GHB

OFFICIAL NAMES: Gamma-hydroxybutyrate (GHB), 4-hydroxy butyrate, gamma hydrate, gamma-hydroxybutyrate sodium, gamma hydroxybutyric acid, gamma-OH, sodium oxybate, sodium oxybutyrate

STREET NAMES: Blue Nitro, cherry meth, easy lay, energy drink, everclear, firewater, G, gamma-oh, Georgia home boy, gjuice, goop, grievous bodily harm, growth hormone booster, insom-X, invigorate, lemon fX drops, liquid ecstasy, liquid E, liquid X, longevity, nature's Quaalude, orange fX rush, oxysleep, poor man's heroin, remforce, Revivarant, salty dog, salty water, scoop, soap, somatomax, vita-G, water, wolfies, zonked

DRUG CLASSIFICATIONS: Schedule I, depressant

OVERVIEW

An odorless, colorless substance, GHB is a fast-acting central nervous system depressant. Sometimes it has a salty taste, while at other times it may be perceived as having no taste at all. Depending on the dose, effects of GHB can range from euphoria (feeling of well being; giddiness), intoxication, muscle relaxation, and hallucinations, to dizziness, nausea, vomiting, respiratory depression (slowed breathing), seizures, confusion, drowsiness, unconsciousness, coma, and even death. GHB may also cause memory loss of events that follow ingestion. The effects of GHB can be felt within 15 to 30 minutes after ingestion and typically last three to six hours.

GHB was first developed in 1960 as an alternative anesthetic (painkiller) for use in surgery because of its ability to induce sleep and reversible coma. But it had little effectiveness as a painkiller, and the coma that it caused was often associated with seizure activity, including jerking movements of the limbs or face.

Then, in the 1980s, GHB was endorsed by the health food industry as a growth hormone stimulator, and was marketed and sold to help body builders increase muscle mass and maintain weight. But, also, GHB was embraced as an aid in weight loss and as an over-the-counter sleep agent because of its sedative side effects.

In response to several accounts of adverse reactions in people taking nutritional and weight loss supplements containing GHB, the Food and Drug Administration (FDA) banned the drug in 1990. In doing so, the agency declared GHB unsafe and illegal for use except under FDA-approved, physician-supervised treatment protocols. In 1997, the FDA reissued its warning on GHB as an unapproved and potentially dangerous, illegal drug in the United States. In March 2000, GHB was placed in Schedule I of the Controlled Substances Act (CSA). This designation labeled GHB as having a high potential for abuse and raised the issue that the drug was potentially unsafe for use even under medical supervision.

Despite these actions, however, GHB continues to be illegally manufactured and sold. GHB, and kits for making GHB, are available on the Internet and on the steroid black market. It is possible to make the drug without sophisticated laboratory equipment. Because of such ease of access, GHB is usually made in a home kitchen and sold locally on the street. The product may be disguised by adding food coloring or flavorings, or by storing it in bottles labeled as other products such as mouthwash or spring water. Storage in water bottles is especially dangerous, because someone might assume the content is plain water and instead drink a large dose of GHB.

Because production is not regulated, the amount of GHB in a dose—typically one level teaspoon—can vary dramatically from 0.5 to 5 grams. Users may ingest many doses while attempting to attain desired effects.

The risk of overdose with GHB is high as the drug is unpredictable; individual reaction to GHB is also highly varied. At higher doses, GHB has become the most deadly of the club drugs, according to government statistics. Overdoses usually require emergency room treatment, sometimes including intensive care for respiratory depression and coma.

Use as a club drug

Despite the fact that it was made illegal in 1990, GHB became a common club drug (drugs used at late-night dance parties or so-called raves or trances, concerts, nightclubs, and bars). In these settings, GHB became commonly known as a euphoriant, and its popularity grew, especially in light of its easy access and low cost. When actor River Phoenix died outside a nightclub in Los Angeles in October 1993, it was suggested that he had overdosed on GHB. While the rumor was never confirmed, it further stimulated interest in GHB.

Common club drugs include other synthetic drugs: MDMA (ecstasy), ketamine (Special K, vitamin K, Kit Kat, Keller, super acid, and super C), and Rohypnol (chemical name is flunitrazepam; also known as roofies, forget pills, the drop drug, rope, LaRocha, ropies, Mexican valium, roachies, ruffles, wolfies, and rophies).

Recreational users of GHB claim that inhibitions are lowered, sex drive increases, and a euphoric, out-of-body high is experienced. Some people who use GHB consider it a weaker alternative to hallucinogens, LSD, and PCP. Others use GHB after taking ecstasy to counteract the stimulant effect. But even those who use GHB recreationally say that its unpredictable effects can sometimes overwhelm them and cause negative reactions, especially when taken at higher doses.

GHB is usually sold by the capful, or "swig," for $5 to $25. It is generally found in liquid form, but may be found in a highly soluble powder form. Either way, it is typically added to a liquid such as water, sports drinks like Gatorade, or soft drinks. Mixing the drug with a sweetened drink can mask GHB's salty taste. GHB is also mixed into an alcoholic drink, which enhances its effects but increases the potential for adverse reaction, particularly respiratory distress. The use of alcohol is typical if date rape is intended, as the victim is usually unaware that GHB has been added to the drink.

Use as a date rape drug

Several cases have documented the use of GHB to incapacitate victims of sexual assault. Along with another club drug, Rohypnol (known most commonly as roofies), GHB is often called a date rape drug. Both Rohypnol and GHB have been implicated in date rape cases.

In higher doses, GHB has powerful tranquilizing effects that can cause a person to pass out. It makes that person more vulnerable to attack by incapacitating him or her. Even though GHB has a slightly salty taste, it can go undetected when mixed into a drink.

Between 1996 and 2001, the U.S. Drug Enforcement Administration (DEA) received reports of at least 15 sexual assault cases believed to involve GHB. Prosecuting rape cases that may involve GHB are particularly difficult because the drug causes memory loss in the victim, an effect called retrograde amnesia. GHB also moves so quickly through the body that it often is not detectable in blood or urine tests by the time the person arrives at a hospital.

In 1996, the Drug-Induced Rape Prevention and Punishment Act made it a felony to give an unsuspecting person a date rape drug with the intent of committing violence, including rape. There are penalties of large fines and up to 20 years in prison for importing or distributing these drugs. Regardless of this law, however, GHB continues to be favored as a date rape drug. As reported by authorities, date rape cases involving GHB are on the rise.

It is possible to reduce the risk of being a victim of date rape drugs like GHB. Protective measures include:

• Never put a drink down and leave it unattended.
• Never drink from a container opened by someone else.
• Do not drink from a communal container such as a punch bowl.
• Do not accept a drink of any sort from someone else.
• Attend parties with friends and watch out for one another.

Additionally, authorities suggest avoiding parties where people are drinking alcohol since GHB and other date rape drugs may be more likely to be available at these events.

CHEMICAL/ORGANIC COMPOSITION

GHB is a natural substance produced in small amounts in the human body. The active ingredient in GHB is a sodium salt known as sodium oxybate, which has a number of other chemical names.

GHB is believed to be a weak partial activator of gamma-aminobutyric acid (GABA-A) receptor (a specialized cell or group of nerve endings that responds to sensory stimuli). The receptor has binding sites present in areas of the brain, including the cortex, hypothalamus, midbrain, basal ganglia, substantia nigra, and the hippocampus.

It may not be possible to detect GHB and related compounds with common urine or serum (body fluid) tests. In cases where an unused portion of the drug cannot be recovered, gas chromatography-mass spectrometry (a high-technology instrument that separates a chemical mixture and identifies its composition) can be used to detect GHB and related compounds from a sample of serum, plasma, blood, or urine.

In its naturally occurring, biological composition, GHB is not readily available. However, GHB can be made in unsophisticated home laboratories from easily obtained materials. By combining gamma butyrolactone (GBL) with either sodium hydroxide or potassium hydroxide, the chemicals give off heat as they react, creating the final product. GHB is a clear liquid that does not have to be isolated or separated from the solution. Some companies sell kits over the Internet that provide the customer with everything needed to manufacture GHB, and include how-to instructions. Selling kits created for the purpose of producing recreational GHB is illegal, however, as is purchasing such kits.

Precursors of GHB

GHB precursors, or analogs (similar chemical compounds also known as "chemical cousins"), were the legal way for users to achieve effects physiologically equivalent to GHB. Then, in February 2000, federal legislation made the GHB precursors controlled substances.

However, ready availability of the precursors has made it very difficult to enforce the law.

Chemicals related to GHB may be listed as party drugs on the Internet, advertised in muscle-building magazines, or sold as dietary supplements in health food stores. A number of chemicals that convert to GHB after ingestion has been identified in scientific papers.

Two of the most potentially deadly precursors of GHB, both of which are converted into GHB in the body, have been identified by the FDA. One is gamma butyrolactone (GBL), which is marketed under brand names such as Renewtrient, Revivarant or Revivarant G, Blue Nitro or Blue Nitro Vitality, GH Revitalizer, Gamma G, and Reinforce. The other is 1,4 butanediol (BD), a chemical in products sold under brand names like Revitalize Plus, Serenity, Enliven, GHRE, SomatoPro, NRG3, Thunder Nectar, and Weight Belt Cleaner.

Gamma butyrolactone (GBL). GBL is a widely used chemical solvent, and one of the more readily available analogues of GHB because it is used in many industrial cleaners. While GBL is not intended for use as a drug, because it converts into GHB inside the body when ingested, it is commonly sold illegally as GHB.

Some partygoers purposely drink small quantities of GBL straight since it is converted into GHB in the stomach. This can cause a severe physical reaction, usually violent vomiting of the fluid. But, as with GHB, GBL can be added to water and is nearly undetectable.

GBL has been marketed as a health supplement as well. However, these products, including Renewtrient, Longevity, Revivarant, Blue Nitro, Insom-X, Remforce, Firewater, and Invigorate, were removed from the market. Many, though, have been re-introduced under new names, utilizing 1,4 butanediol (BD) as a replacement for GBL, which became a List I chemical in February 2000.

1,4 butanediol (BD). The chemical BD has also become part of the recreational drug scene. BD, which is related to both GHB and GBL, also converts to GHB when ingested. BD is also widely available since it is used in making plastics and as an industrial degreaser. As of 2001, BD was not scheduled under federal guidelines, though it has been declared a Class I health hazard.

Potency

The purity and strength of GHB are difficult to determine because the drug can be made from a number of chemical formulas that produce different amounts of GHB when the user's body metabolizes it. The fact that the drug is typically made in home laboratories increases its unpredictability, according to the DEA. A teaspoon of the drug may contain between 0.5 g and 5 g of GHB.

The dose response curve for GHB is varied. A small increase in dose can push the sedative effects to a lethal level. A high dose of GHB can inhibit the body's ability to eliminate the drug, leading to greater effects or longer duration than expected.

As little as one teaspoon of GHB can result in an overdose, which can cause slowed heart rate, confusion, agitation, respiratory depression, seizures, loss of peripheral (outer) vision, agitation, hallucinations, hypothermia (low body temperature), nausea, vomiting, coma, and unconsciousness. The risk of a deadly overdose is increased if both coma and vomiting or coma and a blocked airway occur.

The Drug Enforcement Administration (DEA) warns that GHB is unpredictable, making it a particularly dangerous drug to consume. A dose that might make a small woman high could kill a large man. Or, a person can get high one day while an equal dose another day might prove fatal for that same person.

Effects of long-term GHB use are largely unknown. Individuals who use GHB, however, have reported that they must increase dosage in order to maintain the desired euphoric and relaxing effects.

INGESTION METHODS

GHB is produced in either a liquid form or as a white powdered material. It is taken orally, typically combined with a liquid mixer such as a soft drink, water, or sports drink. It is sometimes mixed with alcohol. It may be sold in small vials at club parties.

GHB usually has a salty taste, but this saltiness can go unrecognized, especially if it is mixed with a sweet drink. Because the taste can be masked, and it is colorless, the risk for accidental ingestion of GHB increases. The drug can be slipped into a drink without the recipient's knowledge.

THERAPEUTIC USE

Although GHB was initially developed as an anesthetic, it was never ultimately used in the United States for that purpose. Outside of the United States, however, GHB is still occasionally used for anesthesia, resuscitation, and addiction therapy.

During the 1990s, a U.S. pharmaceutical company Orphan Medical, Inc. began exploring the use of GHB as a therapeutic solution for narcolepsy, a chronic condition that causes excessive daytime sleepiness.

When President Clinton signed the Hillary J. Farias and Samantha Reid Date Rape Drug Prohibition Act into law in 2000, he ordered the DEA to categorize GHB as a dangerous drug with no medical benefits. However, he also allowed Orphan Medical an exemption to continue its research on therapeutic uses for the compound and to market it for narcolepsy if it was approved by the FDA.

Preliminary studies suggest that GHB-based drugs may also be useful in treating Alzheimer's disease or Parkinson's disease, but it is still too early to tell. Two European studies found GHB effective in relieving alcohol craving and alcohol withdrawal symptoms. In one study, alcoholics took a moderated daily dose for three months. Participants reduced their drinking by half, and their days of abstinence tripled. Another study found that GHB relieved opiate withdrawal symptoms.

USAGE TRENDS

Scope and severity

Little data is available on the relatively new issue of GHB abuse. The government has only been tracking GHB use since it was declared illegal in March 2000. Additionally, GHB abuse is difficult to monitor because the drug is usually clandestinely manufactured. Also, GHB use often goes undetected since there is no simple diagnostic test that can be used by hospital emergency departments.

However, it has been reported that abuse of GHB has increased substantially since the late 1980s. Young people often abuse GHB and other club drugs in club settings such as raves, nightclubs, bars, and parties. Companies have marketed GHB as a strength-training aid and antidepressant. Body builders claim they use GHB because it stimulates the release of growth hormones and builds muscle. Individuals who have trouble sleeping may take it as a sedative. Alcoholics may take GHB in an attempt to eliminate alcohol cravings; this use is not medically approved in the United States.

There are no definitive numbers available on GHB abuse and overdoses, but various agencies have started tracking this information. The DEA reports more than 7,100 GHB overdoses and encounters with law enforcement between 1990 and 2001. Over that same time period, 65 GHB-related deaths, mainly from respiratory depression, have been documented. The Drug Abuse Warning Network (DAWN) listed 20 emergency room episodes in 1992, and the number of episodes has climbed steadily since then to 2,973 in 1999. That number leaped to 4,969 in 2000.

Official reports are believed to under-represent problems associated with GHB use because many doctors are not yet familiar with it and may not know to test for it. Also, emergency rooms are often unable to detect or identify the drug because it leaves the body within 12 hours. In 2001, the National Institute on Drug Abuse (NIDA) announced that, through its GHB Antidote Initiative, it was beginning the process of developing a treatment for GHB poisoning.

GHB use is particularly high in urban areas, although its use is growing in suburban settings throughout the country as well. GHB is mainly known today as a club drug, but is gaining a reputation as a date rape drug. As of 2001, the DEA documented 15 sexual assault cases involving 30 victims under the influence of GHB. Of urine samples submitted from 711 victims of alleged sexual assault, 48 tested positive for GHB.

Additionally, GHB and its precursors are used by body builders as an alternative to anabolic steroids. The drug has been marketed for its alleged ability to release large amounts of "natural" human growth hormone during sleep, build muscle, and reduce fat.

Age, ethnic, and gender trends

GHB is most popular with high school and college students, as it is found most frequently at late-night dance parties, college parties, and nightclubs where attendees are typically between the ages of 18 and 29. But GHB use cuts across all boundaries.

More than 60% of people hospitalized for GHB use were between the ages of 18 and 25 years old. Of the 63 documented deaths attributed to GHB since 1995, 40%

were between the ages of 15 and 24 years old and an additional 29% were between 25 and 29 years old.

A 1999 DAWN report lists 267 emergency department mentions of GHB in patients aged 17 years old and younger, 1,498 mentions of use by patients aged 18–25, 905 mentions by patients aged 26–34, and 299 mentions by patients aged 35 and older.

GHB seems to be most popular among whites; however data show that its use expands to other races and ethnicities. In 1999, the number of emergency department mentions of GHB use included those by 2,297 white patients, 76 mentions by black patients, 52 mentions by Hispanic patients, and 548 mentions by other or unknown ethnicities of patients.

Gender does not seem to play a role in GHB use.

MENTAL EFFECTS

GHB can significantly affect the behavior of a person under the influence of the drug. It can cause confusion, aggressive behavior, and impaired judgment. People under the influence of GHB may be less aware of their surroundings, and they may be unable to fully control or protect themselves.

At lower doses, GHB may cause headache, euphoria, an out-of-body high, sleepiness, increased sex drive, hallucinations, and short-term amnesia (loss of memory). In higher doses, it can induce a coma and seizurelike episodes.

PHYSIOLOGICAL EFFECTS

Besides the mental effects, GHB affects the body in a wide range of other ways, including:

• Neurological system: nystagmus (involuntary, rapid eye movement); vertigo (a false sensation of motion or spinning); dizziness; ataxia (poor muscle coordination); weakness; and sedation.
• Respiratory system: respiratory depression; hypothermia; bradycardia with increases or decreases in blood pressure; apnea (cessation of breathing that is usually temporary).
• Gastrointestinal system: vomiting.
• Endocrine system: mild hyperglycemia (abnormally high concentration of sugar in the blood).

Harmful side effects

GHB can be harmful and even deadly to people who use it. But it may mistakenly be perceived as a safe drug because it was only recently made illegal. Also, it was previously available in health food stores as a dietary supplement, is marketed over the Internet, and is prescribed for limited medical use.

For those who take GHB deliberately, the objective is to take the right amount to achieve the desired high. But the drug is unpredictable and users risk deadly overdose, which can occur within 15 minutes of ingestion. An overdose can result in such severe adverse effects as vomiting, difficulty breathing, seizures (especially when GHB is combined with methamphetamine), unconsciousness, coma (especially when combined with alcohol), and death.

The danger of a fatal overdose is increased when GHB is combined with alcohol or opiates.

Long-term health effects

The long-term effects of GHB use are largely unknown. Recent research shows that some club drugs can have lasting effects on the brain, resulting in memory loss, impaired motor skills, and distorted sensations. It is possible that GHB may cause these long-term effects as well.

Repeated GHB use is associated with mood swings, liver tumors, violent behavior, and dependence. If the drug is discontinued, the user can experience withdrawal. Severe withdrawal symptoms include extreme agitation, delirium, insomnia, tremor, rapid heart rate, and anxiety.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

The danger of taking GHB is increased when the user also takes other drugs. Taking any combination of drugs is always risky because the effect of each drug is amplified and unpredictable. This is particularly true with GHB. Combining GHB with another drug may increase the chance of fatality. Many of the deaths associated with GHB use occurred in individuals who also consumed alcohol or other drugs that depress the central nervous system, such as codeine, heroin, methadone, morphine, barbiturates, nicotine, tranquilizers, and some sleeping pills. Mixing GHB with a central nervous system depressant increases the risk of unconsciousness and coma.

GHB is also sometimes combined with a stimulant drug such as methamphetamine or ecstasy. This combination increases the risk of seizure.

TREATMENT AND REHABILITATION

Overdose treatment

When an overdose is suspected, immediate hospitalization is recommended. If rescue therapy is delayed, incorrectly administered, or is not available, the result may be anoxic injury (lack of oxygen to the brain, which can cause brain damage) or death.

For simple GHB ingestion in a spontaneously breathing patient, intubation (insertion of tube into the trachea) may not be necessary. In these cases, management may include positioning the body to reduce the risk of choking, oxygen supplementation, monitoring, stimulation, treatment for persistent bradycardia (abnormal slowness of the heart), and admission to the hospital for observation.

Intubation is only recommended for severe respiratory depression, hypoxia, or a combination toxic exposure. Coma reversal agents are considered to be of little or no use. Recovery of consciousness generally takes two to six hours.

There is no definitive treatment to counteract the effects of GHB, although two drugs, neostigmine and physostigmine, have shown promise as potential reversal agents. If supportive medical care is delivered in a timely manner, the patient will usually recover several hours post-ingestion.

If evidence of GHB ingestion cannot be confirmed, other causes for the patient's altered mental status must be ruled out. Physicians or others providing care in a medical setting should be aware of the possibility that GHB was co-ingested with other drugs, and treat the patient accordingly.

If it is suspected that GHB intake was combined with another drug, the stomach should be pumped (gastric lavage), and activated charcoal may be considered. In the case of isolated GHB ingestion, however, these interventions are of limited value because GBH is absorbed quite rapidly and only small amounts of the drug are usually involved.

Withdrawal treatment

While the addictive potential of GHB is not yet known, individuals who use GHB have reported that they must steadily increase dosage to achieve the desired effects. Some people who abuse GHB have reported difficulty reducing or discontinuing use.

But since GHB is rapidly absorbed by the body and eliminated within 12 hours, GHB dependence is rare. Frequent dosing every one to three hours is required to maintain levels sufficient for dependence, according to a report in the medical journal American Family Physician. The report concludes that GHB withdrawal syndrome is becoming increasingly common as the accessibility and use of GHB-related products increases. Discontinuation of GHB after long-term use can cause prolonged illness, typically lasting three to 12 days.

The withdrawal syndrome occurs over several days, starting with mild effects that may include tachycardia (rapid heart beat), hypertension (high blood pressure), tremor, and diaphoresis (heavy perspiration). Additional symptoms may include hallucinations and anxiety, as well as confusion, insomnia, disorientation, delirium with agitation, and combative behavior, which often requires restraints and sedation.

As the withdrawal progresses, symptoms can become episodic, ranging unpredictably from mild to severe. Treatment typically focuses on providing support and managing symptoms, such as sedation with benzodiazepines and barbituates. In-patient hospitalization is recommended for detoxification.

The diagnosis of GHB withdrawal may be difficult because it is similar to sedative or alcohol withdrawal syndromes, as well as to withdrawal from sympathomimetic agents such as cocaine, methamphetamine, and ecstasy. GHB withdrawal may also be confused with serotonin syndrome (a reaction caused by a combination of drugs, one of which increases serotonin levels in the body, such as Prozac) and neuroleptic malignant syndrome (a rare reaction to an antiseizure medication).

PERSONAL AND SOCIAL CONSEQUENCES

Use of GHB can impair judgment and cause shortterm (retrograde) amnesia, increasing the possibility for risky behavior and sexual assault. It also impairs ability to drive, increasing the risk for a car accident. If use is long term, the abuser risks unknown health consequences and, if use is discontinued, the abuser is subject to potential withdrawal illness.

When GHB use is suspected or discovered, physicians and other hospital staff may counsel patients about the dangers of GHB use. They may make a referral to a rehabilitation program. As with any other drug, the physician should inquire about the possibility of the abuse of multiple drugs.

To truly restrict GHB use, experts emphasize that public education is needed to supplement legal actions. In an effort to teach people the dangers of GHB and other club drugs, the NIDA has launched a national educational campaign with partner organizations Join Together, National Families in Action, the American Academy of Child and Adolescent Psychiatry, and the Community Anti-Drug Coalitions of America.

LEGAL CONSEQUENCES

Legislation

On February 18, 2000, the Hillary Farias and Samantha Reed Date-Rape Prohibition Act (Public Law 106-172) made the GHB precursor GBL a List I chemical, subject to the criminal, civil, and administrative sanctions of the Controlled Substances Act. On March 13, 2000, GHB became a Schedule I controlled substance (65 FR 13235-13238), subject to the regulatory controls and the criminal, civil, and administrative sanctions of the Controlled Substances Act. Schedule I, which is the same as for heroin, LSD, and marijuana, states that the drug has no medical use and cannot be prescribed, and that the drug has a high potential for abuse.

Previously, the Drug-Induced Rape Prevention and Punishment Act of 1996 had made it a felony to give an unsuspecting person a date rape drug—a category that includes GHB—with the intent of committing violence, including rape. In February 2001, legislators in Pennsylvania strengthened analog statutes to include chemicals substantially similar in substance or effect. The action is intended to further combat the use of GHB precursors like GBL and BD.

GHB was first made illegal in 1990, when several reports of adverse reactions in individuals using nutritional and weight loss supplements containing GHB led the FDA to ban the drug. This ban made GHB use illicit except under FDA-approved, physician-supervised protocols.

GHB remains legal in many countries in Europe, Central, and South America, and elsewhere.

Legal history

Until 1990, when it was declared illegal except for approved medical use, GHB use was legal in the United States, and it was typically sold at health food stores. Numerous cases of illness related to GHB led the federal government to declare its use, manufacture, and distribution illegal.

The first known court case involving GHB use occurred in May 1990, after a teenager in Duluth, Georgia, drank a mixture of water and two teaspoons of Somatomax PM obtained from a health food store. Within 20 minutes, the teen was in a coma; his parents took him to the hospital for emergency treatment, where he recovered. Hospital physicians told the parents that if their son had been found a half hour later, he might have died. When the parents reported the incident to the FDA, the agency launched an investigation that uncovered 57 more cases of GHB-related illness and prompted widescale prosecution of GHB sale and misuse.

In March 1991, the FDA and the U.S. Department of Justice indicted the operators of Amino Discounters Ltd. on criminal charges of making, distributing, and promoting GHB. Amino Discounters manufactured and distributed the drug, sold under the brand name Somatomax PM. The indictment charged the firm and the individuals involved with counts of operating an unregistered drug firm, selling misbranded drugs in interstate commerce, and manufacturing misbranded drugs. The individuals pleaded guilty and were convicted.

In a separate indictment in San Francisco, a grand jury named the operators of a company called California Body Club, in San Leandro and Carmel, California, with illegal distribution of GHB obtained from Amino Discounters. The indictment charged the company with promoting, selling, and shipping GHB, and also with distributing drugs with false and misleading labels. The operators pleaded guilty and were sentenced to in-home detention, probation, and community service.

Since these initial cases, laws against GHB have been tightened and the government has increased efforts to prosecute illegal distributors and users of GHB and its precursors.

Federal guidelines, regulations, and penalties

GHB is a Schedule I controlled substance according to the Controlled Substances Act. As such, it is unlawful for any person knowingly or intentionally to manufacture, distribute, or dispense GHB, or to possess with intent to manufacture, distribute, or dispense GHB. The penalty for manufacturing or distribution of GHB includes sentencing individuals to 20 or more years in jail and a large fine.

It is also unlawful for any person to knowingly or intentionally possess GHB. Any person who violates this law may be sentenced to not more than one year in jail, fined a minimum of $1,000, or both. Repeated offenses may result in greater penalties.

GHB is also officially classified as a date rape drug, a classification intended to establish the basis for harsher penalties under federal law if the distribution facilitates a violent crime. The Drug-Induced Rape Prevention and Punishment Act of 1996 makes it a felony to give an unsuspecting person a date rape drug with the intent of committing violence, including rape. The law also imposes penalties of large fines and up to 20 years in prison for importing or distributing more than one gram of these drugs, which include GHB.

See also Ecstasy (MDMA); GBL; Rohypnol

RESOURCES

Books

National Institutes of Health. National Institute on Drug Abuse. "Epidemiologic Trends in Drug Abuse Advance Report." December 2000.

Periodicals

Cohen, J. S. "Lethal Cocktail: The Tragedy and the Aftermath of GHB (Special Report)." Detroit News. <http://www.detnews.com/specialreports/1999/ghb>.

"GHB: Its Use and Misuse." Harvard Mental Health Letter 17 (March 2001): 7-8.

Li, J., S. A. Stokes, and A. Woeckener. "A Tale of Novel Intoxication: A Review of the Effects of Gamma-Hydroxybutyric Acid with Recommendations for Management." Annals of Emergency Medicine 31 (1998): 729-36.

Nicholson, K. L., and R. L. Balster. "GHB: A New and Novel Drug of Abuse (Review)." Drug and Alcohol Dependence 63 (June 1, 2001): 1-22.

Nordenberg, T. "The Death of the Party." FDA Consumer 34 (March-April 2000): 14-22.

O'Connell, T. "Gamma-Hydroxybutyrate (GHB): A Newer Drug of Abuse." American Family Physician 62 (December 1, 2000): 2478-83.

Sadovsky, R. "Gamma-Hydroxybutyrate and Withdrawal Syndrome." American Family Physician 64 (September, 15, 2001): 1059-60.

Taylor, C. "Turning a Bad Drug Good." New York Times Magazine 151 (December 9, 2001): 105+.

Winickoff, J. P., et al. "Verve and Jolt: Deadly New Internet Drugs." Pediatrics 106 (October 2000): 829-30.

Zvosec, D. L., et al. "Adverse Events, including Death, Associated with the Use of 1, 4-Butanediol." New England Journal of Medicine 344 (January 11, 2001): 87-95.

Other

U.S. Department of Health and Human Services. National Institute on Drug Abuse. Club Drugs: Community Drug Alert Bulletin. December 1999.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Statistics. Drug Alert Warning Network. "The DAWN Report: Club Drugs (December 2000)." <http://www.samhsa.gov/oas/dawn.htm>.

U.S. Department of Justice. Drug Enforcement Agency. "Drugs of Concern: Gamma Hydroxybutyrate (GHB)." <http://www.usdoj.gov:80/dea/concern/ghb.htm>.

U.S. Drug Enforcement Administration. "DEA Press Release Fact Sheet: Gamma Hydroxybutyric Acid, March 13, 2000." <http://www.usdoj.gov/dea/pubs/pressrel/pr031300_01.htm>.

White House Office of National Drug Control Policy. "Drug Facts: Club Drugs, 2001." <http://whitehousedrugpolicy.gov/drugfact/club>.

Whitten, L. "Conference Highlights Increasing GHB Abuse." NIDA Notes 16 (May 2001). <http://165.112.78.61/NIDA_Notes/NNVol16N2/Conference.html>.

Organizations

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.nida.nih.gov>.

U.S. Drug Enforcement Administration, 2401 Jefferson Davis Highway, Alexandria, VA, USA, 22301, (800) 882-9539, <http://www.usdoj.gov/dea>.

U.S. Food and Drug Administration (FDA), 5600 Fishers Lane, Rockville, MD, USA, 20857-0001, (888) 463-6332, <http://www.fda.gov>.

Jennifer F. Wilson