Trends in γ-Hydroxybutyrate (GHB) and Related Drug Intoxication: 1999 to 2003

Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States
Annals of emergency medicine (Impact Factor: 4.68). 03/2006; 47(2):177-83. DOI: 10.1016/j.annemergmed.2005.10.012
Source: PubMed


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.

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Available from: Jo Dyer, Oct 29, 2014
    • "Non therapeutic use of this compound dates back to the 80s, when it was used as enhancer of muscle mass in body building practices and as psychoactive drug for recreational aims (such as in rave parties). Nowadays, GHB is known as " rape drug " in drug-facilitated sexual assault (DFSA) cases, alone or mixed with other substances [10] [11] [12]. Since GHB is odorless, colorless and tasteless, it can be easily added to beverages and administered to unsuspecting victims inducing disinhibition, unconsciousness and amnesia, hence a total defenseless against sexual assault [13]. "
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    ABSTRACT: γ-Hydroxybutyric acid (GHB) spread for recreational purposes or as "rape drug" represents a hard issue for forensic toxicologists due to its endogenous nature. It is clear that an actual and reliable discrimination between basal and exogenous levels is mandatory to achieve a correct evaluation of conscious/unconscious administration. This research aimed to study the GHB baseline in hair samples, collected from 150 volunteers, non-consumers of any drugs of abuse, in order to evaluate if a generic cut-off value could be accepted, also focusing on potential influences of gender and age. The analysis consisted of an overnight incubation with NaOH at 56°C, liquid-liquid extraction with ethylacetate and trimethylsylil derivatization. Detection was carried out through gas chromatography-mass spectrometry in single ion monitoring (m/z 233, 234, 147 for GHB; m/z 239, 240 and 147 for GHB-d6). The endogenous amount in "blank" hair was estimated by the standard addition method. Concentration range was 0.279-2.839ng/mg. In males, the average GHB levels were higher than in females (0.829 vs 0.596ng/mg, respectively), especially in the first age category (<30 years, 1.008 vs 0.606ng/mg, respectively). Age influences on GHB levels seemed to be different among the two sexes: in male population concentrations were higher <30 (1.008ng/mg) and similar in the other age ranges (0.762ng/mg, 30-50; 0.763ng/mg, >50); in female, quite similar levels were registered throughout all the age categories (0.606ng/mg, <30; 0.536ng/mg, 30-50; 0.691ng/mg, >50). Further study should be performed on GHB physiology in order to better understand these differences among ages and genders. Moreover, we demonstrated that for hair analysis a cut-off reference value is not strictly mandatory, underlining the great interpretative valence of segmental analysis.
    Journal of pharmaceutical and biomedical analysis 11/2015; 118:161-166. DOI:10.1016/j.jpba.2015.10.036 · 2.98 Impact Factor
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    • "Also, among suspected exposures to GHB and congener drugs reported to the California Poison Control System the proportion of women increased from 38% in 1999 to 60% in 2003 [15]. However, this increase could be partly explained by the proportional increase of 'malicious' events, such as sexual assaults, where the majority of victims were female [15]. "
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    ABSTRACT: 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.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 02/2012; 20(1):7. DOI:10.1186/1757-7241-20-7 · 2.03 Impact Factor
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    • "We have previously documented a steep decline in GHB exposures reported through poison control reporting and other U.S. surveillance and survey data sources. (Anderson et al., 2006) Nonetheless, even in the U.S. GHB use is still an ongoing concern especially among gay and bisexual men (Halkitis and Palamar, 2006), individuals with GHB dependence and victims of GHB drug facilitated assault (Anderson et al., 2006) Furthermore, the picture internationally appears to be more heterogeneous. For example, recent reports from Sweden suggest an upswing there in total GHB abuse (Knudsen et al., 2005), while in a report of hospitalized patients following acute overdoses in Oslo, Norway, GHB was among the drugs most frequently involved. "
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    ABSTRACT: AIMS: To conduct an Internet-based survey of GHB use, identifying differences by respondent residence. METHODS: We recruited GHB-knowledgeable persons via "social networking Internet sites." Individuals (n=314) or groups (n=66) were approached based on GHB-use testimonials. DATA COLLECTED: location, use, reason for cessation (if applicable). FINDINGS: We recruited 155 GHB users. U.S. respondents (53 of 70; 76%) compared to non-U.S. respondents (38 of 85; 45%) were older and more highly educated (p<0.05) but manifest a 3-fold greater adjusted odds of GHB cessation (Odds Ratio [OR] 3.1; 95% CI 1.4-6.9; p < 0.05). Of the 80 respondents stating reason for cessation, 36 (45%) cited legal risk, price, or access; 44 (55%) cited health or related concerns. U.S. compared to non-U.S. respondents more frequently invoked legal and related concerns (OR 2.5; 95% CI 0.99-6.3; p=0.05). In a nested analysis, narrowly stated legal (n=4/5 U.S.) versus health (n=6/18 U.S.) reasons differed by location (p=0.048, one-tailed). CONCLUSIONS: In the U.S., where GHB has stricter legal penalties, GHB cessation is more likely, with legal and related reasons more commonly invoked for cessation. These findings support a link between declining U.S. GHB abuse and more stringent restrictions; although other un-assessed factors may also explain this association. The Impact of Gamma Hydroxybutyrate (GHB) Legal Restrictions on Patterns of Use: Results from an International Survey.
    Drugs: Education Prevention and Policy 10/2010; 17(5):455-469. DOI:10.3109/09687630902729594 · 1.00 Impact Factor
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