33 and range 0.16-29.3). GHB is rapidly metabolized and cleared from the bloodstream, whereas there is no metabolism occurring in the urinary bladder. In five autopsy cases, U-GHB was lower than B-GHB, which suggests that these individuals died before equilibration of the drug in all body fluids and tissues. In the other 32 deaths, U-GHB was higher than B-GHB, sometimes appreciably higher, which points towards a longer survival time after intake or administration of GHB. The analysis of urine extends the window of detection of GHB by several hours compared with blood samples, depending in part on when the bladder was last voided before death. Furthermore, the urinary concentration of GHB gives a hint about the concentration in blood during the time that the urine was produced in the kidney and stored in the bladder since the previous void.

Topics: Adult; Autopsy; Databases, Factual; Female; Forensic Toxicology; Humans; Male; Poisoning; Postmortem Changes; Sodium Oxybate; Specimen Handling; Substance Abuse Detection; Substance-Related Disorders

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid used recreationally as a drug of abuse due its strong suppressive effect on the central nervous system. The detection window of GHB in blood and urine is very narrow (t1/2=30min) but can be substantially prolonged using alternative matrices such as hair. We here present a newly developed and limited validated method with a solid phase extraction (SPE) using GC-MS/MS to determine concentrations of GHB in hair samples. The soft extraction technique (water and 90min ultrasonic bath) preserves GHB with a high yield and clean extracts. In addition, endogenous GHB can be detected in hair of non-GHB users. However, little is known about GHB concentrations in hair of abstinent, frequent and chronic GHB users. Therefore, we present data from hair samples of healthy volunteers to evaluate the proposed endogenous GHB ranges, and from GHB-dependent patients to address GHB concentrations in hair with GHB intake. In 20 non-GHB users, a mean endogenous concentration of 1.1±0.6ng/mg hair (range of 0.3-2ng/mg) was found. In GHB-dependent patients, concentrations between 6.3-239.6ng/mg hair were found, with no correlation between concentrations in hair and dose of GHB intake. In summary, we present a new and limited validated method, adequately sensitive for the detection of GHB in hair, as well as first-time measurements of GHB concentrations in dependent patients in order to better understand the relationship between the frequency of use/dose and concentrations observed in hair samples.

Topics: Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Hair; Healthy Volunteers; Humans; Male; Reproducibility of Results; Sodium Oxybate; Solid Phase Extraction; Substance Abuse Detection; Substance-Related Disorders

In case of drug-facilitated sexual assault (DFSA), the evidence is frequently anecdotal, with few investigations based on scientific evidences being carried out and thus most cases are diagnosed as an acute drug or alcohol intoxication. The reason may lay in the lack of specific knowledge by the victim on the possibility to retrospectively study the allegedly events and to the absence of standardized and shared protocols among health, forensic and police subjects. On this basis, in 2015 the Unit of Forensic Toxicology of University of Florence and the Sexual Assaults Centre in Hospital Careggi have fixed a common protocol to be applied in case of DFSA. The purpose of the study was to describe the results of the application of the shared protocol for toxicological findings among women seeking health care after sexual assault, and to assess the relationship with so-called proactive DFSA drugs. We conducted a study on female patients above 18 years of age consulting the Sexual Assault Centre between 2010 and July 2018. Among the 256 patients included, 37.1% was positive at least for a substance. Alcohol was the most detected substance (57 cases), followed by Cannabis (19 cases), cocaine (15 cases) and opiates/methadone (heroine: 5; morphine:1; methadone: 6); benzodiazepines and amphetamine were found in 13 and in 2 cases, respectively. Only case of gamma-hydroxybutyrate (GHB) consumption was observed while new psychoactive substances were not detected. Among the patients suspecting proactive DFSA, sedative drug findings, not explained by voluntary intake, were encountered.

Topics: Adolescent; Adult; Blood Alcohol Content; Child; Chromatography, Liquid; Crime Victims; Female; Forensic Toxicology; Humans; Italy; Middle Aged; Narcotics; Retrospective Studies; Sex Offenses; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; Young Adult

To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse.. We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes.. We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01).. The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.

Topics: 4-Butyrolactone; Adult; Akathisia, Drug-Induced; Consciousness; Drug Interactions; Drug Overdose; Emergency Service, Hospital; Europe; Female; Humans; Illicit Drugs; Intubation, Intratracheal; Male; Motor Activity; Prospective Studies; Respiration, Artificial; Severity of Illness Index; Sodium Oxybate; Substance-Related Disorders; Time Factors; Treatment Outcome

Gamma-hydroxybutyrate (GHB) detoxification procedures have been insufficiently studied for effectiveness and safety. Based on case reports, benzodiazepines are generally regarded as first-choice agents in GHB detoxification. Detoxification by titration and tapering (DeTiTap) with pharmaceutical GHB in an open-label consecutive case series of 23 GHB-dependent patients showed to be feasible, effective and safe. This study further explored the feasibility, effectiveness and safety of this detoxification procedure in a large group of patients.. A large observational multicenter study was carried out in six addiction treatment centers in the Netherlands. GHB-dependent inpatients (229 unique patients, 274 admissions) were titrated on and tapered off with pharmaceutical GHB.. Successful detoxification was achieved in 85% of cases. Detoxification was carried out in 12.5days in most patients. The DeTiTap procedure proved to be feasible and significantly reduced the experienced withdrawal symptoms and craving (p≤0.001). Several symptoms were found to influence the course of subjective withdrawal symptoms. During detoxification, psychological symptoms such as depression, anxiety, and stress decreased (p≤0.05). The main complications were hypertension and anxiety. Six patients were sent to the general hospital for observation, but all six were able to continue detoxification in the addiction treatment centers. Most patients (69%) relapsed within three months after detoxification.. The DeTiTap procedure using pharmaceutical GHB seems a safe alternative to benzodiazepines as a GHB detoxification procedure. However, the high relapse rates warrant further investigation.

Topics: Adult; Benzodiazepines; Craving; Dose-Response Relationship, Drug; Female; Humans; Male; Netherlands; Psychotherapy; Recurrence; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

Gamma-hydroxybutyrate (GHB) is the drug most linked to acute harm out of those used in chemsex, the incidence of which is reported to be increasing. However, there have been few systematic studies of the harms associated with GHB use. We investigated GHB-associated deaths from London coroners' jurisdictions between 2011 and 2015.. Blood and urine samples were collected by pathologists and submitted for toxicological analysis at the request of coroners. Data from the Toxicology Unit, Imperial College London was retrospectively analysed. This comprised of 6633 cases from seven out of eight coroners' jurisdictions in London that underwent toxicological analysis between January 2011 and December 2015.. A total of 61 GHB-associated deaths (0.92% of total cases), 184 cocaine-associated deaths (2.8% of total cases) and 83 MDMA-associated deaths (1.3% of total cases) were identified. There was a 119% increase in the proportion of GHB-associated deaths detected in 2015 compared to 2014. Over the same time period there was a 25% increase in cocaine-associated deaths and a 10% decrease in MDMA-associated deaths.. Our data suggest that GHB-associated deaths are increasing in London, and that this is likely at least in part due to increasing use of GHB for chemsex. Further studies on the use of GHB are urgently required to understand the extent of its use, whether this is as prevalent in other major urban areas in the UK, and the full extent of the harms it causes.

Topics: Adult; Aged; Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; HIV Infections; Homosexuality, Male; Humans; Illicit Drugs; London; Male; Middle Aged; Retrospective Studies; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders; Vitreous Body; Young Adult

Gamma-hydroxybutyrate (GHB) is a recreational drug, a drug of abuse, as well as an endogenous molecule in mammals. The drug has become infamous as a tool for drug-facilitated sexual assault. GHB is found in low concentrations in living humans, while at postmortem the concentration of GHB rises due to fermentation processes. The endogenous nature of GHB leads to difficulty in interpretation of concentrations, as the source of GHB is not obvious. Postmortem brain and blood samples were collected from 221 individuals at autopsy. Of these, 218 were not suspected of having ingested GHB, while GHB intake was reported for the last three (cases A-C). Decomposition level was estimated and cases classified into no/minor and advanced decomposition. Brain samples were extracted from the frontal lobe; only gray matter from the cerebral cortex was used. Blood was drawn from the femoral vein. Brain samples were homogenized and diluted with water. Brain homogenates or femoral blood were then prepared using protein precipitation and GHB was quantified with UHPLC-MS/MS. For 189 cases where ingestion of GHB was not suspected and where no/minor decomposition had occurred the concentrations were in the range 4.8-45.4mg/kg (median 15.3mg/kg) in blood and not-detected to 9.8mg/kg (median 4.8mg/kg) in brain tissue. For case A, where intoxication with GHB was deemed to be the sole cause of death, the concentrations were 199 and 166mg/kg in blood and brain, respectively. For case B, where intoxication with GHB was a contributing factor of death, the respective concentrations were 142 and 78.4mg/kg. For case C, where GHB was ingested but the cause of death was opioid poisoning, the concentrations were 40.3 and 12.7mg/kg. The results demonstrate that postmortem-formed levels of GHB are much lower in brain than peripheral blood. Analysis of GHB in brain tissue thus provides for an improved capability to identify an exogenous source of GHB. By measuring GHB in brain tissue and employing a cut-off concentration of 10mg/kg, a tentative distinction can be made between an endo- and exogenous source of GHB. An exception to this strategy is for extensively decomposed corpses, where endogenous GHB concentrations can be high even in brain.

Topics: Adult; Chromatography, High Pressure Liquid; Female; Frontal Lobe; Gray Matter; Humans; Male; Narcotics; Postmortem Changes; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; Young Adult

In recent years, the involvement of GHB in drug facilitated sexual assaults has been one of the most frequently studied aspects of GHB in both clinical and non-clinical settings. GHB-involved acquisitory crimes, however, can be mentioned as understudied research topics, as well as the poisoning severity properties of GHB.. The medical reports of Péterfy Sándor Street Hospital Clinic and Casualty Centre's 408 GHB-intoxication cases (352 patients) were reviewed and registered. Analyzed data consisted of epicrisis, serum and urine concentration of various substances (including GHB), scores of Glasgow Coma Scale and Poisoning Severity Score.. Majority of the patients were males, in their twenties. GHB was detected in 34.1% and it was solely consumed in 27.7% of all the cases. Ethanol was found to be the most frequently co-ingested substance. A higher rate of severe poisonings was observed among males. We found significant difference in the frequency of enduring sexual assaults and acquisitory crimes between intentional and unintentional GHB intake cases. Among unintentional GHB intake cases, 6.5% endured GHB-involved sexual assaults, whereas 21.7% endured an acquisitory crime. Among recurrent GHB intoxication cases generated by the same patients, voluntary and sole GHB consumptions were more frequently observed, however, enduring any crime was less characteristic.. Our results regarding demographic and substance use characteristics and the frequency of GHB-facilitated sexual assaults are in line with former findings. Enduring acquisitory crimes due to unintentional GHB intake was found to be more inherent than enduring sexual assaults. Authors emphasise that the victims of these acquisitory crimes were typically males.. GHB's role in drug facilitated acquisitory crimes seems to be significant, although the decrease in GHB's popularity is observed among intoxicated patients as well. The need for further research on GHB's impact on cognitive impairment and on sexual correlates of intentional GHB use is addressed by the authors.

Topics: Adult; Crime; Crime Victims; Female; Glasgow Coma Scale; Humans; Hungary; Male; Severity of Illness Index; Sex Offenses; Sodium Oxybate; Substance-Related Disorders

Various studies have dealt with gamma-hydroxybutyrate's (GHB) potential role in sexual assaults, while the sexual correlates of intentional recreational GHB use have not well been highlighted. Our study aims to explore GHB's sexual effects, the patterns of choice of sexual partners, the frequency of experienced blackouts, and endured sexual or acquisitory crimes as a result of GHB use.. Sixty recreational GHB users filled out a questionnaire on experienced subjective, somatic, and sexual effects of GHB, the frequency of blackouts due to their GHB use, and items on their sexual experiences in relation to GHB use.. Of the sample, 25.9% reported increased sexual arousal as well as more intense attraction towards their sexual partners and increased sexual openness when using GHB; 34.8% had sexual intercourse with strangers, or with others, but not with their partners when using GHB; and 8.6% were victims of acquisitory crimes, whereas 3.4% were victims of a sexual assault. Furthermore, 24.6% typically experienced blackouts when using GHB.. Gamma-hydroxybutyrate seems to be a potential substitute for both stimulant and depressant substances. Increased sexual desire and disinhibition may lead to a more frequent and potentially more riskful sexual activity. Experienced blackouts need to be considered as risk factors for suffering sexual or acquisitory crimes.

Topics: Adjuvants, Anesthesia; Adult; Female; Humans; Male; Sexual Behavior; Sodium Oxybate; Statistics, Nonparametric; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

Topics: Adult; Depression; Humans; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Use of and acute poisoning by substances of abuse represent a major health problem and are often linked to social destitution. We describe associations between place of residence, living conditions and the incidence of poisoning by substances of abuse in Oslo.. All patients who were 12 years of age or older and resident in Oslo and who were treated for acute poisoning by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) were included prospectively for a continuous period of one year, from October 2011 to September 2012. The 15 districts of Oslo were categorised into three groups of living conditions, from the best (I) to the poorest (III) living conditions, based on the City of Oslo's living conditions index. Homeless people were grouped separately. The incidence of poisoning by substances of abuse treated in the OAEOC was estimated.. Of a total of 1,560 poisonings by substances of abuse, 1,094 cases (70%) affected men. The median age was 41 years. The most frequent toxic agents were ethanol, with 915 cases (59%), and heroin, with 249 cases (16%). The incidence of poisoning by substances of abuse treated in the OAEOC per year per 1,000 inhabitants amounted to 1.75 in living conditions group I, to 2.76 in living conditions group II and 3.41 in living conditions group III. Living conditions group III had a significantly higher incidence than living conditions group II (p < 0.001), and living conditions group II had a significantly higher incidence than living conditions group I (p < 0.001).. The incidence of acute poisoning by substances of abuse was higher, the poorer the living conditions in the district.

Topics: Acute Disease; Adolescent; Adult; Aged; Ambulatory Care Facilities; Analgesics, Opioid; Benzodiazepines; Central Nervous System Stimulants; Child; Ethanol; Female; Heroin; Humans; Ill-Housed Persons; Male; Middle Aged; Norway; Poisoning; Prospective Studies; Social Conditions; Socioeconomic Factors; Sodium Oxybate; Substance-Related Disorders; Urban Population

The aim of this study was to identify in recreational drug users the factors which increase the risk of overdosing (OD) with γ-hydroxybutyrate (GHB). A purposive sample of 45 experienced GHB users was interviewed, equally divided into three groups (never OD, occasional OD, and repeat OD). The repeat OD group scored highest on many risk factors regarding GHB use, the occasional OD group scored intermediate, and the never OD group scored lowest. Participants, whether or not they had overdosed on GHB, most often perceived GHB use (e.g. using more GHB than usual, using GHB doses too closely together) as the main reason for GHB OD, and many participants who had overdosed on GHB reported that they had taken more GHB than usual at their most recent occasion of GHB OD. No significant differences in co-use of GHB with other substances were found between the three groups. Our findings indicate that using GHB in the company of groups of friends probably reduces, but does not eliminate, the risk of OD.

Topics: Adolescent; Adult; Drug Overdose; Female; Humans; Illicit Drugs; Male; Netherlands; Risk Factors; Self Report; Sodium Oxybate; Substance-Related Disorders; Young Adult

Club drugs have become increasingly popular with young adults and adolescents. Although users report similar effects of these drugs, they are pharmacologically and physiologically different. Understanding these differences and recognizing trends and effects of club drugs is essential for nurse practitioners.

Topics: Adolescent; Adult; Female; Flunitrazepam; Humans; Illicit Drugs; Ketamine; Lysergic Acid Diethylamide; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Nurse Practitioners; Primary Care Nursing; Sodium Oxybate; Substance-Related Disorders; Young Adult

Research connecting club drug use to risky sex among gay/bisexual men (GBM) contains methodological issues that have limited knowledge about the relative risks of distinct drugs. This paper reports drug use and sexual behavior data from 197 GBM who frequented at least one party venue within 3 months of participating. Alarming rates of drug use and unprotected anal intercourse (UAI) with casual sex-partners were reported in connection with time spent at a bar, club or circuit party. Structural equation modeling revealed that use of methamphetamine, gammahydroxybutrate (GHB), and/or ketamine (K), but not use of ecstasy, at a party venue helped explain likelihood of UAI with a casual sex-partner while under the influence of a drug during/following time partying (β = 0.41, p < .01). Findings suggest use of methamphetamine, GHB and/or K at party venues increases risk for subsequent UAI with casual sex-partners. Study implications, limitations, and recommendations for future research are discussed.

Topics: Adult; Amphetamine-Related Disorders; Bisexuality; Homosexuality, Male; Humans; Ketamine; Male; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Risk Factors; Social Behavior; Sodium Oxybate; Substance-Related Disorders; Unsafe Sex; Young Adult

In emergency medicine and anesthaesiology liquid ecstasy (LE), the street name for GHB, GBL or 1,4-B, has become infamous for causing severe intoxications and withdrawal. In general psychiatry, however, it is little known. Therefore, we set out to gather data about the role of LE in general psychiatry, typical users and common clinical problems associated with the use of LE.. We retrospectively identified and studied all patients with a reported the use of LE seen at the Department of Psychiatry, University of Ulm, Germany, between 1998 and 2011.. In 14 years, 19 users of LE were identified, the first dating from 2005. The majority reported a use of GBL (63 %), GHB was less common, and 1,4-B was not reported. Patients were predominantly young men (median age 25 years, 79 % men) with a history of multiple substance abuse. Ten patients had only a former use of LE, the other nine patients used it at the time of presentation. Of these, every third patient had to be transiently treated in an intermediate care unit, usually because of very severe and sudden withdrawal symptoms. Otherwise, detoxification was possible in psychiatry, but often required high doses of benzodiazepines. Three patients met the criteria for dependence from GBL.. In recent years, a small number of users of LE is seen also in general psychiatry, The problem is rather the severity of withdrawal than the number of cases. Close cooperation with intermediate care units is needed. In any case of coma of unknown origin or delirium with sudden onset LE use or withdrawal has to be taken into consideration, respectively. Many clinical problems result from the fact that LE cannot be detected in routine drug screenings. According to our experience, withdrawal from LE can be controlled with benzodiazepines.

Topics: Adult; Delirium; Emergency Medical Services; Female; Humans; Legislation, Drug; Male; Retrospective Studies; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

1,4-Butanediol (1,4-BD) is a gamma-hydroxybutyrate (GHB) pro-drug, with multiple commercial uses, and a drug of abuse. Although there are case reports of a withdrawal syndrome following 1,4-BD use, no studies have evaluated the physical dependence potential of 1,4-BD and characterized the time course of withdrawal.. Vehicle and then 1,4-BD were administered continuously 24 h/day via intragastric catheters in male baboons (Papio anubis, n=3). Dosing was initiated at 100 mg/kg and increased by 100mg/kg/day to 400mg/kg. After a stabilization period, doses of 500 and then 600 mg/kg/day were each maintained for 3-4 weeks. Plasma levels of 1,4-BD and GHB were determined for each dose condition. Physical dependence was assessed via administration of a GABA-B antagonist (precipitated withdrawal test) during administration of the 600 mg/kg dose and via abrupt termination of chronic 1,4-BD administration (spontaneous withdrawal test). Outcome measures included the number of food pellets earned, performance on a fine-motor task, observed behaviors, and plasma levels of GHB and 1,4-BD.. Following maintenance of 1,4-BD 600 mg/kg for 3 weeks, the number of food pellets earned was significantly decreased. At the end of chronic 1,4-BD dosing, the levels of GHB in plasma ranged from 1290 to 2300 μmol/L and levels of 1,4-BD in plasma ranged from 13.1 to 37.9 μmol/L. Signs of physical dependence were observed following precipitated and spontaneous withdrawal tests. Seizures were not observed.. These data indicate chronic 1,4-BD produced physical dependence in baboons and the withdrawal syndrome can be characterized as mild to intermediate.

Topics: Animals; Butylene Glycols; Conditioning, Operant; Infusions, Parenteral; Male; Papio anubis; Prodrugs; Severity of Illness Index; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

This communication reports the blood concentrations of alcohol and drugs from 376 cases of alleged driving under the influence of drugs analysed at the Forensic Science Service Chorley and London laboratories between February 2010 and March 2011. The samples were analysed for alcohol, amphetamine, benzodiazepines, cocaine, MDMA, opiates, γ-hydroxybutyrate (GHB), ketamine, methadone and methylmethcathinone (the 4-isomer of which is known as mephedrone). The results were interpreted with respect to the number and type of drugs of abuse detected and the concentrations measured. Alcohol was quantified in 113 cases (30%), and of these a level in excess of the prescribed UK limit for driving of 80 mg% was present in 90 cases. In 80 cases, only the concentration of alcohol was measured, the concentrations of both drugs and alcohol were measured in 33 cases. In the remaining 263 cases, only the concentrations of relevant drugs of abuse were measured. The most common drug of abuse quantified was cocaine which was detected in 92 cases, either as the active drug or as its major metabolite benzoylecgonine, followed by diazepam which was quantified in 76 cases. Concentrations of some new drugs, and drugs rarely reported in driving under the influence cases are also presented.

Topics: Adolescent; Adult; Amphetamine; Automobile Driving; Central Nervous System Depressants; Chromatography, Liquid; Cocaine; Diazepam; England; Ethanol; Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Humans; Ketamine; Male; Methadone; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nordazepam; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Wales; Young Adult

A new detoxification method for GHB dependence was developed recently in the Netherlands. The method involves the use of pharmaceutical GHB.. To describe the characteristics of GHB dependent inpatients, the course of the detoxification process and patients' progress in the three months following inpatient detoxification.. 229 GHB dependent patients were monitored during and after inpatient detoxification. Records were kept of the psychiatric symptoms, withdrawal symptoms and relapses.. The average age of the patients was 29 years; 69% of the patients were male. They reported severe symptoms of co-occurring depression and anxiety. Detoxification was successful in 86% of the patients and, on a whole, the procedure ran smoothly, without complications. However, within three months following detoxification two-thirds of the patients had relapsed and were again taking GHB.. Pharmaceutical GHB can be used as an alternative to the benzodiazepine method for detoxifying patients with GHB dependence. However, the high relapse rates following detoxification are of great concern.

Topics: Adult; Female; Humans; Male; Recurrence; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

The number of admissions to addiction treatment centers in the Netherlands for gamma hydroxybutyrate (GHB) dependence is rapidly growing. Until now, treatment seeking GHB users have hardly been studied. This study characterizes inpatients in treatment for GHB dependence in terms of sociodemographics, motives for substance use and reasons for seeking treatment. In addition, variables associated with dependence severity are identified.. Patients were recruited by their therapists at 4 different addiction treatment centers dispersed throughout the Netherlands. They were asked to fill out the questionnaire, including sociodemographic and clinical characteristics, GHB and other drug use, and a modified version of the Drug Use Disorders Identification Test (DUDIT) to screen for GHB dependence. The associations of relevant variables with dependence severity were determined using multiple regression analysis.. A total of 75 inpatients (response rate 90.4%) participated in the study. Most patients were young (mean 26.8 ± 9.1) males (73%) with low education (78%) and not employed (48%). Most of them (75%) had started using GHB the year before treatment admission, 42 (56%) frequently combined GHB with sedatives and 26 (35%) frequently combined GHB with stimulants. Dependence severity was strongly associated with sleep problems and the combined use of GHB and stimulants.. This study shows that sociodemographic characteristics of GHB inpatients are similar to those of problematic users of other club drugs. Sleep problems and combined use of GHB and stimulants were strongly associated with GHB dependence. Together, these factors might help to better identify people at risk for GHB dependence.

Topics: Adolescent; Adult; Female; Humans; Male; Netherlands; Severity of Illness Index; Socioeconomic Factors; Sodium Oxybate; Substance Abuse Treatment Centers; Substance-Related Disorders; Young Adult

When non-alcohol drugs are detected in blood samples from apprehended drivers in Norway, individualised expert opinions are required to evaluate degree of impairment. For alcohol, legislative limits have been in use since 1936. To harmonize the current practice for driving under the influence of alcohol and non-alcohol drugs, a judicial reform with legislative limits for non-alcohol drugs has been suggested.. Impairment limits, representing drug concentrations in blood likely to be accompanied by a degree of impairment comparable to a blood alcohol concentration (BAC) of 0.02%, were proposed for 20 psychotropic drugs, including the most prevalent benzodiazepines, cannabis, GHB, hallucinogens and opioids. Limits for graded sanctions, representing drug concentrations in blood likely to induce impairment comparable to BACs of 0.05% and 0.12%, were defined for 13 of the 20 substances. The suggested limits were based on assessments of impairment after single doses of the drugs in naïve individuals. The proposed limits will not apply to individuals with valid prescriptions for medicinal drugs, where the present system with individualised expert evaluations will be maintained.. Norway is the first country planning to implement legislative limits for non-alcohol drugs corresponding to impairment seen at increasing BACs. The background and justification for the suggested limits are presented herein.

Topics: Automobile Driving; Benzodiazepines; Cannabinoids; Central Nervous System Depressants; Central Nervous System Stimulants; Ethanol; Forensic Toxicology; Humans; Narcotics; Norway; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

To determine the effectiveness and safety of a new detoxification procedure in γ-hydroxybutyrate (GHB)-dependent patients. GHB is an endogenous inhibitory neurotransmitter and anesthetic agent that is being abused as a club drug. In many GHB-dependent patients a severe withdrawal syndrome develops that does not respond to treatment with high dosages of benzodiazepines and often requires an admission to an intensive care unit.. Based on the knowledge of detoxification procedures in opioid and benzodiazepine dependence, we developed a titration and tapering procedure. A consecutive series of 23 GHB-dependent inpatients were transferred from illegal GHB (mostly self-produced) in various concentrations to pharmaceutical GHB. They were given initial doses that resulted in a balance between sedation and withdrawal symptoms. After this titration period, patients were placed on a 1-week taper.. We have found that after titration the patients experienced a low level of withdrawal symptoms. During tapering these symptoms decreased significantly and no patient developed a delirium or a psychosis. None of the patients had to be transferred to a medium or intensive care unit.. This detoxification procedure proved to be safe and convenient in patients with moderate to severe GHB dependence.

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Male; Neurotransmitter Agents; Pilot Projects; Sodium Oxybate; Substance Abuse Treatment Centers; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have been profiled as 'party drugs' used mainly at dance parties and in nightclubs on weekend nights. The purpose of this study was to examine the frequency of injecting drug use among GHB/GBL overdose patients and whether there are temporal differences in the occurrence of GHB/GBL overdoses of injecting drug and recreational drug users.. In this retrospective study, the ambulance and hospital records of suspected GHB- and GBL overdose patients treated by the Helsinki Emergency Medical Service from January 1st 2006 to December 31st 2007 were reviewed. According to the temporal occurrence of the overdose, patients were divided in two groups. In group A, the overdose occurred on a Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. Group B consisted of overdoses occurring on outside this time frame.. Group A consisted of 39 patient contacts and the remaining 61 patient contacts were in group B. There were statistically significant differences between the two groups in (group A vs. B, respectively): history of injecting drug abuse (33% vs. 59%, p = 0.012), reported polydrug and ethanol use (80% vs. 62%, p = 0.028), the location where the patients were encountered (private or public indoors or outdoors, 10%, 41%, 41% vs. 25%, 18%, 53%, p = 0.019) and how the knowledge of GHB/GBL use was obtained (reported by patient/bystanders or clinical suspicion, 72%, 28% vs. 85%, 10%, p = 0.023). Practically all (99%) patients were transported to emergency department after prehospital care.. There appears to be at least two distinct groups of GHB/GBL users. Injecting drug users represent the majority of GHB/GBL overdose patients outside weekend nights.

Topics: 4-Butyrolactone; Adult; Drug Overdose; Emergency Medical Services; Female; Finland; Humans; Illicit Drugs; Male; Retrospective Studies; Sodium Oxybate; Substance Abuse, Intravenous; Substance-Related Disorders; Urban Population; Young Adult

Gamma-hydroxybutyrate (GHB) is a drug with significant abuse potential. The present study aimed to assess the relative value of escalating doses of GHB to current GHB users via the Multiple Choice Procedure (MCP), and to validate that the dose rated highest with the MCP would be self-administered at a greater rate than placebo. Participants were 5 current GHB users who were not currently trying to stop using GHB. To examine the value of escalating doses of GHB, the following doses of GHB were used: 0 (placebo), 12.5, 25, 37.5, and 50 mg/kg. Participants typically assigned higher doses of GHB had higher crossover points on the MCP. During choice sessions, participants made repeated choices between administering GHB, placebo or nothing. All participants selected GHB exclusively (5 out of 5 instances) except for one participant who selected GHB on 4 out of 5 instances, thus 96% (i.e., 24/25) of choices were for active GHB. Based on these data, GHB appears likely to function as a dose-dependent reinforcer for humans based on our sample.

Topics: Adult; Central Nervous System Depressants; Choice Behavior; Dose-Response Relationship, Drug; Female; Humans; Male; Reinforcement, Psychology; Sodium Oxybate; Substance-Related Disorders

Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.. To describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.. Retrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011. Main outcome measures Clinical presentation, medical interventions and discharge destination.. Sixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.. The deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.

Topics: Adjuvants, Anesthesia; Ambulances; Dancing; Drug Overdose; Emergency Medical Services; Female; Humans; Male; Mass Behavior; Mobile Health Units; Music; Prescription Drug Misuse; Retrospective Studies; Social Behavior; Sodium Oxybate; Substance-Related Disorders; Victoria; Young Adult

A gas chromatography-mass spectrometry (GC-MS) and a liquid chromatography tandem mass spectrometry (LC-MS/MS) method were validated for quantifying endogenous and exogenous hair concentrations of gamma-hydroxybutyrate (GHB). The GC-MS method is based on overnight extraction of 25 mg hair in NaOH at 56 °C, liquid/liquid extraction in ethylacetate and trimethylsylil derivatization; analysis is by electron ionization and single ion monitoring of three ions. The LC-MS/MS method entails a rapid digestion of 25 mg hair with NaOH at 75 °C for 40 min, liquid/liquid extraction in ethylacetate and reconstitution of the extract in the LC mobile phase; negative ion electrospray ionization and multiple reaction monitoring (MRM) analysis are employed for the LC-MS/MS detection. In both cases, GHB-d6 is used as an internal standard. The endogenous amount in "blank" hair are estimated by the standard addition method. Limits of detection are 0.4 and 0.5 ng/mg for GC-MS and LC-MS/MS respectively, while the limit of quantification (LOQ) is 0.6 ng/mg for both methods; the GC-MS method proved to be linear in the range 1-50 ng/mg whereas linearity was demonstrated from 0.6 to 50 ng/mg for the LC-MS/MS; imprecision and inaccuracy were always lower than 23% for quality controls samples. The two methods were applied to a real case of a man addicted to GHB; the drug concentration in segments from 17 cm hair strand well correlated with self-reported use of GHB in different periods of his life. Performances of the two methods were similar.

Topics: Acetates; Adult; Calibration; Chromatography, Liquid; Crime; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Hair; Humans; Illicit Drugs; Limit of Detection; Linear Models; Liquid-Liquid Extraction; Male; Quality Control; Reference Standards; Reproducibility of Results; Sodium Hydroxide; Sodium Oxybate; Spectrometry, Mass, Electrospray Ionization; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; Temperature

Topics: Adolescent; Adult; Ambulatory Care; Anesthetics, Intravenous; Humans; Sodium Oxybate; Substance-Related Disorders

The present study examined patterns of recent club drug use among 400 young adults (18-29) recruited using time-space sampling in NYC. Subjects had used at least one of six club drugs (methylenedioxymethamphetamine (MDMA), ketamine, gamma-hydroxybutyrate (GHB), cocaine, methamphetamine, and D-lysergic acid diethylamide (LSD)) within the prior 3 months. We used latent class analysis (LCA) to estimate latent groups based on patterns of recent club drug use and examined differences in demographic and psychological variables by class. A 3-class model fit the data best. Patterns were: Primary cocaine users (42% of sample), Mainstream users (44% of sample), and Wide-range users (14% of sample). Those most likely to be Primary cocaine users were significantly less likely to be heterosexual males and had higher educational attainment than the other two classes. Those most likely to be Wide-range users were less likely to be heterosexual females, more likely to be gay/bisexual males, dependent on club drugs, had significantly greater drug and sexual sensation seeking, and were more likely to use when experiencing physical discomfort or pleasant times with others compared to the other two groups. Findings highlight the utility of using person-centered approaches to understand patterns of substance use, as well as highlight several patterns of club drug use among young adults.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Cocaine; Dopamine Uptake Inhibitors; Drug Users; Excitatory Amino Acid Antagonists; Female; Hallucinogens; Humans; Ketamine; Lysergic Acid Diethylamide; Male; N-Methyl-3,4-methylenedioxyamphetamine; New York City; Prevalence; Risk Factors; Sex Factors; Sexual Behavior; Social Environment; Sodium Oxybate; Space-Time Clustering; Substance-Related Disorders; Young Adult

Topics: Emergency Service, Hospital; Humans; Prevalence; Reagent Strips; San Francisco; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

Acute psychosis and extreme agitation brought about by gamma-hydroxybutyrate GHB withdrawal can be life-threatening. In order to prevent states of excitement accompanied by aggression and somatic complications it is advisable to intervene by administering strong sedatives. It is argued that GHB should be tapered off as an alternative treatment for fixation and high doses of benzodiazepines.

Topics: Adult; Anesthetics, Intravenous; Humans; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

gamma-Hydroxybutyrate (GHB) is a drug of abuse with a status as being safe. In spite of a reputation of low toxicity, a huge number of deaths associated with this drug have been recorded during recent years in Sweden. It is unclear whether coingestion with other drugs or ethanol causes death in GHB overdoses or whether GHB itself is the main cause of death.. The aim of this study was to analyze the cause of death in GHB-related fatalities seen in our region.. All cases of deaths with GHB during the year 2000-2007 in the region of western Sweden were studied retrospectively. The cases were classified as either GHB poisonings without any, with a minor or a major influence of other drugs on the cause of death.. Twenty-three cases were diagnosed as deaths due to GHB overdose. Ninety-one percent coingested other substances. Ninety-one percent of the decedents were male. Age varied between 16 and 46, with the median age at 25 years. Forty-three percent of the cases were classified as GHB poisonings without any or a minor influence of other drugs on the cause of death. Thirty percent also ingested ethanol. Two patients (9%) were only intoxicated with GHB.. Intoxication with GHB carries some mortality. Combining GHB with ethanol does not explain the many deaths in our region, nor do extremely high plasma concentrations of GHB. The intake of opioids increases the toxicity of GHB. The drug itself has such biological activities that an overdose is dangerous and may lead to death.

Topics: Adolescent; Adult; Central Nervous System Stimulants; Cocaine; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Immunoassay; Male; Marijuana Abuse; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Prescription Drugs; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Sweden; Young Adult

gamma-Hydroxybutyrat (GHB) is used medically for narcolepsy and as a narcotic. It is also a rare illegal drug. In this case report the development of a GHB-dependency against the background of a primary alcohol dependency is described.. Based on established alcohol withdrawal scales (AWSS by Wetterling, CIWA) and neuropsychological testing procedures (CGI, GAF, SKID-II, PISQ, analog-scale for Craving), the initial situation, the development of psychopathological findings, and the course of detoxification were shown.. The combined detoxication of GHB and alcohol was successfully finished by a reduction schedule of diazepam. Withdrawal-assessment scales for alcohol were helpful, but show limitations for GHB-withdrawal symptoms. The patient suffers, according to ICD-10, from a multiple drug dependence (alcohol, GHB, abstinence from amphetamines). Symptoms of insomnia, major depression, and generalized anxiety disorder can be associated with the use of GHB.

Topics: Adjuvants, Anesthesia; Adult; Alcoholism; Comorbidity; Drug Tolerance; Humans; Illicit Drugs; Male; Neuropsychological Tests; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome

Gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are prodrugs for gamma-hydroxybutyrate (GHB). Like GHB, GBL and 1,4-BD are drugs of abuse, but their behavioral effects may differ from GHB under some conditions.. The first study compared the behavioral effects of GBL (32-240 mg/kg) and 1,4-BD (32-240 mg/kg) with each other and to effects previously reported for GHB (32-420 mg/kg). A second study determined GHB pharmacokinetics following intragastric administration of GHB, GBL, and 1,4-BD.. Operant responding for food, observed behavioral effects, and a fine-motor task occurred at multiple time intervals after administration of drug or vehicle. In a separate pharmacokinetics study, blood samples were collected across multiple time points after administration of GHB, GBL, and 1,4-BD.. Like GHB, GBL, and 1,4-BD impaired performance on the fine-motor task, but the onset of motor impairment differed across drugs. GBL and 1,4-BD dose dependently decreased the number of food pellets earned, but at lower doses than previously observed for GHB. Similar to GHB, both GBL and 1,4-BD produced sedation, muscle relaxation, gastrointestinal symptoms, and tremors/jerks. Administration of GBL and 1,4-BD produced higher maximum concentrations of GHB with shorter times to maximum concentrations of GHB in plasma when compared to GHB administration.. GBL and 1,4-BD produced behavioral effects similar to those previously reported with GHB and the time course of effects were related to blood levels of GHB. Given their higher potency and faster onset of effects, the abuse liability of GBL and 1,4-BD may be greater than GHB.

Topics: 4-Butyrolactone; Animals; Area Under Curve; Behavior, Animal; Butylene Glycols; Conditioning, Operant; Dose-Response Relationship, Drug; Food; GABA Modulators; Male; Motor Skills; Papio; Prodrugs; Reward; Sodium Oxybate; Substance-Related Disorders

This paper documents the operation of Australia's Ecstasy and Related Drugs Reporting System (EDRS), using multiple data sources to document trends in gamma-hydroxybutyrate (GHB) use in Sydney, Australia between the years 2000-2006.. The EDRS monitors trends in ecstasy and related drug markets by means of a triangulation of data from interviews with regular ecstasy users (REU), surveys with key experts (KE), and analysis of secondary indicator data sources.. The proportion of REU reporting lifetime GHB use increased from 5% in 2000 to 40% in 2006 and the proportion reporting recent use increased from 1% in 2000 to 21% in 2006. KE reports suggest GHB use may be a concern amongst specific drug user subcultures. REU and KE data suggest a change in the locations in which GHB is used, with a shift from dance venues and events to private homes and parties. There is a lack of indicator data from both health and law enforcement data collection systems concerning GHB.. The EDRS has effectively monitored the increase in GHB amongst REU over the past seven years in Sydney, Australia. This increase is unlikely to have been as readily identified by other surveillance systems.

Topics: Drug and Narcotic Control; Expert Testimony; Humans; Illicit Drugs; New South Wales; Population Surveillance; Prevalence; Sodium Oxybate; Substance-Related Disorders

The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

Topics: Buprenorphine; Buprenorphine, Naloxone Drug Combination; Dextroamphetamine; Drug and Narcotic Control; Drug Industry; History, 20th Century; History, 21st Century; Humans; Lisdexamfetamine Dimesylate; Methylphenidate; Naloxone; Oxycodone; Product Surveillance, Postmarketing; Risk Management; Sodium Oxybate; Substance-Related Disorders

To examine the nature and extent of ambulance attendances involving gamma-hydroxybutyrate (GHB) and to compare these with heroin-related attendances in Melbourne, Victoria.. Retrospective analysis of a database of ambulance service records on attendances at non-fatal drug overdoses, March 2001-October 2005.. Patients who took GHB and were attended to by an ambulance, as recorded by Metropolitan Ambulance Service (Melbourne) paramedics.. Transportation to hospital by ambulance; other outcomes included number, age, sex and Glasgow Coma Score (GCS) of patients, characteristics of attendances (in public or private space, others present, police co-attendance).. There were 618 GHB-related ambulance attendances across the 46 months of data collection; 362 involving GHB only and 256 involving the concurrent use of GHB and other drugs. These figures compare to 3723 heroin overdoses observed during the same period. The number of GHB-related attendances increased by around 4% per month, which was a higher rate of increase than that found for heroin overdose attendances. Most patients were younger than 25 years, were attended in public spaces, and had a GCS <10. Around 90% of patients were transported to hospital, compared with 21% of heroin overdose attendances.. Ambulance attendance data can be used to index GHB-associated harms. The clear increases in GHB-related ambulance attendances over time highlights the need for further research on how best to respond to this emergent drug-related harm.

Topics: Adult; Ambulances; Drug Overdose; Emergency Medical Services; Female; Humans; Incidence; Male; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Victoria

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a year-long longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs-cocaine, GHB, ketamine, ecstasy, and methamphetamine-using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.

Topics: Adolescent; Adult; Aged; Bisexuality; Cocaine; Homosexuality, Male; Humans; Ketamine; Longitudinal Studies; Male; Methamphetamine; Middle Aged; Models, Statistical; Multivariate Analysis; N-Methyl-3,4-methylenedioxyamphetamine; New York City; Social Behavior; Social Facilitation; Sodium Oxybate; Substance-Related Disorders

Focus group discussions elicited descriptive experiences of driving under the influence of gamma hydroxybutyrate (GHB), and uncovered motivations that led participants to decide whether to get behind the wheel after ingesting this illegal psychoactive substance. Of the 51 current and past users interviewed, average age 31.1 +/- 7.7 years, 40% were female. All were recruited from the San Francisco Bay Area, in 2004. Factors making users vulnerable to adverse complications of driving while under the influence of GHB are also examined. Study limitations were noted. Implications for various law enforcement agencies and health professionals are derived from the data.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Automobile Driving; Decision Making; Female; Focus Groups; Humans; Male; Middle Aged; Motivation; San Francisco; Social Class; Sodium Oxybate; Substance-Related Disorders

Gamma hydroxybutyrate (GHB) is a psychoactive substance with complex neurophysiological activity and significant potential for abuse, addiction, and dangerous toxicity. In this study, a semistructured interview was administered to 17 subjects to investigate GHB use, including: manner of use; setting; positive and negative consequences; other drug history; and sexual practices. Respondents were overwhelmingly male, but otherwise had a broad demographic background. Settings varied from nightclubs to private use at home. There was significant variability in the drug obtained, which subjects found problematic because of the narrow therapeutic window and ease of accidental overdose. Common positive experiences included increased sexual desire, decreased sexual inhibitions, and decreased anxiety. Common negative consequences included oversedation, loss of consciousness, motor incoordination, and mental confusion. Nine subjects reported that they would use GHB again, some despite severe negative consequences. Although most subjects reported negative experiences, only three felt their use was problematic, and none sought treatment for GHB abuse or addiction. Subjects were highly drug-experienced, most commonly using MDMA, ketamine, cocaine, alcohol, and methamphetamine. Some reported that GHB could cause poor decision making in sexual situations. This effect has significant ramifications for issues such as date rape and control of sexually transmitted diseases, such as HIV.

Topics: Adult; Data Collection; Drug Overdose; Female; Humans; Illicit Drugs; Male; Middle Aged; New York City; Risk-Taking; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders; Young Adult

This study assesses medical students' use of and attitudes towards club drugs, classified as "Generation I" (i.e., cocaine and lysergic acid diethylamide), and "Generation II" (i.e., methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in club settings. An anonymous questionnaire was administered to 340 medical students. The prevalence of any club drug use was 16.8%, with MDMA (11.8%) and cocaine (5.9%) the most commonly used. Results discussed also include the relationship of age and gender to having ever used club drugs and to their attitudes regarding use. Additionally, the study identifies differences in patterns of use and attitudes toward Generation I versus Generation II club drugs based on age, gender, and participants' prior club drug use. Findings are compared to those of earlier studies about medical students and those in a similar age group in the general population.

Topics: Adult; Anesthetics, Intravenous; Anti-Anxiety Agents; Central Nervous System Stimulants; Dextromethorphan; Excitatory Amino Acid Antagonists; Female; Flunitrazepam; Hallucinogens; Health Knowledge, Attitudes, Practice; Humans; Illicit Drugs; Ketamine; Lysergic Acid Diethylamide; Male; Methamphetamine; Midwestern United States; N-Methyl-3,4-methylenedioxyamphetamine; Sex Distribution; Sodium Oxybate; Students, Medical; Substance-Related Disorders; Surveys and Questionnaires; Young Adult

To describe epidemiology, symptomatology, resource use and complications in patients attending the ED following gamma-hydroxybutyrate (GHB) ingestion.. Retrospective chart review of GHB-related emergency attendances over 30 months.. One hundred and seventy emergency attendances attributed to GHB ingestion occurred. Monthly attendance rate doubled during the study, and was highest on public holidays and weekends between 04.00 and 08.00 hours. The majority (63%, 95% CI 55.7-70.3) were young men (median 22 years). GHB was ingested alone in 62 cases (36%, 95% CI 29.6-43.9). Poly-substance ingestion was common (108 cases; 64%; 95% CI 56.1-70.4). The commonest presenting symptom was altered conscious state (89%, 95% CI 84.1-93.5) with 54% (95% CI 46.6-61.6) having low Glasgow Coma Score (GCS 3-8) on arrival at the ED. Eight per cent (95% CI 3.6-11.6) were intubated. Eighty-seven per cent (95% CI 79.8-93.8) with low GCS were not intubated. There were no serious adverse outcomes or fatalities. Recovery time from ED arrival to high GCS (9-15) was rapid (median 76 min, interquartile range 80). Overall median length of stay was 199 min (interquartile range 162).. This is the largest GHB-related case series to date. Attendance rate doubled during the study, and peaked at times of lowest staffing. Poly-substance ingestion is common. Attendances are of high acuity with decreased conscious state and airway threat. With close conservative management, most recover quickly without adverse sequelae.

Topics: Adolescent; Adult; Bradycardia; Consciousness Disorders; Emergency Service, Hospital; Female; Glasgow Coma Scale; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders; Tachycardia; Victoria; Young Adult

Topics: Amphetamine-Related Disorders; Cocaine-Related Disorders; France; Heroin Dependence; Humans; Illicit Drugs; Marijuana Abuse; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

We used an in-house forensic toxicology database (TOXBASE) to evaluate the occurrences of gamma-hydroxybutyrate (GHB) in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID) between 1998 and 2007. Age, gender, and concentrations of GHB in blood were compared and contrasted when GHB was the only drug present and when it occurred along with other drugs. GHB was determined in blood by gas chromatography (GC) after conversion to gamma-butyrolactone (GBL) and analysis of the latter with a flame ionization detector. The cut-off concentration of GHB in blood for reporting a positive result was 8 mg/l, which served as limit of quantitation. The mean and median GHB concentrations were 89 mg/l and 82 mg/l, respectively (2(1/2) and 97(1/2) percentiles 12 and 220 mg/l) in 548 arrested drivers. These individuals were predominantly men (95%) with an average age of 26 +/- 5.5 years (range 15-50 years) and women (5%) were several years older with an average age of 32 +/- 8.0 years (range 19-47). There were 102 individuals (29%) who were arrested more than once with GHB in blood (average approximately 3 times per person) and one as many as 10 times. GHB was the only psychoactive substance detected in 215 cases (39%) at mean and median blood-concentrations of 91 mg/l and 83 mg/l, respectively. These concentrations were not significantly different from poly-drug users. A weak but statistically significant correlation existed between the concentration of GHB in blood and the person's age (N = 548, r = 0.135, P < 0.01). The signs of drug influence noted by arresting police officers included sedation, agitation, unsteady gait, slurred speech, irrational behavior, jerky body movements, dilated pupils, and spitting. The blood concentrations reported here are probably appreciably less than at time of driving (30-90 min earlier) owing to the short elimination half-life of GHB (t ((1/2)) = 30-40 min).

Topics: Adolescent; Adult; Automobile Driving; Databases, Factual; Female; Flame Ionization; Forensic Toxicology; Humans; Male; Middle Aged; Narcotics; Recurrence; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Sweden; Young Adult

Self-reported use of gamma-hydroxybutyrate (GHB) among clubbers has increased over the last decade, and is often reported in the scientific literature in association with negative events such as amnesia, overdose, and use in drug facilitated sexual assault. However, there has been relatively little work investigating the phenomenology of GHB intoxication, and the reasons underlying use. In this study, 189 individuals reporting at least one lifetime use of GHB completed an online questionnaire recording GHB use behaviours, GHB use function, and subjective GHB effects. The most frequently reported primary GHB use functions were for recreation (but not in nightclubs) (18.3%); to enhance sex (18.3%); to be sociable (13.1%); and to explore altered states of consciousness (13.1%). GHB was more commonly used within the home (67%) compared to nightlife environments (26.1%) such as clubs, although this differed on the basis of respondent's sexuality. Principle components analysis of GHB user responses to the subjective questionnaire revealed six components: general intoxication effects, positive intoxication effects, negative intoxication effects, negative physiological effects, positive sexual effects and negative sexual effects. Component scores predicted function of use.

Topics: Adult; Female; Harm Reduction; Humans; Inhibition, Psychological; Male; Sexual Behavior; Sleep Stages; Social Behavior; Social Environment; Sodium Oxybate; Substance-Related Disorders

There have been apparent increases in recent years in the illicit use of ketamine and gamma-hydroxybutyrate (GHB), but to date there has been no examination of the epidemiology of use in the general population. This paper provides the first such Australian data on the patterns and correlates of GHB and ketamine use.. Data were analysed from the 2004 National Drug Strategy Household Survey, a multistage probability sample of Australians aged 14 years or older. Associations between GHB and ketamine use, and core demographic and other drug use variables, were examined.. 0.5% of Australians aged 14 years or older reported ever using GHB, and 0.1% reported recent use, with the prevalence of use being highest amongst those aged 20-29 years. Lifetime use of ketamine was reported by 1% of Australians aged 14 years or older, with 0.3% reporting recent use. Again, prevalence of ketamine use was highest amongst those aged 20-29 years. Those who reported ever using these drugs described a pattern of occasional use, with the large majority not using these drugs in the past year. Multiple regression analyses suggested that compared to non-users, GHB and ketamine users were more likely to report the recent use of a wide range of other drugs.. The prevalence of GHB and ketamine use in Australia appears to be quite low. The present study found high rates of polydrug use, as have been documented in convenience samples of GHB and ketamine users in previous work. As for other illegal drugs used by small proportions of the population, detailed data on patterns of use and associated risks of use are probably best derived from targeted samples of users; household survey data allow comparisons of the relative prevalence of use compared to other illicit drugs and future work will provide the opportunity to consider changes in the extent of use in the general population.

Topics: Adolescent; Adult; Age Factors; Australia; Data Collection; Female; Humans; Illicit Drugs; Ketamine; Male; Prevalence; Sodium Oxybate; Substance-Related Disorders

This study investigates the effect of voluntary and involuntary drug use on attributions about sexual assault. The sample was composed of 280 randomly selected male and female undergraduate students. The type of drug used (GHB, alcohol, or none) and the voluntariness of the administration were varied in an unambiguous date rape scenario. Participants viewed sexual assault facilitated by alcohol or drugs similarly to sexual assault without drug or alcohol involvement, assigning the highest levels of responsibility and blame to the perpetrator and the lowest levels of both to the victim in these situations. In contrast, women's voluntary consumption of drugs prior to a sexual assault reduced perpetrator responsibility and blame and increased blame to the victim compared to other situations (except in some cases, voluntary drunkenness). These findings extend the limited research on date rape drugs and previous work on the influence of alcohol on date rape attributions.

Topics: Adult; Alcohol Drinking; Alcoholic Beverages; Beverages; Coercion; Crime Victims; Female; Food Contamination; Humans; Illicit Drugs; Interpersonal Relations; Male; Middle Aged; Rape; Social Responsibility; Sodium Oxybate; Stereotyping; Students; Substance-Related Disorders; Surveys and Questionnaires; United States; Women's Health

Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects.. The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs.. Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present.. In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions.. Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.

Topics: 4-Butyrolactone; Adult; Aged; Butylene Glycols; Emergency Medical Services; Female; Humans; Illicit Drugs; Length of Stay; Male; Middle Aged; Retrospective Studies; Sodium Oxybate; Substance-Related Disorders

Topics: Amphetamines; Benzodiazepines; Cannabis; Cocaine; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Naloxone; Narcotic Antagonists; Piperazines; Sodium Oxybate; Substance-Related Disorders

GHB is a drug of abuse and acute poisonings have been an increasing medical problem over the last decade in Sweden.. To document all cases of GHB poisonings in Gothenburg during 1995-2004 and to record drug-related deaths to compare the toxicity of GHB with other illicit drugs, such as heroin and amphetamine.. The number of GHB-poisoned patients treated at the Sahlgrenska University Hospital has been recorded with the help of an in-house database. The number of deaths by illicit drugs was recorded during 2004. Seizures of the drugs GHB, 1,4-butanediol, and GBL were registered between 1996 and 2004.. The number of poisoned patients was 259. The number of seizures with GHB was 743, GBL 343, and 1,4-butanediol 236. In 2004 the number of deaths was 6 with heroin, 7 with GHB, 32 with amphetamine, 6 with cocaine, and one with methadone. One patient with GHB poisoning died during hospital care.. Intoxication by GHB has substantial morbidity and abuse of GHB has substantial mortality. The acute prognosis is good but long-term prognosis is insecure with an increased risk for drug dependency and an early death.

Topics: 4-Butyrolactone; Adolescent; Adult; Anesthetics, Intravenous; Butylene Glycols; Cause of Death; Female; Forensic Medicine; Humans; Illicit Drugs; Male; Police; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Sweden

Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

Topics: Bisexuality; Cocaine; Drug Combinations; Homosexuality, Male; Humans; Illicit Drugs; Ketamine; Leisure Activities; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Piperazines; Purines; Sildenafil Citrate; Sodium Oxybate; Substance-Related Disorders; Sulfones

Gamma-hydroxybutyrate (GHB) is used to treat narcolepsy but is also abused. GHB has many actions in common with the GABA(B) receptor agonist baclofen.. To further study the role of GABA(B) receptors in the effects of GHB.. The experiments examined the ability of the GABA(B) receptor antagonist CGP35348 to attenuate GHB-induced catalepsy in comparison with its ability to attenuate the cataleptic effects of GABA(B) receptor agonists.. In C57BL/6J mice, GHB, the GHB precursor gamma-butyrolactone (GBL), and the GABA(B) receptor agonists baclofen and SKF97541 all produced catalepsy but differed in potency (i.e., SKF97541>baclofen>GBL>GHB) and in onset of action. The cataleptic effects of drug combinations were assessed at the time of peak effect of each compound, i.e., 60 min after CGP35348 and 60, 30, 30, and 15 min after baclofen, SKF97541, GHB, and GBL, respectively. At 100 mg/kg, CGP35348 shifted the dose-response curves of baclofen and SKF97541 to the right but not those of GHB and GBL; at 320 mg/kg, CGP35348 shifted the curves of all four compounds to the right.. The finding that CGP35348 was about threefold less potent to antagonize GHB and GBL than baclofen and SKF97541 is further evidence that the mechanisms mediating the effects of GHB and GABA(B) agonists are not identical. Differential involvement of GABA(B) receptor subtypes, or differential interactions with GABA(B) receptors, may possibly explain why GHB is effective for treating narcolepsy and is abused whereas baclofen is not.

Topics: 4-Butyrolactone; Animals; Baclofen; Catalepsy; Dose-Response Relationship, Drug; GABA Agonists; GABA Antagonists; GABA-B Receptor Agonists; Male; Mice; Mice, Inbred C57BL; Narcolepsy; Organophosphorus Compounds; Receptors, GABA-B; Sodium Oxybate; Substance-Related Disorders

Although ethanol is frequently used in combination with other psychoactive drugs, the behavioral and pharmacological reasons for this form of polydrug abuse have not been well described.. Rhesus monkeys with indwelling intravenous catheters produced intravenous injections of ethanol (50, 100, or 200 mg/kg/inj), flunitrazepam (0.001-0.03 mg/kg/inj), cocaine (0.01 or 0.03 mg/kg/inj), or combinations of ethanol and these drugs or gammahydroxybutyrate (GHB) (1.0 or 3.2 mg/kg/inj) by lever pressing according to a fixed-ratio schedule. The response requirement for each drug or drug combination was increased across sessions (10, 32, 100, 320, or 1,000). The dependent variables were rates of responding maintained by the drug or drug combination and the elasticity of drug demand when consumption was expressed as a function of price.. Elasticity (P (max)) values for each drug varied among the monkeys but retained the same rank order for the monkeys, suggesting a fundamental difference in the animals' apparent sensitivities to the reinforcing effects of the drugs. Combining ethanol with the other drugs did not increase their reinforcing effectiveness. GHB (ineffective in previous studies) did not modify ethanol's reinforcing effects; demand functions for the combination of ethanol and flunitrazepam were slightly less elastic than for ethanol alone, but no different from that for flunitrazepam alone; adding ethanol to cocaine detracted from the reinforcing effectiveness of cocaine.. The hypothesis that use of ethanol in combination with sedative and stimulant drugs is due to an ability of ethanol to enhance the reinforcing effects of these drugs is not supported.

Topics: Animals; Behavior, Addictive; Behavior, Animal; Central Nervous System Depressants; Cocaine; Dopamine Uptake Inhibitors; Dose-Response Relationship, Drug; Drug Interactions; Ethanol; Female; Flunitrazepam; GABA Modulators; Injections, Intravenous; Macaca mulatta; Male; Reinforcement Schedule; Self Administration; Sodium Oxybate; Substance-Related Disorders

(1) Narcolepsy is characterised by sudden, overwhelming daytime drowsiness, sometimes associated with cataplexy (more or less complete loss of muscle tone during an emotional reaction). (2) Modafinil moderately reduces daytime drowsiness but has no effect on cataplexy. Methylphenidate, an amphetamine psychostimulant, seems to act on both drowsiness and cataplexy, although its clinical evaluation is limited to observational series. (3) Oxybic acid, long used in general anaesthesia, but also misused for recreational and criminal purposes (chemical or drug-induced submission), has been approved to treat adults with both narcolepsy and cataplexy, in the form of an oral solution of sodium oxybate. (4) The rationale behind the use of sodium oxybate is to re-establish a near-normal pattern of the different phases of sleep. Because of its short-lasting action, sodium oxybate has to be taken once at bedtime and then again 2.5 to 4 hours later. (5) Clinical evaluation mainly consists of 4 double-blind placebo-controlled trials of sodium oxybate. Three short-term trials, involving 136 patients treated for 4 weeks and 228 and 270 patients treated for 8 weeks, showed that sodium oxybate at a dose of 4.5 g to 9 g a day reduced the number of cataplexy attacks but that a dose of at least 6 g was needed to reduce daytime drowsiness. A trial involving 56 patients who had been taking sodium oxybate for nearly 2 years, assessed the effects of stopping versus continuing treatment. The results suggest that sodium oxybate is effective in the long term. (6) During clinical trials, 61% of patients had adverse effects attributed to sodium oxybate. These included gastrointestinal disorders (nausea (18%)), neurological disorders (dizziness (15%), headache (6%)), confusion (3%), and enuresis (7%). (7) Altered consciousness and respiratory depression occurred after a single intake of a dose two or three times higher than the recommended dose. (8) Misuse, especially to obtain chemical or drug-induced submission (i.e. as a 'date rape' drug), is facilitated by the odourless and colourless nature of the oral solution. (9) In practice, for some patients who are seriously affected by persistent episodes of cataplexy or drowsiness, despite treatment of narcolepsy, sodium oxybate is preferable to methylphenidate, which has been less thoroughly evaluated. However, the risks of misuse and overdose mean that this drug should only be proposed to patients in whom the benefits are likely to outweig

Topics: Adjuvants, Anesthesia; Adult; Cataplexy; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Drug Approval; France; Humans; Narcolepsy; Randomized Controlled Trials as Topic; Sleep; Sodium Oxybate; Substance-Related Disorders; Treatment Outcome; Wakefulness

Little is known about behaviors linked to gamma hydroxybutyrate (GHB) morbidity.. We surveyed 131 GHB users, using logistic regression to test the associations between the high risk behaviors and hospital treatment for GHB (26 [20%] of subjects).. Increased risk of GHB hospital treatment was associated with: co-ingestion of ethanol (OR 5.2; 95% CI 1.7-16), driving under the influence of GHB (OR 3.2; 95%, CI 1.3-7.8),use of GHB to treat withdrawal symptoms (OR 2.9; 95% CI 1.1-7.9), and co-ingestion of ketamine (OR 2.7; 95% CI 1.1-6.7).. Targeted prevention activities could focus on selected high-risk behaviors.

Topics: Adult; Alcohol Withdrawal Delirium; Alcohol-Related Disorders; Analgesics; Automobile Driving; Comorbidity; Female; Health Surveys; Hospitalization; Humans; Illicit Drugs; Ketamine; Male; Regression Analysis; Risk-Taking; Sodium Oxybate; Substance-Related Disorders; United States

Topics: Alcohol Drinking; Alcoholism; Anesthetics, Intravenous; Drug Interactions; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders

GHB (gamma hydroxybutyrate) is a significant new drug of abuse added to the United States Controlled Substance Act in 2000. The majority of the published literature on GHB consists of clinical case reports, mainly from emergency departments, and a collection of laboratory-based studies, focused mainly on anesthesia. While comments about the various experiences and behaviors of human users are often included in such studies or reports, these aspects of GHB are only just beginning to be systematically investigated or detailed. Reported here are data from a qualitative study using focus group methods on the consumption habits, experiences, and beliefs of GHB users. A total of 51 people, 30 men and 21 women, mean age of 31.1+/-7.6 years (range 18 to 52 years), who report having used GHB for an average of 4.3+/-2.5 years (range one to 11 years), were interviewed in 10 separate groups held in 2004. This article discusses broadly the general experience of the GHB high, major perceived benefits including sexual responses to the drug, perceived risks and dangers of ingestion, co-ingestion, and various contexts of use. It concludes with a discussion of the implications drawn from this information for clinicians treating patients who use GHB.

Topics: Adolescent; Adult; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Illicit Drugs; Male; Middle Aged; Risk Assessment; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders

Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This case report describes a patient with a novel type of Cushing's syndrome due to the use of party drugs. A 35-year-old woman had gained 8 kg body weight in 5 months and complained of anxiety. She showed a Cushing-like appearance and mild hypertension (blood pressure, BP 150/95 mmHg). She reported daily use of increasing doses of gamma-hydroxybutyric acid (GHB), a popular party drug. ACTH plasma levels were in the upper normal range (41 ng/l), with normal plasma cortisol (0.36 micromol/l). She showed an abnormal overnight 1 mg dexamethasone suppression test (cortisol 0.38 micromol/l). The urinary excretion of free cortisol in 24 h was also increased (0.47 micromol/24 h). CT scanning of the abdomen showed normal adrenals. After stopping GHB intake she lost 7 kg body weight and her BP normalized (BP 135/80 mmHg). GHB is a popular party drug in the Netherlands, but it is also used as a narcotic and for the treatment of narcolepsy. We hypothesize that GHB may bind to the pituitary gland gamma-aminobutyric acid-B receptors leading to ACTH overproduction.

Topics: Adult; Cushing Syndrome; Female; Humans; Hydrocortisone; Hypertension; Sodium Oxybate; Substance-Related Disorders

To analyze changes in gamma-hydroxybutyrate (GHB) case reporting, we review GHB or congener drug cases reported to the California Poison Control System, comparing these to other data sets.. We identified cases from the California Poison Control System computerized database using standardized codes and key terms for GHB and congener drugs ("gamma butyrolactone," "1,4-butanediol," "gamma valerolactone"). We noted California Poison Control System date, caller and exposure site, patient age and sex, reported coingestions, and outcomes. We compared California Poison Control System data to case incidence from American Association of Poison Control Centers and Drug Abuse Warning Network data and drug use prevalence from National Institute for Drug Abuse survey data.. A total of 1,331 patients were included over the 5-year period (1999-2003). California Poison Control System-reported GHB exposures decreased by 76% from baseline (n=426) to the final study year (n=101). The absolute decrease was present across all case types, although there was a significant proportional decrease in routine drug abuse cases and an increase in malicious events, including GHB-facilitated sexual assault (P=.002). American Association of Poison Control Centers data showed a similar decrease from 2001 to 2003. Drug Abuse Warning Network incidence flattened from 2001 to 2002 and decreased sharply in 2003. National Institute for Drug Abuse survey time trends were inconsistent across age groups.. Based on the precipitous decrease in California Poison Control System case incidence for GHB during 5 years, the parallel trend in American Association of Poison Control Centers data, and a more recent decrease in Drug Abuse Warning Network cases, a true decrease in case incidence is likely. This could be due to decreased abuse rates or because fewer abusers seek emergency medical care. Case reporting may account for part of the decrease in the incidence of poison center contacts involving GHB.

Topics: Adolescent; Adult; Age Distribution; California; Causality; Child; Comorbidity; Databases, Factual; Female; Hospitalization; Humans; Male; Middle Aged; Poison Control Centers; Poisoning; Prevalence; Referral and Consultation; Retrospective Studies; Sex Distribution; Sodium Oxybate; Substance-Related Disorders; Survival Analysis

The recreational use of gamma-hydroxybutyrate (GHB) has been relatively understudied, despite its popularity in gay communities. We examined the use of GHB in a sample of 450 club drug using gay and bisexual men. Of these, 29% indicated use of the substance in the recent past. GHB users were similar to those in the sample who reported no use along key demographic factors, although GHB users were more likely to identify as gay than bisexual and were slightly older. Poly-drug use was common, with close to half of GHB users combining with methamphetamine, MDMA, or ketamine; approximately one quarter also used GHB with alcohol. Participants reported that GHB was often used at nightclubs, circuit parties, sex parties, and sex clubs, with HIV-positive men more likely to use the substance in sexual contexts. Use of GHB is common among a certain subset of gay men despite warnings within the community about the potentially fatal effects of the substance, suggesting that more effort be given to educate drug using gay men about GHB.

Topics: Adolescent; Adult; Bisexuality; HIV Seropositivity; Homosexuality, Male; Humans; Illicit Drugs; Longitudinal Studies; Male; Recreation; Risk Factors; Social Environment; Socioeconomic Factors; Sodium Oxybate; Substance-Related Disorders; Time Factors

The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N=19,084).. Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs.. Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence.. Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.

Topics: Adolescent; Adult; Age of Onset; Data Collection; Demography; Female; Flunitrazepam; Humans; Incidence; Ketamine; Lysergic Acid Diethylamide; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Prevalence; Sodium Oxybate; Substance-Related Disorders

Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time-space sampling from dance clubs in New York City during 2005 (N=1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.

Topics: Adolescent; Adult; Age Factors; Amphetamine-Related Disorders; Bisexuality; Cocaine-Related Disorders; Female; Gender Identity; Homosexuality, Female; Humans; Illicit Drugs; Ketamine; Lysergic Acid Diethylamide; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; New York City; Sexuality; Sodium Oxybate; Substance-Related Disorders

Abuse of gamma-hydroxybutyrate (GHB) and its precursors is a public health concern. Gamma-butyrolactone (GBL) is found in commercially available products and, when ingested, is metabolized to GHB.. The goal was to evaluate the physical dependence potential and behavioral effects of GBL.. Vehicle and then GBL were administered continuously (24 h per da y) in baboons (Papio anubis, n=5) via intragastric catheters. GBL dosing was initiated at 100 mg/kg/day and then progressively increased stepwise by increments of 100 mg/kg to a final dose of 600 mg/kg. The number of food pellets earned, fine-motor task performance, and observed behaviors were used as dependent measures. Precipitated withdrawal was evaluated after administration of GABA-B and benzodiazepine receptor antagonists during chronic GBL dosing (400-600 mg/kg). Spontaneous withdrawal was evaluated after discontinuation of chronic GBL 600 mg/kg. Blood GHB levels were determined during chronic dosing of each GBL dose by isotope dilution assay.. Chronic GBL dose-dependently decreased food-maintained behavior, disrupted performance on the fine-motor task, and produced signs of sedation and muscle relaxation. The GABA-B antagonist SGS742 [56 mg/kg, intramuscular (IM)] precipitated a withdrawal syndrome, whereas the benzodiazepine antagonist flumazenil (5 mg/kg, IM) produced little or no effect. Signs of physical dependence were also demonstrated when chronic GBL dosing was discontinued. Analysis of plasma indicated GBL was metabolized to GHB; levels were 825 to 1,690 micromol l(-1) GHB and 2,430 to 3,785 micromol l(-1) GHB after week 1 of 400 and 600 mg/kg/day, respectively.. These data indicate that, like GHB, chronic GBL dosing produced physical dependence that likely involved the GABA-B receptor.

Topics: 4-Butyrolactone; Animals; Behavior, Animal; Catheters, Indwelling; Conditioning, Operant; Dose-Response Relationship, Drug; Flumazenil; Food; GABA Antagonists; GABA-A Receptor Antagonists; GABA-B Receptor Antagonists; Male; Motor Skills; Muscle Relaxation; Organophosphorus Compounds; Papio anubis; Receptors, GABA-A; Receptors, GABA-B; Sleep; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

The emergence of gamma-hydroxybutyrate (GHB) dependence in the UK is described, with specific reference to a case study of serial episodes of GHB withdrawal. Symptoms are broadly similar to those for alcohol withdrawal, and rapid deterioration into delirium is common in severe dependence. This case report reflects the variability in clinical presentation of GHB withdrawal and response to treatment, even within the same patient. It is concluded that GHB withdrawal requires vigorous clinical management, preferably on an elective basis, in an inpatient setting if dependence is severe.

Topics: Adult; Female; Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

The first case in France involving a fatal overdose resulting from the ingestion of gamma-hydroxybutyrate (GHB) is presented. GHB was tested by gas chromatography-mass spectrometry (GC-MS) after precipitation. Briefly, 20 microL of body fluids (blood, bile, urine, gastric contents, or vitreous humor) was pipetted in a glass tube, followed by 20 microL GHB-d6 and 45 microL acetonitrile. After vortex mixing and centrifuging, the supernatant was collected and evaporated to dryness. The residue was derivatized with BSTFA with 1% TMCS for 20 min at 70 degrees C. After injection on a 30-m HP5 MS capillary column, GHB (m/z 233, 204, and 147) and GHB-d6 (m/z 239) were identified by MS. GHB was also tested in pubic hair after incubation in 0.01 N NaOH, neutralization, acidification, extraction in ethyl acetate and derivatization with MTBSTFA, using GC-MS-MS. GHB was positive in all the tested specimens, with the following concentrations 2937, 33,727, 1800, and 2856 mg/L in femoral blood, urine, bile, and vitreous humor, respectively. This seems to be the highest blood concentration ever observed. Postmortem redistribution appears weak, as the concentration in cardiac blood was 3385 mg/L (cardiac blood/femoral blood ratio of 1.15). Oral route was suggested with GHB at 7.08 g in 100 mL of gastric contents. Pubic hair analysis clearly indicated chronic GHB abuse, with concentrations along the shaft in the range 19.4 to 25.0 ng/mg (in comparison with physiological concentrations < 2 ng/mg). Methylenedioxymethamphetamine was present in femoral blood at 144 ng/mL. These results are consistent with an acute fatal overdose of GHB.

Topics: Adult; Body Fluids; Drug Overdose; Fatal Outcome; Gas Chromatography-Mass Spectrometry; Hair; Humans; Male; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

There are increasing reports about the misuse of gamma hydroxybutyric acid (GHB) related compounds. The objective of this article is to examine the use of GHB-containing dietary supplements among college students. An anonymous survey was completed at a university health clinic. The survey asked participants about their experience using GHB compounds and their knowledge about the legal status of GHB and its addictive potential. Two hundred fifteen students responded to the survey. Twenty-eight percent had used GHRE and 19% had used GHB. Growth Hormone Release Extract (GHRE) users reported consumption 2-3 times per month and GHB users reported 1-2 times per month. Males tended to use GHB for euphoria and energy, while females tended to use the compounds for weight loss. GHB was particularly popular among homosexual and bisexual responders. There was little knowledge of the addictive potential and illegal status of GHB and related compounds. GHB compounds are commonly used among college students. Given the different reasons for use according to gender and sexual orientation, prevention programs need to sculpt their message according to the target audience.

Topics: Adolescent; Adult; Female; Growth Hormone-Releasing Hormone; Health Status; Humans; Male; Sodium Oxybate; Students; Substance-Related Disorders; Universities

gamma-Hydroxybutyric acid (GHB) is a central nervous system (CNS) depressant and hypnotic which, in recent times, has shown an increasing abuse either as recreational drug (due to its euphoric effects and ability to reduce inhibitions) or as doping agent (enhancer of muscle growth). Analogues of GHB, namely gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), share its biological activity and are rapidly converted in vivo into GHB. At present, GHB and analogues are placed in the Schedules of Controlled Substances. Numerous intoxications in GHB abusers have been reported with depressive effects, seizures, coma and possibly death. The purpose of the present work was the development of a rapid analytical method based on capillary zone electrophoresis for the direct determination of GHB in human urine and serum at potentially toxic concentrations. Analytical conditions were as follows. Capillary: length 40 cm (to detector), 75 microm i.d.; buffer: 5.0 mM Na(2)HPO(4), 15 mM sodium barbital adjusted to pH 12 with 1.0 M NaOH; voltage: 25 kV at 23 degrees C; indirect UV detection at 214 nm; injection by application of 0.5 psi for 5 s. alpha-Hydroxyisobutyric acid was used as internal standard (IS). Sample pretreatment was limited to 1:8 dilution. Under these conditions, the sensitivity was approximately 3.0 microg/ml (signal-to-noise ratio >3). Calibration curves prepared in water, urine and serum were linear over concentration ranges 25-500 microg/ml with R(2)>/=0.998. Analytical precision was fairly good with R.S.D.<0.60% (including intraday and day-to-day tests). Quantitative precision in both intraday and day-to-day experiments was also very satisfactory with R.S.D.

Topics: Calibration; Doping in Sports; Drug Overdose; Electrophoresis, Capillary; Emergency Medical Services; Humans; Hydrogen-Ion Concentration; Hypnotics and Sedatives; Indicators and Reagents; Reference Standards; Sodium Oxybate; Spectrophotometry, Ultraviolet; Substance-Related Disorders

Topics: Drug Tolerance; History, Medieval; Humans; Illicit Drugs; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; United Kingdom

Topics: Age Factors; Bradycardia; Humans; Hypotension; Middle Aged; Seizures; Sodium Oxybate; Substance-Related Disorders

Topics: Flunitrazepam; Humans; Ketamine; Leisure Activities; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

Topics: Humans; Illicit Drugs; Rape; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

Topics: Female; Humans; Obstetric Labor Complications; Pregnancy; Respiratory Insufficiency; Sodium Oxybate; Substance-Related Disorders

To identify deaths in Australasia associated with overdose of gamma-hydroxybutyrate (GHB) and its precursors (gamma-butyrolactone and 1,4-butanediol).. A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000-August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data.. Death associated with forensic data implicating GHB or its analogues.. Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology.. Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.

Topics: Adult; Age Distribution; Australia; Cause of Death; Central Nervous System Depressants; Drug Overdose; Female; Humans; Incidence; Male; Registries; Retrospective Studies; Risk Factors; Sex Distribution; Sodium Oxybate; Substance-Related Disorders

Topics: Australia; Drug Overdose; Female; Humans; Incidence; Male; Risk Assessment; Sodium Oxybate; Substance-Related Disorders; Survival Rate

Blood specimens from 146 suspected gamma-hydroxybutyrate (GHB) overdose cases, presenting to an emergency department in Washington State over a 12-month period, were analyzed for GHB and other drugs. Of these 146 patients, GHB was confirmed in approximately one-third of the patients (N = 54), sometimes in potentially toxic concentrations. These patients were aged between 17 and 59 years (median 28 years), and 83% were male. Blood GHB concentrations ranged from 29 to 490 mg/L (mean 137 mg/L; median 103 mg/L). In 36 (67%) of the 54 patients, other drugs were additionally detected. Ethanol was measured in 22 (41%) patients, with concentrations ranging from 0.01 to 0.26 g/100 mL (median 0.04 g/100 mL). Other commonly co-administered drugs included 3,4-methylenedioxymethamphetamine, marijuana, methamphetamine, cocaine, and citalopram. Frequently observed clinical symptoms on admission for the GHB overdose group included copious vomiting, ataxia, lack of gag reflex, respiratory depression, mild acute respiratory acidosis, unconsciousness, and sudden altered states of consciousness. Many patients required intubation, and several became combative and required restraints. The majority of patients were discharged within 6 h of hospital admission. However, despite presenting with similar clinical symptoms on admission, GHB was not confirmed in 92 of the 146 overdose patients, suggesting that GHB overdose cases may frequently be indistinguishable from other drug overdoses or medical conditions.

Topics: Adolescent; Adult; Drug Overdose; Emergency Service, Hospital; Female; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Sodium Oxybate; Substance-Related Disorders; Suicide, Attempted

A 38-year-old male was arrested 7 times over an 8-month period for driving under the influence (DUI) of drugs. In each incident, gamma-hydroxybutyrate (GHB) was determined to be the causative agent. A blood specimen was drawn between 1.5 and 2.5 h after first police contact in each arrest. GHB was analyzed by gas chromatography-mass spectrometry, following extraction from blood using ethyl acetate and subsequent derivatization using BSTFA/TMCS. Blood GHB concentrations ranged from 44 to 184 mg/L (N = 7, mean 100 mg/L, median 73 mg/L). Overall signs of impairment included erratic driving (severe lane travel, collisions, and near-collisions), slurred speech, disorientation, slow to react, shaking, agitation, unable to focus, poor coordination and balance, poor performance in field sobriety tests, somnolence, and unconsciousness. On only one occasion were other drugs present in the subject's blood (thiopental and diazepam), which may have contributed to the observed driving impairment. During several police interviews, the subject stated he was addicted to GHB and gamma-butyrolactone (GBL), and admitted to previously taking "RenewTrient", "Dream On", "V35", "fitness supplements", and/or "GBL". During the same period as his DUI arrests, the subject had been admitted at least six times to different hospitals for GHB/GBL intoxications.

Topics: 4-Butyrolactone; Automobile Driving; Behavior; GABA Modulators; Gas Chromatography-Mass Spectrometry; Humans; Immunoenzyme Techniques; Male; Middle Aged; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

Topics: Cataplexy; Drug and Narcotic Control; Drug Approval; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders; United States; United States Food and Drug Administration

This preliminary descriptive study was designed to assess the reasons, primary contexts, and consequences (physical, psychological, lifestyle) of club drug use in a sample of young adults in a mid-size U.S. city. Fifty young adults (18 to 30 years old) reported on their use of club drugs (Ecstasy, GHB, ketamine, Rohypnol, methamphetamine, LSD) in face-to-face interviews that included quantitative and qualitative measures. Ecstasy was the most frequently used club drug followed by ketamine, LSD and methamphetamine. All of the participants reported using club drugs to "experiment" and most reported using these drugs to feel good and enhance social activities. Club drugs were frequently used at raves, in bars or clubs, and at home with friends. An average of 16 negative physical, psychological, and lifestyle consequences were reported for club drug use. Despite substantial negative consequences, participants perceived several positive consequences of regular recreational club drug use. These findings corroborate descriptions of club drug use in other countries (e.g., Australia, United Kingdom) and provide additional information on perceived positive consequences that users experience with club drug use. Further exploration of the reasons and positive consequences that are associated with use of each of the club drugs may provide important information on the growing trend in use of these drugs.

Topics: Adolescent; Adult; Central Nervous System Stimulants; Dextromethorphan; Female; Flunitrazepam; Hallucinogens; Humans; Illicit Drugs; Interviews as Topic; Ketamine; Life Style; Lysergic Acid Diethylamide; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders; United States

A case report of a male presenting with a gamma-hydroxybutyrate (GHB) induced coma at a gay-oriented dance event is reported. A friend accompanying the patient reported that when the patient started to become stuporous, he attempted to revive him with intranasally administered aliquots of crystal methamphetamine. Such treatment partially counters the hypotonia of GHB induced coma, resulting in "automatic" movements by the patient; however, it does not reverse the cognitive effects of the drug. The result increases the difficulty of medical management. The authors report the physical findings and implications for increased difficulty in managing such patients.

Topics: Adult; Amphetamine; Coma; Drug Interactions; Drug Overdose; Emergencies; Humans; Male; Sodium Oxybate; Substance-Related Disorders

During 'I love techno' (edition 2001), an indoor rave party attended by 37 000 people, data about medical problems (especially drug-related problems) were collected. To place these data in a wider perspective, a similar registration was done during 'De Nacht', a traditional New Year's Eve dance party held at the same location and attended by 12 000 people. Furthermore, a prospective study on the time course of the level of consciousness (Glasgow Coma Score) and blood concentrations of illicit drugs, especially gamma-hydroxybutyrate was set up. The results revealed that during 'I love techno' the incidence of medical problems was high (66.5/10 000 attendees), but not higher than during 'De Nacht' (70.0/10 000 attendees). At 'I love techno', however, mainly illicit drugs were used, more frequently leading to severe drug-related medical problems. The observations in patients with a drug-related medical problem who had taken gamma-hydroxybutyrate showed that for a given level of consciousness the gamma-hydroxybutyrate concentrations may show important differences, that the transition from coma (Glasgow Coma Score < or =7) to full recovery (Glasgow Coma Score 15) takes only 30-60 min (and only a small decrease in gamma-hydroxybutyrate concentrations), and that the time it takes before a comatose patient reaches the above-mentioned 'transition area' may be a few hours.

Topics: Adolescent; Adult; Belgium; Coma; Comorbidity; Dancing; Female; Glasgow Coma Scale; Humans; Illicit Drugs; Incidence; Male; Prospective Studies; Recovery of Function; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Wounds and Injuries

This study examined the characteristics of gay men attending circuit parties and their drug use. In particular, the role of methylenediomethamphetamine (MDMA, "ecstasy") was considered in relation to other drug use and sexual behavior. A one-page survey was distributed to 173 men attending a circuit party. Respondents were generally gay men, Caucasian, employed, and well-educated. Twenty-five percent self-identified as HIV-positive. Eighty-six percent reported using at least one substance on the day of the party; polydrug use was frequent. The most common substances were MDMA, ketamine, and methamphetamine. MDMA use was highly associated with ketamine, methamphetamine, and cocaine use. MDMA use was also associated with significantly more receptive anal intercourse. Circuit parties are settings of increased drug use and associated high-risk sexual behavior. A better understanding of these issues is needed to develop interventions aimed at reducing drug use and sexual risk taking among gay men who attend circuit parties.

Topics: Adult; Anniversaries and Special Events; Female; HIV Infections; Homosexuality, Male; Humans; Ketamine; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; New York; Risk-Taking; Sexual Behavior; Sodium Oxybate; Substance-Related Disorders

Previously used as a general anesthetic, gamma-hydroxybutyrate is now used as a recreational drug. Not surprisingly, an increasing number of acute overdose cases requiring emergency medical care have been reported and described, especially in the United States.. To determine the number and percentage of gamma-hydroxybutyrate overdoses over a 15-month period and to describe the clinical hallmarks and course of this new drug in overdose.. All toxicological emergencies, including those caused by illicit drug consumption, were recorded for 15 months in an urban public hospital emergency department. Accurate toxicological history was obtained from the patients and, if gamma-hydroxybutyrate was suspected, confirmation was performed by urine mass spectrometry. The study data were compared with data recorded in the same emergency department in 1989.. The total number of toxicological emergencies attended in our emergency department have remained unchanged during the last decade, with a significant decrease in number of opiate overdoses and an increase in the number of cocaine, amphetamine, and gamma-hydroxybutyrate overdoses. During the study period, 104 gamma-hydroxybutyrate overdoses presented to the emergency department (3.1% of all toxicological emergencies), ranking second in illicit drugs requiring emergency consultation. The profile of a patient with gamma-hydroxybutyrate intoxication is well defined: a young individual (23 +/- 5 years), male (64%), emergency department presentation on weekends (90%), with simultaneous ethanol consumption (73%) and ingestion of additional illicit drugs (86%), decrease of consciousness being the main complaint in all cases [16% with Glasgow Coma Scale (GCS) = 3]. Complete recovery without sequelae occurred in all cases.. Health authorities must be aware of the hazards of recreational gamma-hydroxybutyrate, and physicians must be cognizant of this recent cause of coma among youths presenting to the emergency departments.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Drug Overdose; Emergencies; Emergency Service, Hospital; Female; Humans; Male; Sodium Oxybate; Spain; Substance-Related Disorders

Topics: Adolescent; Amphetamine-Related Disorders; Canada; Culture; Dancing; Female; Hallucinogens; Humans; Music; N-Methyl-3,4-methylenedioxyamphetamine; Rape; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

Topics: Alcohol Drinking; Crime Victims; Flunitrazepam; Forensic Medicine; Humans; Memory Disorders; N-Methyl-3,4-methylenedioxyamphetamine; Rape; Sodium Oxybate; Substance-Related Disorders; Unconsciousness; Violence

Gammahydroxybutyrate (GHB) is an endogenous chemical found in the human brain that when administered systemically readily crosses the blood-brain barrier and produces behavioral effects. Some previously reported observations, including reports of specific antagonism by NCS382 (6,7,8,9-tetrahydro-5-[H]-benzocycloheptene-5- ol-4-ylidene acetic acid), support the hypothesis that GHB is a neurotransmitter with its own receptor system. In addition to its uncertain physiological role, the recent interest in GHB has been engendered by its illicit use and abuse.. To further characterize the behavioral effects of GHB and to evaluate NCS382 for its potential antagonistic effects.. Following the administration of GHB alone and in combination with NCS382, mice were tested in a Functional Observational Battery (FOB) and for their effects on locomotor activity and on schedule-maintained behavior. Additionally, spontaneous and NCS382-precipitated withdrawal in rats chronically treated with GHB was examined.. In the FOB, GHB generally produced depressant-like effects that were generally not reversed by NCS382. GHB also dose dependently reduced locomotor activity and rates of operant behavior, which were generally not reversed by co-administrations with NCS382. Neither spontaneous nor NCS382-precipitated signs of physical dependence were observed following chronic GHB administration.. GHB dose dependently produced depressant-like effects on learned and unlearned behavior. The putative GHB antagonist NCS382 failed to convincingly antagonize these effects. Physical dependence was not evident following spontaneous withdrawal or NCS382 challenge. Taken together, these results suggest that NCS382's ability to antagonize GHB's effects may be very limited.

Topics: Anesthetics, Intravenous; Animals; Behavior, Animal; Benzocycloheptenes; Body Weight; Conditioning, Operant; Dose-Response Relationship, Drug; Male; Mice; Motor Activity; Reinforcement Schedule; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

The aim of this study was to examine the characteristics of gamma-hydroxybutyrate (GHB) users, their GHB and other drug use patterns, and the harms associated with GHB use. Seventy-six GHB users were recruited and administered a structured interview on GHB use and related harms. GHB users appeared to be a stable, highly educated and well-functioning group. They had had extensive experience with a range of drugs, and GHB was typically used in conjunction with other drugs. Despite the fact that most GHB users had not had a long or extensive experience with GHB use, the proportion reporting significant negative side effects when using GHB was high (99% reported at least one), and the mean number of side effects ever experienced was 6.5. Notably, half (52%) reported becoming unconscious, 53% reported vomiting, 58% reported profuse sweating, and 8% reported having a fit or seizure. The high rate of problems reported by a group with limited use of this drug suggests that in a context of polydrug use, GHB use is associated with significant risks to users.

Topics: Adolescent; Adult; Comorbidity; Cross-Sectional Studies; Dose-Response Relationship, Drug; Female; Humans; Illicit Drugs; Incidence; Male; Middle Aged; New South Wales; Personality Inventory; Sodium Oxybate; Substance-Related Disorders; Victoria

1,4-Butanediol is an industrial solvent that, when ingested, is converted to gamma-hydroxybutyrate, a drug of abuse with depressant effects, primarily on the central nervous system. After reports of toxic effects of gamma-hydroxybutyrate and its resultant regulation by the federal government, 1,4-butanediol and gamma-butyrolactone, another precursor of gamma-hydroxybutyrate and an industrial solvent, began to be marketed as dietary supplements. We investigated reports of toxic effects due to the ingestion of 1,4-butanediol and reviewed the related health risks.. From June 1999 through December 1999, we identified cases of toxic effects of 1,4-butanediol involving patients who presented to our emergency departments with a clinical syndrome suggesting toxic effects of gamma-hydroxybutyrate and a history of ingesting 1,4-butanediol and patients discovered through public health officials and family members. We used gas chromatography-mass spectrometry to measure 1,4-butanediol or its metabolite, gamma-hydroxybutyrate, in urine, serum, or blood.. We identified nine episodes of toxic effects in eight patients who had ingested 1,4-butanediol recreationally, to enhance bodybuilding, or to treat depression or insomnia. One patient presented twice with toxic effects and had withdrawal symptoms after her second presentation. Clinical findings and adverse events included vomiting, urinary and fecal incontinence, agitation, combativeness, a labile level of consciousness, respiratory depression, and death. No additional intoxicants were identified in six patients, including the two who died. The doses of 1,4-butanediol ingested ranged from 5.4 to 20 g in the patients who died and ranged from 1 to 14 g in the nonfatal cases.. The health risks of 1,4-butanediol are similar to those of its counterparts, gamma-hydroxybutyrate and gamma-butyrolactone. These include acute toxic effects, which may be fatal, and addiction and withdrawal.

Topics: Adult; Butylene Glycols; Dietary Supplements; Fatal Outcome; Female; Humans; Male; Psychomotor Agitation; Pulmonary Edema; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Unconsciousness; Vomiting

Topics: Anti-Anxiety Agents; Diazepam; Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Acute Disease; Adjuvants, Anesthesia; Adult; Brain Chemistry; Dopamine; Female; Homovanillic Acid; Humans; Male; Sodium Oxybate; Substance-Related Disorders

Gamma hydroxybutyrate (GHB) was identified in the blood of 13 subjects arrested for impaired driving. GHB concentrations ranged from 26 to 155 mg/L (mean 87 mg/L, median 95 mg/L). In eight cases, GHB was the only drug detected, and signs of impairment were consistent with those of a CNS depressant, including erratic driving (weaving, swerving, ignoring road signs), confusion, incoherent speech, unresponsiveness, lack of balance, unsteady coordination, poor performances on field sobriety tests, and varying states of wakefulness. Given the ability of GHB to induce sleep and unconsciousness, it is evident from these cases that recreational use of the drug has the potential to impair a person's driving ability.

Topics: Adult; Anesthetics, Intravenous; Automobile Driving; Cognition Disorders; Female; Humans; Male; Motor Skills Disorders; Sleep; Sodium Oxybate; Substance-Related Disorders; Unconsciousness

GHB can be produced either as a pre- or postmortem artifact. The authors describe two cases in which GHB was detected and discuss the problem of determining the role of GHB in each case. In both cases, NaF-preserved blood and urine were analyzed using gas chromatography. The first decedent, a known methamphetamine abuser, had GHB concentrations similar to those observed with subanesthetic doses (femoral blood, 159 microg/ml; urine, 1100 microg/ml). Myocardial fibrosis, in the pattern associated with stimulant abuse, was also evident. The second decedent had a normal heart but higher concentrations of GHB (femoral blood, 1.4 mg/ml; right heart, 1.1 mg/ml; urine, 6.0 mg/ml). Blood cocaine and MDMA levels were 420 and 730 ng/ml, respectively. Both decedents had been drinking and were in a postabsorptive state, with blood to vitreous ratios of less than 0.90. If NaF is not used as a preservative, GHB is produced as an artifact. Therefore, the mere demonstration of GHB does not prove causality or even necessarily that GHB was ingested. Blood and urine GHB concentrations in case 1 can be produced by a therapeutic dose of 100 mg, and myocardial fibrosis may have had more to do with the cause of death than GHB. The history in case 2 is consistent with the substantial GHB ingestion, but other drugs, including ethanol, were also detected. Ethanol interferes with GHB metabolism, preventing GHB breakdown, raising blood concentrations, and making respiratory arrest more likely. Combined investigational, autopsy, and toxicology data suggest that GHB was the cause of death in case 2 but not case 1. Given the recent discovery that postmortem GHB production occurs even in stored antemortem blood samples (provided they were preserved with citrate) and the earlier observations that de novo GHB production in urine does not occur, it is unwise to draw any inferences about causality unless (1) blood and urine are both analyzed and found to be elevated; (2) blood is collected in NaF-containing tubes; and (3) a detailed case history is obtained.

Topics: Adult; Alcohol Drinking; Autopsy; Chromatography, Gas; Ethanol; Female; Forensic Anthropology; Humans; Illicit Drugs; Male; Postmortem Changes; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Time Factors

Gamma-hydroxybutyric acid (GHB) is gaining popularity as a drug of abuse. Reports of toxicity and lethality associated with GHB use have increased. This survey study was designed to identify patterns of GHB use, its effects, and withdrawal syndrome. A survey inquiring about the effects of GHB was administered to 42 users. The results showed that GHB was used to increased feelings of euphoria, relaxation, and sexuality. Adverse effects occurred more frequently in daily users and polydrug users than in occasional GHB users. Loss of consciousness was reported by 66%, overdose by 28%, and amnesia by 13% of participants during GHB use and by 45% after GHB use. Three daily users developed a withdrawal syndrome that presented with anxiety, agitation, tremor, and delirium. Participants described GHB intoxication as having similarities to sedative-hypnotic or alcohol intoxication. Regular use has been shown to produce tolerance and dependence. Participants dependent on GHB reported using multiple daily doses around the clock. High frequency users appeared at the greatest risk for developing withdrawal delirium and psychosis after abrupt discontinuation of GHB use.

Topics: Adult; Drug Tolerance; Female; Humans; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Surveys and Questionnaires

Topics: Cocaine; HIV Infections; Humans; Ketamine; Phytotherapy; Sodium Oxybate; Substance-Related Disorders

Topics: Cannabis; Drug and Narcotic Control; Forecasting; History, 20th Century; Humans; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Oxycodone; Sodium Oxybate; Substance-Related Disorders; United States

Topics: Hallucinogens; Humans; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

The new recreational drug, gamma-hydroxybutyrate (GHB, "liquid ecstasy"), reached Switzerland in 1998. We describe two cases from the city of Zurich. In both of them the subjects were profoundly unconscious and needed hospitalization after intake of a colourless liquid. Both patients recovered after a few hours, rapidly and without after-effects. Gamma-hydoxybutyrate is abused mainly for its euphorigenic and sedative properties by young people in discos, at raves, or on the drug scene. It is also taken as an alleged anabolic agent among bodybuilders. Criminals use it to narcotise potential victims. We summarise its effects, adverse effects, diagnosis, treatment, toxicology, pharmacology, and medical applications.

Topics: Adult; Coma; Crime; Humans; Illicit Drugs; Male; Sodium Oxybate; Substance-Related Disorders; Switzerland

To obtain information about the relationship of alcohol and drug usage in victims of sexual assault, including the newly identified "date rape" drugs gamma hydroxybutyrate and flunitrazepam.. Analysis of urine samples with gas chromatography combined with mass spectrometry can identify alcohol and numerous other drugs with a high degree of specificity. This service was offered to rape treatment centers throughout the United States in May 1996; urine samples obtained from sexual assault victims suspected of drug use by history or physical examination were sent for testing at the discretion of the examiner.. As of March 1999, a total of 2,003 specimens were analyzed. Nearly two-thirds of the samples contained alcohol and/or drugs; the predominant substances found were alcohol, present in 63%, and marijuana, present in 30%. A substantial subset of the specimens was found to contain other illicit substances, frequently in combination. GHB and flunitrazepam were found in < 3% of the positive samples. Additionally, over the two-year study period, the use of these two drugs appeared to be declining.. These findings support prior data indicating that alcohol, marijuana and/or other drugs are important risk factors in sexual assault. Continued monitoring of drug use by victims of sex crimes is important, and programs that serve victims should modify protocols to reflect this.

Topics: Dronabinol; Ethanol; Flunitrazepam; Gas Chromatography-Mass Spectrometry; Humans; Illicit Drugs; Incidence; Los Angeles; Rape; Sodium Oxybate; Substance-Related Disorders

Gamma hydroxybutyrate (GHB) is a product of the metabolism of both gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD). Gamma hydroxybutyrate (GHB) is an illegal agent that causes central nervous system depression. Chemical precursors of GHB, such as GBL and 1,4-BD, have been available for purchase from many health food stores and Internet websites for mood-enhancement, sleep-induction, and stimulation of growth hormone release. We report three cases of ingestion of products containing GHB and chemical precursors of GHB. All three patients had severe presentations followed by full recoveries. Some products containing GBL were withdrawn from the market after the FDA issued a warning regarding these products. Products containing 1,4-butanediol remain on the market today.

Topics: Adult; Central Nervous System Depressants; Coma; Humans; Male; Middle Aged; Respiratory Insufficiency; Sodium Oxybate; Substance-Related Disorders

Topics: Adolescent; Adult; Hallucinogens; Humans; N-Methyl-3,4-methylenedioxyamphetamine; Poisoning; Sodium Oxybate; Substance-Related Disorders

Topics: Adult; Chloral Hydrate; Delirium; Female; Humans; Psychoses, Substance-Induced; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adjuvants, Anesthesia; Adult; Hospitalization; Humans; Inactivation, Metabolic; Male; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Newer drugs of abuse, such as MDMA, GHB, GBL, 1,4-BD and ketamine, are frequently used in the settings of raves and are often promoted on the internet. The popularity of these agents is increasing; therefore, emergency physicians should become familiar with the clinical presentations and management of the toxicity induced by these agents.

Topics: Age Factors; Anesthetics; Emergencies; Hallucinogens; History, 20th Century; Humans; Ketamine; N-Methyl-3,4-methylenedioxyamphetamine; Prognosis; Sodium Oxybate; Substance-Related Disorders

The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. Toxic effects of ingestion include bradycardia, slow respiration or apnoea, coma and death. We present seven cases, all of which had consumed GHB either alone or in conjunction with other drugs and alcohol. The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.

Topics: Adolescent; Emergencies; Female; Humans; Male; Sodium Oxybate; Substance-Related Disorders

Topics: Adult; Coma; Electrocardiography; Glasgow Coma Scale; Humans; Male; Psychotropic Drugs; Sodium Oxybate; Substance-Related Disorders; Wolff-Parkinson-White Syndrome

Gamma-hydroxybutyrate (GHB) is a metabolite of GABA that is present in the CNS and fulfils at least some of the criteria for a neurotransmitter. Its effects are generally similar to those of CNS depressants and include ataxia, sleep and anesthesia. It has also been suggested that GHB is a drug of abuse. The present experiment was designed to evaluate GHB in procedures predictive of abuse and dependence potential in rhesus monkeys. Three monkeys were surgically prepared with indwelling silicone venous catheters and allowed to self-administer methohexital or saline in twice-daily experimental sessions. Other groups of monkeys were trained in drug discrimination paradigms to discriminate D-amphetamine (AMPH; n = 4), pentobarbital (PB; n = 3) or triazolam (n = 3) from saline. Another group was maintained on diazepam daily and trained to discriminate flumazenil from saline (n = 2). GHB (0.01-10 mg/kg per injection) maintained self-administration marginally above saline levels at one dose (3.2 or 10 mg/kg) in two of the three monkeys tested. GHB (1.0-178 mg/kg, subcutaneously (s.c.) or intragastrically (i.g.)) did not reliably substitute as a discriminative stimulus for any of the training conditions. Taken together with previous results, the present experiment suggests that GHB has, at most, low potential for abuse.

Topics: Anesthetics, Intravenous; Animals; Appetitive Behavior; Behavior, Addictive; Discrimination, Psychological; Dose-Response Relationship, Drug; Macaca mulatta; Psychotropic Drugs; Reinforcement, Psychology; Sodium Oxybate; Substance-Related Disorders

There is growing public concern about the use of gamma-hydroxybutyrate (GHB) as a party drug. This justified concern about misuse, however, should not lead to prohibition of the drug as it is efficacious in narcolepsy.

Topics: Central Nervous System Stimulants; Drug and Narcotic Control; Humans; Illicit Drugs; Narcolepsy; Netherlands; Sodium Oxybate; Substance-Related Disorders

Topics: Amphetamine; Amphetamine-Related Disorders; Cocaine; Cocaine-Related Disorders; Denmark; Drug Overdose; Hallucinogens; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; Sodium Oxybate; Substance-Related Disorders

In the last months we have seen an increasing number of younger patients admitted to the emergency room in a deep coma, mostly without cardio-pulmonary symptoms. After a few hours they suddenly woke up without any after-effects. Subsequently the patients related that they had taken an unknown drug for recreational purposes and afterwards fell asleep. The patients did not remember anything else about the episode. We believe they had taken gammahydroxybutyrate (GHB). This drug has not previously been described in Danish scientific reports.

Topics: Adult; Central Nervous System Stimulants; Drug Overdose; Humans; Illicit Drugs; Male; Sodium Oxybate; Substance-Related Disorders

We describe what we believe is the first psychiatric hospitalization due to GHB-induced delirium reported in the medical literature. We examine the use of the substance gamma hydroxybutyric acid (GHB) and describe the clinical findings in a patient who presented to an acute inpatient psychiatric unit with a chief complaint of feeling suicidal and a 1-year history of GHB use. A review of the literature and GHB's availability through the Internet are discussed.

Topics: Adjuvants, Anesthesia; Adult; Delirium; Female; Hallucinations; Humans; Mental Status Schedule; Psychoses, Substance-Induced; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Suicide; Suicide Prevention

Topics: Anesthetics; Humans; Sodium Oxybate; Substance-Related Disorders

Topics: Coma; Humans; Muscle, Skeletal; Sodium Oxybate; Substance-Related Disorders; Syncope

We describe seven patients presenting with combination substance abuse involving gamma-hydroxybutyric acid (GHB).. During a 3 month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department.. All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients.. Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Drug Overdose; Electrocardiography; Emergency Service, Hospital; Female; Gastric Lavage; Humans; Male; Respiration, Artificial; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB), a compound found in the mammalian brain, meets many criteria of a neurotransmitter. Experimentally, GHB has been used as a model for petit mal epilepsy; clinically it has been used as a general anaesthetic, to treat certain sleep disorders and alcoholism. Lately GHB has been abused for its euphoric, sedative and anabolic effects. Coma and seizures following abuse of GHB have been reported, but dependency has received little attention. Adverse effects of GHB include seizure activity and a withdrawal syndrome characterised by insomnia, anxiety and tremor. The present paper reviews the neuropharmacology, potential therapeutic uses and acute adverse effects of GHB, together with a presentation of three cases.

Topics: Adult; Humans; Male; Neurotransmitter Agents; Sodium Oxybate; Substance-Related Disorders

Topics: Adult; Coma; Humans; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is a compound found in mammalian brain which meets many criteria of a neurotransmitter. GHB has been investigated as a tool for inducing absence (petit mal) seizures, for use as an anesthetic, and for treatment of narcolepsy, alcohol dependence and opiate dependence. Since 1990 GHB has been abused in the United States for euphoric, sedative and anabolic effects. Coma and seizures have been reported following abuse of GHB, but dependence liability has received little attention. The neuropharmacology, potential therapeutic uses and acute adverse effects of GHB are reviewed, followed by a case series of eight people using GHB. Adverse effects of GHB may include prolonged abuse, seizure activity and a withdrawal syndrome. This withdrawal syndrome includes insomnia, anxiety and tremor; withdrawal symptoms resolve in 3-12 days. GHB has the potential to cause a significant incidence of abuse and adverse effects. Prolonged use of high doses may lead to a withdrawal syndrome, which resolves without sequelae. Educational efforts should address the narrow therapeutic index, possible physical dependence and dangers of combining GHB with other drugs of abuse.

Topics: Adult; Anesthetics, Intravenous; Anxiety; Coma; Female; Humans; Male; Sleep Initiation and Maintenance Disorders; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders; Tremor

Gamma hydroxy butyrate (GHB) is a central nervous system depressant approved as an anaesthetic in some countries; however, with the exception of investigational research, it is not approved for any use in the United States. Primary groups using GHB include party and nightclub attendees and bodybuilders. In addition, GHB is one of several agents characterized as a "date rape" drug. During August 1995-September 1996, poison control centers in New York and Texas received reports of 69 acute poisonings and one death attributed to ingestion of GHB. This report describes two cases and summarizes the investigations of GHB use in Texas and New York. The findings of these investigations underscore the health hazards associated with use of GHB.

Topics: Adolescent; Adult; Central Nervous System Depressants; Coma; Fatal Outcome; Female; Heart Arrest; Humans; Male; New York; Respiratory Insufficiency; Seizures; Sodium Oxybate; Substance-Related Disorders; Texas

Topics: Coma; Drug and Narcotic Control; Drug Overdose; Humans; Sodium Oxybate; Substance-Related Disorders; United States

Topics: Adolescent; Adult; Central Nervous System Depressants; Coma; Fatal Outcome; Female; Heart Arrest; Humans; Male; New York; Respiratory Insufficiency; Seizures; Sodium Oxybate; Substance-Related Disorders; Texas

The effects of gamma hydroxybutyrate, a coma inducing recreational drug, are described and illustrated by case reports of five patients presenting to accident and emergency (A&E). All had depressed levels of consciousness. There was strong circumstantial evidence of gamma hydroxybutyrate ingestion in all cases, and laboratory evidence in two. All recovered and supportive treatment. gamma Hydroxybutyrate has become a fashionable recreational drug. The majority of people who have ingested it will recover spontaneously without long term sequelae but its toxic effects may be dramatic while they last, particularly when it is taken with other drugs or alcohol.

Topics: Adult; Coma; Female; Humans; Male; Sodium Oxybate; Substance-Related Disorders

Topics: Adjuvants, Anesthesia; Adult; Benzodiazepines; Crime Victims; Fatal Outcome; Female; Forensic Medicine; Humans; Illicit Drugs; Male; Middle Aged; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders

Topics: Alcohol Deterrents; Alcoholism; Humans; Sodium Oxybate; Substance-Related Disorders

Gamma-hydroxybutyrate (GHB) is a naturally occurring GABA-like drug used illicitly by bodybuilders. Although there are reports of several cases of GHB abuse, with a variety of nervous system complications, we present the first case associated with a Wernicke-Korsakoff syndrome.

Topics: Adult; Alcohol Amnestic Disorder; Female; Humans; Illicit Drugs; Sodium Oxybate; Substance-Related Disorders; Suicide, Attempted

Topics: 3,4-Methylenedioxyamphetamine; Designer Drugs; Diagnosis, Differential; Humans; Seizures; Sodium Oxybate; Substance-Related Disorders; Unconsciousness

Topics: Adult; Female; Humans; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

Sixteen cases of adverse effects due to a new health-food product, gamma-hydroxybutyrate (GHB), were reported to the San Francisco Bay Area Regional Poison Control Center in the 5-month period from June to October 1990. Cases have also been reported in eight other states. Adverse effects included coma (four patients) and tonic-clonic seizurelike activity (two patients). Doses ranged from 1/4 teaspoon to 4 tablespoons. Acute symptoms resolved within 7 hours. GHB was investigated as an anesthetic agent during the 1960s until seizures and lack of analgesia precluded its use. It was recently introduced in the health-food market as a food supplement for body builders with claims of anabolic effects by stimulating growth hormone release. GHB remains under investigational new drug status with the Food and Drug Administration and is illegal for over the counter sale. The Food and Drug Branch of the California Department of Health Services has prohibited further sale of this product in California as have health departments in Florida and South Carolina; however, new cases continue to be reported. Health professionals should be aware of the potential health hazards of GHB.

Topics: Adolescent; Adult; Coma; Diet Fads; Female; Humans; Male; Middle Aged; Seizures; Sodium Oxybate; Substance-Related Disorders