Understanding and Assessing the Motivations and Habits of GHB Users

Gamma hydroxy butyrate abusers are about as cloistered as recreational drug using populations get. For the amount of GHB abuse that exists in the world of club drugs and the designer drug scene, little is known about the habits and tendencies of the people who abuse it. A recently published survey by Rhode Island research authorities has shed light on GHB and has revealed some of the underlying facts and trends that prompt GHB users. The research involved the participation of Project GHB, an organization led by Ms. Trinka Poratta, a retired LAPD narcotics detective and periodic contributor to this journal. Researchers from the University of Rhode Island, Social Sciences Research Center, The Rhode Island Training School, The Center for Alcohol and Addiction Research Studies at Brown University, and the Providence VA were each involved in the establishment of the survey and the collection of data. They published the results of the GHB survey in a recent publication of the American Journal of Addictions.[1] This research shines a light on a cohort of GHB users to establish for the first time a clear picture of their habits and motivations.

Sixty-one participants were involved in this web-based survey over a period of five months, of those 56 of them completed three quarters or more of the instrument. It did not appear that participants had any real problems in dealing with the survey. Over 75% of respondents indicated that they used one of the GHB family drugs one or more times per day. The respondents were mostly men. Around half of the participants expressed some surprise that these drugs were the subjects of law enforcement action and government warnings as to the danger they posed. Ominously, 50 respondents reported having driven while under the influence (DUI) of GHB and/or its analogs.

Respondents had casual reflections on their use of GHB; most endorsed the recreational use of the drugs even though they remarked that they had experienced significant withdrawals at various points during their experience. Further, a substantial number of participants seemed disinterested in cutting back on their use of the drug or alter their patterns of use. Respondents tended to indicate that they were influenced by friends in their use of the drug, and that they did not want to disappoint others who may have been leveraging them to use it. Researchers found that participants were overly reliant on utilization of their cognitive coping skills than more active behavioral coping skills in controlling their use of GHB. Users who take GHB in active social settings appear to have fewer issues with GHB dependency. Those who claim to be using the drug for its health benefits report more drug dependence problems over the course of the prior 12 months. It would appear that those who initiate GHB use as a wellness tonic are the ones who have problems limiting their use. This subgroup would tend to involve those who began using the drug as a nutrient to facilitate recovery from bodybuilding and other weightlifting programs.

In the past, GHB studies have revealed that users take the drug for various motivations. Some users seek to get a relaxing high, others a more euphoric high; others take it for its aphrodisiac powers and its ability to increase sociability. Many GHB users ingest two or three other drugs with it. In that respect, GHB can be quite dangerous, especially those instances where GHB may be combined with alcohol or benzodiazepines (or both).

Laboratory Testing Availability for Bath Salts

A recent be-on-the-lookout news bulletin from the Journal detailed the threats posed by drug-spiked bath salts and drug-infused plant foods.  These products are quickly proliferating the psycho-stimulants mephedrone (4-MMC) and methylenedioxypyrovalerone (MDPV). These two substances have found their way into a number of commercial products that are being sold directly to the public as bath tonics and special plant foods. Known as Ivory Wave, Red Dove, and Vanilla Sky, drug users buy these compounds and snort them like they would cocaine or methamphetamine; they can also be smoked or injected. Until very recently, these drugs were undetectable in commercial drug testing assays.  These drugs are powerful and unpredictable and they are patently dangerous. More information regarding these substances can be found in the DAR Journal's archives at Archived Journal Issues.

In response to reader demands, MEDTOX has established several lab-testing protocols for these compounds and a plethora of other designer drugs that are currently popularly abused. Readers may contact the medtox journal (medtoxjournal@medtox.com) or any other MEDTOX sales representative for information on this testing program.

MEDTOX's Drug Abuse Recognition (DAR) Institute also announced on January 1, 2011 the availability of a new DAR: Designer Drug Course. This eight-hour seminar is taught by master DAR and DRE instructors. Readers or institutions interested in obtaining DAR: Designer Drug instruction should contact Donald MacNeil at dmacneil@medtox.com. The DAR Institute offers nearly 30 different courses dealing with substance abuse, mental health, and community corrections issues. MEDTOX courses are certified and approved for continuing education and advanced training units.  

Street Beat: Minnesota Nurse Anesthetist Diverts Surgical Patient's Fentanyl

Kidney stone surgery is no walk in the park. In fact for men, the surgery is about as close as they will come to experiencing the pain of childbirth. A Minneapolis man recently checked into an area hospital to have several kidney stones removed. These procedures are generally conducted under some amount of anesthesia and with liberal amounts of narcotic added in to manage the pain. In this instance, a nurse anesthetist was responsible for establishing anesthesia and administering narcotics. Fentanyl was supposed to be utilized as the narcotic for this procedure. As it turns out, the nurse anesthetist allegedly had a substance abuse problem and diverted the fentanyl for her own use. In fact, the nurse essentially forewarned the patient that he was not going to get the entire narcotic that he was supposed to get. The nurse told the patient to "man up and take some of the pain." It was obvious to surgeons that something was terribly wrong as the patient moaned and writhed on the table. Suspicions soon centered on the nurse anesthetist. When she was detained, hospital authorities found two fully loaded syringes and four empty syringes in her pocket.

Fentanyl is a very powerful synthetic opiate. Very small doses go along way. It is a short acting drug and, as a result, addicts must take multiple doses with frequent intervals. On the street, fentanyl is usually encountered in the form of a transdermal patch or in a lollipop sucker form called Actiq. The drug is widely used in pain management programs to deal with acute episodes of breakthrough pain. Because its use is largely restricted to hospitals and other special healthcare settings, the drug is more likely to be abused by susceptible doctors and nurses.

Test Your Knowledge: A Drug of Abuse for All Seasons

The subject of this month's mystery drug column is certainly not a mystery to those who work in the trenches of rehabilitation and addiction. Favored by body builders and strength athletes, this drug has carved out a niche with substance abusers that bridges several different drug using genres. Despite the favor it curries with body builders and other workout devotees, it is not an anabolic steroid. In fact, the drug's central actions are considered to be a depressant. For expert evaluators, such as DRE's (Drug Recognition Expert) and DAR (Drug Abuse Recognition) trained and certified personnel, the core symptoms associated with the use of this drug are a central nervous system depressant. In fact, the sedating effects of this medication are profound. Many who experiment with this drug land in hospital emergency rooms. Although intoxication at the hands of this drug is often overlooked or chalked up to alcohol intoxication, it is not ethyl alcohol.

This month's drug is a substance that speeds the healing and rehabilitation of tissues and systems impacted by harsh, rigorous physical training. For over 20 years, athletes have turned to this substance as a means of accelerated recovery. Once available as an over-the-counter and Internet supplement, the drug is now carefully regulated under terms of DEA Schedule II. On the streets, bootlegged versions of the drug flow like water. Precursor and metabolite forms of the drug have saturated the drug using black market and are often easier to obtain than original forms of the drug. In its most common form, the drug is found as a liquid. The drug usually appears as a clear solution that emits a subtle, musty odor. Some preparations have been found to emit a stronger chemical odor and sport an oily, viscous constitution. Prodrug substances of this month's drugs can possess stronger powers and may emit chemical odors that are more evocative of solvents and ketones. In fact, some of this drug's relative compounds can be found in a variety of commercial solvents and paint strippers. Of significant value as a clue is the fact that some desperate users of this drug have been known to drink paint and nail polish remover in order to absorb some of the drug's analogs (and prodrugs) that are contained therein. Teenagers and younger users of this drug have been known to steal nail polish remover from store displays and drink the contents on the spot. Empty nail polish remover bottles are found on the floor and in the trash cans of stores where these products are sold. Fortunately, most manufacturers of polish removal have taken to using safer alternative solvents in their products. Nevertheless, the fact that some users would resort to drinking such a caustic substance belies the power that the drug exerts over some people.

This drug is an amino acid precursor of gamma amino butyric acid (GABA), a powerful inhibitory system of the human central nervous system. The drug appears to biologically activate at a particular GABA receptor. It is likely that at some level, the drug is actually converted to GABA. This hint is profound, but some readers probably jumped this clue and have already identified the drug. Moving on though, in its capacity as a GABA-ergic drug, it can initiate notable sedative and muscle relaxing effects. Striated muscle, the skeletal muscle tissue involved in the stress of body-building and exercise, is believed to rehabilitate more quickly and efficiently when this drug is used in post-exercise recovery. The relaxing effects of this drug are also mediated through activation of dopamine receptors in the central nervous system. The combined GABA-ergic and dopaminergic effects can lead certain types of users into frequent, compulsive patterns of consumption. The drug can bring about a rather vicious drug dependency, one that is difficult if not outright dangerous to take on.

Physical dependency can occur quickly with the use of this drug. The half-life of this drug is relatively short; repeated doses every couple of hours is common. It can be very difficult to detect in urine. It can be impossible to detect in the blood. Related abused compounds are equally difficult to screen and test for. These chemical complications have made this drug the perfect coconspirator for sexual predators. This month's drug has developed a notorious reputation as a chemical agent for drug facilitated sexual assault. Having a cursed designation as a date-rape drug, this substance is notoriously associated with the clubbing scene and singles crowds. Users seek out the drug because of its ability to increase feelings of sociability and sexuality. Higher or more concentrated doses of the drug can lead to altered states of consciousness; for some users, that's an attractive proposition. Higher doses can lead to a state of unconsciousness and opens the door for predators to undertake sexual assault. In its original pharmaceutical forms, this month's drug was utilized as a general anesthetic. Related compounds are used today in many operating rooms.

Police officers are chagrined by this drug. Instances of DUI at the hands of this drug are common and oftentimes go unprosecuted. Motorists inebriated by this drug are often misidentified as being under the influence of alcohol. Drug test results come back negative for alcohol. This can lead to the dismissal of a case or pleading to a lower level reckless driving charge.

Oftentimes people who use this drug will do so in combination with alcohol. There is a synergistic relationship between alcohol and this month's drug. The combined effects of the two substances have logarithmic results, a phenomenon where 1 plus 1 equals 3, 4 or 5. When combined, users with low blood alcohol effects (i.e. .02% or .04% B.A.C.) may exhibit signs of impairment that are more consistent with someone with a blood alcohol content of .15% or more. Symptoms of someone intoxicated by this drug include but are not limited to the following:

Absence of odor of alcohol

Absence of speech or slow, non-responsive speech

Blank stare

Exaggerated facial expressions

Horizontal gaze nystagmus (immediate onset)

Vertical nystagmus

Lack of convergence

Slow heart rate (low dose)

Slow Romberg clock (low dose)

Hyperflexia

Poor balance

Difficulty sitting or standing still

At higher doses of this drug, users may exhibit very bizarre symptoms. They may alternate between states of near paralysis (catatonia) to being very energized, impulsive and uncontrollable. For users who push on to even higher doses, the drug may lead to nausea, vomiting, and seizures. Of great concern are those who become physically dependent on this drug (or its analogs). The effects of withdrawal can be excruciating, worse than those associated with alcohol or benzodiazepines. Ironically years ago, this months drug was used to help treat alcohol and other sedative withdrawal.

On the street this drug is known as "G" and Liquid X, a nod to its Ecstasy (MDMA)-like effects. A pharmaceutical brand is available of this drug and is highly regulated and scheduled (Schedule II). Called Xyrem (sodium oxybate), this drug has been approved by the FDA to treat narcolepsy and excessive daytime sleepiness. The drug has been utilized "off-label" by some physicians to treat sleep disorders and diagnoses of fibromyalgia. There have been reports of diversion and abuse of the pharmaceutical form of the drug. A recent effort to officially approve Xyrem in the treatment of fibromyalgia was blocked by the FDA after an advisory panel voted 20-2 against it.

This month's drug is a pernicious threat, more dangerous than most experts and public policy experts give it credit for. In the eyes of many activists, its roll in drug facilitated sexual assault is sufficiently serious enough to warrant a total ban from all markets and its assignation to DEA Schedule I of the controlled substances act.

This month's drug: gamma hydroxy butyrate (GHB). Active precursors and analogs include: 1,4-butanediol (1,4-BD), gamma butyl lactone (GBL), gamma hydroxyvalerate (GHV) and gamma valerolactone (GVL).

Does Mixing Caffeine with Alcohol Make A More Alert and Safer Driver?

Recent editions of this news journal have reported on the proliferation of alcoholic beverages infused with caffeine and clever marketing campaigns that target younger drinkers, especially young adults. The sales message has stirred widespread interest again in the relationship that caffeine has with alcohol and what, if any, antagonistic effect can be realized when these two very different drugs are used in combination. Does caffeine reverse or blunt some of the depressant and impairing effects of alcohol? A recent study of the effects of these two drugs was undertaken to answer that question. Non-caffeinated alcoholic beverages were compared with alcoholic beverages spiked with caffeine.

Volunteer drivers were randomly assigned to one of three groups. 127 heavy episodic drinkers participated in this study (age range 21-30, 53% men, 83% students). Participants were randomly assigned to one of several experimental groups. One cohort was administered and drank alcoholic beer; another group drank alcoholic beer spiked with caffeine. Yet another cohort consumed non-alcoholic beer treated either with caffeine or non-alcoholic beer with placebo. The participants drinking alcohol were carefully guided in their consumption until they reached a breath alcohol level of .12% BAC, a good distance above the presumptive intoxicated DUI benchmark of .08% BAC. Participants were then put through a battery of driving challenges in a carefully controlled laboratory setting. The testing protocol involved a 30-minute simulated, sustained driving task and a set of divided attention skill challenges.

Participants who consumed alcoholic beer produced rather dismal results compared to those participants who drank non-alcoholic beer. Their speeds were excessive, their lane changes were exaggerated and sloppy, and their reaction times were slowed. Those who drank alcohol beer spiked with caffeine did no better than those who drank alcoholic beer with placebo added.

This straightforward experiment undercuts the marketing claims that alcoholic beverages tinged with caffeine are an effective means of mitigating the impairing effects of drinking. Hopefully this study will help fuel federal and state effects to ban the sale of alcoholic beverages infused with caffeine. This study is particularly relevant to college and university officials in their efforts to reign in excessive drinking by their young students.

Human Growth Hormone (HGH) is an anabolic growth hormone that is widely available in the United States. HGH has been implicated in a number of high profile sporting scandals where ultra-athletes resorted to it to boost physical performance, increase strength and muscularity, and/or to accelerate recovery from extreme training. Also known as somatotropin, HGH is a polypeptide that is stored in the pituitary glands. The drug is available by prescription; a great deal of HGH transportation and sales is conducted via the Internet.

With the relatively low cost of HGH, experts have opined that its utilization by weightlifters and power sports athletes is on the rise. But little reliable research has been published on the validity of those views. Long-term and/or chronic use can lead to the development of serious health problems. Cardiomyopathy, acromegaly (excessive growth in hands, feet and face), hypertension, and arrhythmias are examples of some of the life-threatening side effects that can come from non-medical use of HGH. A Swedish study of anabolic steroid addicts conducted in 2009 revealed that nearly half of them co-abused many classical drugs of abuse, including opiates, amphetamines and marijuana. In those cases it was averred that HGH and steroid abuse were just single components of a larger pattern of drug and alcohol abuse.

In 2009, researchers at McLean Hospital in Belmont Massachusetts undertook a study of 231 diverse, experienced male weightlifters spanning in age from 18-40.[1] The scientists focused on HGH and IGF-I, insulin-like growth factor use. They also recorded data regarding weightlifter use of other anabolic steroid products. Steroid using weightlifters often incorporate a variety of anabolic agents into their workout regimens; rarely does a steroid using weightlifter stick with just one type or one brand of product. In this study, researchers revealed that HGH use is common and it is used over extended periods of time. HGH use was closely associated with abuse of other anabolic steroids and classically abused drugs. A good number of the respondents met the criteria for drug dependency. The level of lifetime HGH/IGF-I use with prior anabolic steroid users was noticeably elevated when compared to results of similar research done in 2003. The authors opined that the spread of HGH use in steroid using weightlifters is largely attributable to decreased prices and wider availability over the Internet. The authors also pointed out that although young weightlifters are the most prominent user-group of HGH, there are many 40- and 50-somethings who obtain HGH subscriptions from "anti-aging" clinics and other illicit sources.

Worrisome is the fact that many HGH/IGF-I users admit to being long-term users of anabolic steroids; HGH use was just one chapter in a lengthy career of anabolic steroid use. By contrast, users of other anabolic steroids who did not use HGH/IGF-I reported significantly overall shorter lifetime use of steroids. HGH seems to be an escalation in an overall pattern of anabolic agent use. And although non-HGH using anabolic steroid users exhibited shorter terms of drug use, they did show a substantial prevalence towards lifetime abuse of classical drugs of abuse. HGH/IGF-I anabolic steroid users displayed the highest percentage of lifetime use of classical drugs when compared to other steroid and non-steroid using weightlifters. In this study, more than half of the HGH/IGF-I users reported a history of drug dependence on opiates, Ecstasy (MDMA), cocaine, amphetamine and non-amphetamine stimulants, and/or poly drug use. Non-HGH/IGF-I or steroid using weightlifters (comparably "clean" weightlifters) demonstrated the lowest incidence of classical drug dependencies.

This study points out the prevalence of HGH/IGF-I abuse in ranks of young and older weightlifters. HGH/IGF-I use stands out as a marker, a red flag for other substance abuse problems. Long-term HGH use can lead to serious health problems that can then directly trigger life-threatening events. The use of these drugs can lead to noticeable changes in mood and may lead to episodes of depression. The tendency for this population to be struggling with other substance abuse disorders should be a trigger for treatment and rehabilitation professionals to dig deeper into the histories of clients they may be treating for steroid abuse and dependency.

Until the late 1990s, there were no commercially available HGH drug tests available. In 2000, a blood test was developed that could distinguish natural occurring (endogenous) HGH from synthetically produced HGH.