GHB

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=__Gamma-Hydroxybutyric Acid, or GHB Outlanders - Chrissy Couchi, Hilary Kisbee & Jennifer Thomson__=

=**What is GHB;**= GHB is a naturally occuring substance found in the central nervous system. As a drug GHB is illegal in many countries. It is currently regulated in the US and used to treat cataplexy a condition found in people with nacolepsy. GHB has been known for some time to be a central nervous system depressant and has also been used in other countries as an aneshetic (Ksir, Hart & Ray, 2008). As an illegal drug GHB causes intoxication or is used as a date rape drug. GHB is usually taken orally, and in most cases it is sold as a light-colored powder that easily dissolves in liquids. It can also be found as a pure liquid packaged in vials or small bottles. In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink.

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=GHB Street names:= Tranquili G, Midnight Blue, Verve, Rejoov, Somax, SomatoPro, Flower Power, Puritech, Alcover, G-riffick, Eclipse, GHGold, Soap, Vita G, Gina, Dormir, Enliven, FX, Serenity, Inner G, Zen, White Magic Cleaner, Weight Belt Cleaner, Ink Jet Cartridge Cleaner, Plant Food, Fingernail Polish Remover, Paint Stripper There are more then 90 known names for GHB.

=Effects Of GHB:= GHB is a powerful synthetic drug that is rapidly metabolized by the body. The effects of the drug can be felt within 15 minutes after ingestion. GHB is a "sedative-hypnotic." It suppresses the central nervous system, making you feel relaxed and/or sleepy. The typical dose is one teaspoon; two teaspoons can cause some people to pass out. It takes effect between ten minutes to one hour, and lasts two to three hours, although some effects can last up to a day. The physiological effects of GHB in low doses may be mild impairment of concentration, impaired motor skills, tonic myoclionic seizures (slight trembling and loss of muscle control), and nausea. When a medium size dose is taken it can cause Cheynes-stokes respiration, grogginess when awaken, serious loss of coordination, and sleep paralysis. When taken in high doses GHB can can reduce or depress breathing, incontinence (urinating or defafcating uncontrollably), overdose, and death (Australian Drug Foundation, 2002). The psychological effects of GHB can range from a feeling of euphoria, relaxation, uninhibited feelings, insomnia, memory loss, and intoxication (Australian Drug Foundation, 2002). GHB has a high risk of overdose because of the small difference between the amount required to produce a high and the amount that causes an overdose. It is also dangerous because there is no way to tell if the drug was manufactured correctly. Improperly made GHB can result in an extremely toxic mixture of GHB and the chemical sodium hydroxide. The signs of an overdose on GHB are person appears to be asleep but cannot be awaken, the person is incoherent, sweating profusely, vomitting and has irregular or shallow breathing. The person also may have involuntary muscle contractions and may not be able to stand (Australian Drug Foundation, 2002). If you think someone you know is having a GHB overdose call 9-11 immediately. When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory depression, unconsciousness, coma, and overdose. media type="youtube" key="xPZqdJq9lg0" height="344" width="425"

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=Medical Uses of GHB= GHB has been used in the past as a general anesthetic in the 1960s, as a hypnotic in the treatment of insomnia, to treat depression, and to improve athletic performance. In Italy, under the trade name Alcover, GHB is used in the treatment of alcoholism (50 to 100 milligrams per kilogram per day, in 3 or more divided doses), both for acute alcohol withdrawal and medium to long-term detoxification. In the United States, the Food and Drug Administration permits the use of GHB under the trade name Xyrem to reduce the number of cataplexy attacks and excessive daytime sleepiness in patients with narcolepsy. Effects from Xyrem in clinical trials included: headache, nausea, dizziness, nasopharyngitis, somnolence, vomiting, urinary incontinence, confusion, dyspnea, hypoesthesia, paresthesia, tremor, vertigo, and blurred vision. Side effects associated with GHB may include:

o nausea, o vomitting o delusions, o depression, o vertigo, o hallucinations, o seizures, o respiratory distress, o loss of consciousness, o slowed heart rate, o lowered blood pressure, o amnesia, o coma

=**History of Ghb:**= Ghb was first synthesized in the early 1960's. It's structure is similar to the neurotransmitter GABA. GHB apparently effects the body by temporarily increasing the supply of dopamine and GABA to the brain. Ghb was originally used as an anesthetic but was withdrawn from use due to dicoveries of it's poor analgesic effects. An the 1970's GHB was recommended for the use in the treatment of narcolepsy but was unpopular due to it's euphoric effects. Use of Ghb began to intensify in the 1980's as it was being marketed as a fat burner and muscle developer. In 1990 the FDA ordered the drug unsafe based on more than 30 reports of GHB related illnesses. It was removed from store shelves making it difficult for users to purchase. Producers of the drug then started to use GBL and BD ingredients in sleep aids and muscle enhancers to bypass the ban on GHB. In 1999 the FDA asked manufactures to stop using GBL as it was never approved for human consumption. It is about this time that GHB gained popularity among club goers for it's euphoric and aphrodisiac effects. In March of 2000 GHB was classified as a "schedule 1 drug" (Center for Substance Abuse Research, 2005). Ghb has been involved in date rapes, sexual assaults, poisonings, overdoses and deaths (GHB {gamma-hydroxybutyrate}, n.d.).

=Use for Performance Enhancement= GHB was widely availabe in the U.S. during the 1980's in health food stores as a dietary supliment. Claims were made that it could help build muscle and burn fat. It was seen as an alternative to steroids in the late 1980's, when steroids were being controlled. (Project GHB, 2008). "GHB appears to play a role in general cellular metabolism, and is taken (mostly in fairly low doses) by athletes and body-builders hoping to stimulate muscle growth" (Ksir et al, 2008, p.170). There is no solid evidence that GHB is effective for this use. Still, some body-builders continue to use it, believing it stimulates the production of growth hormones (CAMH, 2009).

Body-builders and other atheletes are the least recognized users. This group, often using it on a daily basis, are the ones most likely to become addicted (Project GHB, 2008).

=Use as a Club Drug= Club drugs at one time were found most frequently in night clubs and at raves, but have now become some of the fastest growing drugs used by college students (Brown University, 2008). There are a range of drugs used to enhance the club experience such as ecstasy (MDMA), ketamine and GHB. Like other "club drugs," GHB is taken because users feel that it enhances the experience of the club or at a party. GHB is sometimes referred to as liquid ecstasy due to its tendancy to produce euphoria and sociability and its use in the dance party scene (Wikipedia, 2009).

=Use as a Date Rape Drug= GHB has been used to facilitate date rape. It is colourless and odorless and though it usually has a salty taste it is usally masked by the flavour of the drink it is being added to. It is usually used when the victim is vulnerable due to intoxication, generally from alcohol, so that the person is less likely to notice the strange taste to their drink (National Institute on Drug Abuse, 2005). When GHB is mixed with alcohol it can cause the person to become dizzy, confused, drowsy and lose consciousness. It is difficult to know how often GHB is used as a date rape drug because GHB leaves the body's system relatively quickly and it is not easily detected by medical tests. (Brown University, 2008). It is difficult to detect in a urine sample after only one day. Many victims may not even recall the rape untill some time after this (Wikipedia, 2009).

=Overdose= Overdose of GHB can occur rapidly with devastating consequences. Signs of overdose are drowsiness, nausea, vomiting, coma, convulsions, suppression of the gag reflex, respiratory depression and ultimatley death. These effects vary between persons and depend on the dose taken. Doses of 3500 mg can cause rapid unconciousness and doses over 7000 mg often cause life-threatening respiratory depression, and even higher doses can induce bradycardia (a slow heart rate) and consequent heart failure.

Overdose can be difficult to treat because of its multiple effects on the body. While it produces depressant effects on breathing and the heart, it aso causes nausea, vomiting, coma and convulsons. A person who is overdosing may simultaneously be unconsious, vomiting and convulsing. Overdose is best managed in a hospital setting. Pulse and breathing rate need to be monitored and the patient must not be left alone until they have fully woken up. This is because people tend to become conscious enough to roll onto their backs just before they start to vomit again though they are still too deeply unconscious to protect their own airway. Sometimes recovery can be rapid. There are reports of patients suddenly awakening from an apparently profound coma (Passmore, M. J., 2001).

The immediate cause of death from GHB tends to be from respiratory failure (Passmore, M. J., 2001). Also, in many cases, death resulted from choking on vomit and asphyxiating while unconscious (Wikipedia, 2009). Death while using GHB is most likely when it is combined with alcohol or other depressant drugs but an overdose of GHB alone may be lethal. Determining conclusively whether a death was caused by GHB is very difficult because it is a naturally occuring substance and is always present in everyone. Little is known about what levels are normal in what parts of the body (Wikipedia, 2009).

=Addiction & Withdrawal= GHB can be both physically and psychologically addictive. Physical dependence occurs when a persons body adapts to GHB (Australian Drug Foundation, 2002) and is taken on a regular basis such as every 2-4 hours for multiple days or weeks. Stopping abrubtly can result in withdrawal syndrome which can be severe and prolonged. Withdrawal symptoms may include insomnia, restlessness, anxiety, tremors, sweating, loss of appetite, edginess, delerium, chest pain and tightness, muscle and bone aches, high blood pressure and mental dullness.The side effects can last from 2 - 21 days, depending on the frequencey of usage and the size of the doses used. In particularly severe cases, withdrawal from GHB may cause symptoms similar to acute withdrawal from alcohol or barbiturates and can cause convulsions and hallucinations. Administration of benzodiazepines (sedative psychoactive drugs) have successfully treated the withdrawal symptoms (Project GHB, 2008). People who are psychologically addicted to GHB find that using the drug becomes far more important than other activities in their life (Australian Drug Foundation, 2002). Dependent users should seek medical help to ease withdrawal since withdrawal from GHB can be life threatening. There have been reported fatalities due to GHB withdrawal but reports are inconclusive and further resarch is needed (Wikipedia, 2009).

=Legal Status= Currently GHB is illegal to possess, traffic, import or produce in Canada and the United States. In the United states GHB is placed on Schedule I of the Controlled Substances Act. It was placed in Schedule I in March 2000 after widespread recreational use. Uniquely, this drug is also listed in Schedule III for limited uses, under the trademark Xyrem which is a drug used to treat narcolepsy. Any other form of GHB remains on Schedule I (Ksir et al, 2008). Making GHB a schedule I drug makes it a crime to possess, manufacture or sell GHB or it's precursors, with up to 20 years jail time for it (Project GHB, 2008).

In Canada it was placed on Schedule III of the Controlled Drugs and Substances Act in 1998. Examples of other drugs in Schedule III are amphetamines, LSD and mescaline. Possession of GHB can result in a maximum of 3 years imprisonment and trafficking or production can lead to a maximum of 10 years imprisonment. (Wikipedia, 2009)

In many other countries GHB is catagorized as an illegal drug for recreational use and is regulated or controlled. In Hong Kong, GHB is regulated under Schedule 1 of their Dangerous Drugs Ordinance. It can only be used legally by health professionals for research purposes and it can be given by pharmacists under a prescription. The penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and life imprisonment. Some other countries that regulate it for medical use are Brazil, the U.K., Norway and New Zealand (Wikipedia, 2009).

media type="youtube" key="KK095jgjoRU" height="344" width="425" = = = = =Production of GHB= GHB can be easily manufactured. GHB is produced in laboratories with no guarantee of quality or purity, making its effects less predictable and more difficult to diagnose. Abusers have figured out that this drug can be manufactured with inexpensive ingredients and using recipes on the Internet. There are some substances such as Gamma butyrolactone (GBL) and 1,4-butanediol which represent the analogs of GHB and can be substituted for it. Once ingested, these analogs convert to GHB and produce the identical effects. The FDA has issued warnings for both GBL and 1,4-butanediol, stating that the drugs have a potential for abuse and are a public health danger.

=Local News Involving GHB:= On Janary 22, 2009 a woman at a club in Toronto claimed something was slipped in her drink and she was then sexually assaulted by a strange man in the bathroom of the bar. The police believe the drug to be GHB or another known date rape drug, rohypnol. The man whose image was caught on a security camera was sought after by police. The day after his photo was released to the media, a man surrendered to police. Jagdeep Chahal has been charged with administering noxious thing and sexual assualt (TORSTAR NEWS SERVICE, 2009).

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=Discussion Questions=

How concerned are you that GHB could be slipped into your drink?

Have you ever suspected that GHB had been put in your drink or do you know of anyone who has?

Were you aware of GHB before our presentation? If so, were you aware of the various recreational uses? = = =References= Australian Drug Foundation. (2002). GHB (fantasy): What are the effects?. Retrieved March 14, 2009, from []

Brown University. (2008). //GHB.// Retrieved March 9, 2009 from http://www.brown.edu

Center for Substance Abuse Research. (2005, May 2). Retrieved March 5, 2009, from []

Centre for Addiction and Mental Health. (2009). //Do You Know...GHB.// Retrieved January 11, 2009 from [|http://www.camh.net]

GHB (gammahydroxy-butyrate). (n.d.). Retieved March 5, 2009, from [|http://www.a1b2c3.com/drugs/ghb_01.htm#top]

Ksir, C., Hart, C.L., & Ray. O. (2008). //Drugs, Society, and Human Behavior. (12th ed.)//. New York, NY: McGraw-Hill

National Institute on Drug Abuse. (2005). //NIDA InfoFacts: Club Drugs.// Retrieved January 22, 2009 from [|http://www.drugabuse.gov]

Passmore, M. J., (2001), //Gama-hydroxybutyrate (GHB).// Retrieved January 22, 2009 from [|http://www.theberries.ca]

Project GHB. (2008). //Welcome to Project GHB.// Retrieved March 11, 2009 from [|http://www.projectghb.org]

TORSTAR NEWS SERVICE. (Febuary 9, 2009). //Suspect charged in date rape case//. Retrieved March 14, 2009, from []

Wikipedia, The Free Encyclopedia. (2009). //Gamma-Hydroxybutyric Acid.// Retrieved January 22, 2009 from [|http://en.wikipedia.orghttp://www.steadyhealth.com/articles/What_is_GHB__a266_f113.html]

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