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Analyses of Substance Abuse and Treatment Need Issues 

Gamma Hydroxy Butyrate (GHB) Abuse in the United States

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GHB-Related Deaths

GHB-Related Hospital ED Episodes

References

Table 1:  Distribution of GHB-Related Emergency Department Episodes by Selected Demographic Characteristics: 1991-1995

Table 2:  Estimated Number of Emergency Department GHB Mentions in the U.S. and In Selected Metropolitan Areas: 1992-1996


4. Gamma Hydroxy Butyrate (GHB) Abuse in the United States

By Janet C. Greenblatt

Data from the Drug Abuse Warning Network (DAWN) strongly suggest that there has been an increase in the abuse of GHB. These increases in GHB-related emergency department episodes have occurred primarily since 1992. Although most activity occurred in the western region of the U.S., episodes involving GHB appeared in some north central and southern cities.

GHB was originally developed as an anaesthetic, but was withdrawn due to unwanted side effects. The only legal use of GHB has been as an investigational treatment for the treatment of narcolepsy. In Europe, GHB has been used as an anaesthetic and experimentally to treat alcohol withdrawal (Gallimberti, 1989). GHB is being marketed in England as an anti-aging medicine which allegedly increases the libido, decreases body fat, aids alcohol withdrawal, and induces sleep.

In the United States, GHB has been marketed illicitly 1) to body builders as a growth hormone stimulant and 2) as a replacement for L-tryptophan, a food supplement which reportedly induced sleep and was withdrawn in 1989 due to complications (MMWR, 1990, Sanguineti, 1997). The substance is currently circulating within the dance music scene (at raves and night clubs) as an alternative to Ecstasy or Amphetamine Sulphate (speed). GHB, which is easily home-brewed in basement chemistry labs, is often used in conjunction with alcohol.

GHB is usually available as an odorless, colorless, and nearly tasteless liquid. Sometimes the substance is available as a powder, or in a capsule. At small doses, GHB encourages a reduction of social inhibitions, similar to alcohol, and an increased libido. At higher doses, this euphoria gives way to feelings of sedation. Reported symptoms include vomiting, drowsiness, dizziness, vertigo, and seizures. After excessive use, some users have experienced loss of consciousness, irregular and depressed respiration, tremors, or coma (MMWR, 1990).

Data presented come from the Drug Abuse Warning Network (DAWN) which consists of two data collection efforts: 1) data on drug abuse deaths that were reported by medical examiners in participating metropolitan areas, and 2) data collected on drug-related episodes to a national probability sample of hospital emergency departments (OAS, 1996). GHB use is currently too rare in the U.S. population to be listed separately in data on client admissions to specialty substance abuse treatment programs, obtained from the Treatment Episode Data Set (TEDS) or to be found in data from the National Household Survey on Drug Abuse (NHSDA).

GHB-Related Deaths

Data reported to DAWN by participating medical examiners show that there was only one GHB-related death reported between 1992 and 1995 which occurred in 1995 in the mid-West. The decedent was a white, female between the ages of 18 and 25 who took the drug in combination with alcohol.

GHB-Related Hospital ED Episodes

GHB-related ED episodes to hospitals increased from 20 in 1992 to 629 in 1996 (see Table 1). Two-thirds of the episodes occurred among those age 18 to 25 (66%) and 79 percent were male. Of those on whom race/ethnicity was reported, nearly all were white (94%). Among episodes involving GHB for which a motive was reported, 91 percent reported "recreational use" as the reason for drug use. In those episodes in which a reason for the ED episode was shown, "overdose" was listed in 65 percent of the episodes and "unexpected reaction" in 33 percent.

Nearly 60 percent of episodes involved multiple drugs. GHB was taken in combination with alcohol in 76 percent of these episodes, with cocaine in 6 percent, with marijuana in 5 percent and with ecstasy in 4 percent. In episodes where the form of the drug was reported, GHB was acquired as a liquid in 82 percent of episodes and a tablet or powder in the remaining episodes.

Between 1992 and 1996, episodes increased in six of the 21 metropolitan areas oversampled by DAWN. During that time period, the number of GHB-related episodes went from zero to: 103 in Los Angeles, 83 in San Francisco, 33 in Atlanta, 32 in San Diego, and 29 in Chicago. Between 1992 and 1996, episodes went from 20 to 79 in Dallas.

References

1)Gallimberti L, Gentile N, Cibin M, Fadda F, Canton G, Ferri M, Ferrara SD and Gessa GL. Gamma-hydroxybutyric acid for treatment of alcohol withdrawal syndrome. The Lancet, 787-9, 30 September 1989.

2)Multistage outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. Morbidity and Mortality Weekly Report, 1990 November 30, 39(47):861-3.

3)Sanguineti, VR, Angelo, A, and Frank, MR. GHB: A Home Brew. Am. J. Drug Alcohol Abuse, 23(4), pp. 637-742 (1997).

4)Office of Applied Studies. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network 1992-1996. Rockville, Maryland: US Department of Health and Human Services (Unpublished data).

Table 1:Distribution of GHB-Related Emergency Department Episodes by Selected Demographic Characteristics: 1991-1995


1992

1993

1994

1995*

1996*

Total

Age

6-17

18-25

26-34

35+

Sex

Male

Female

Unknown

Race/Ethnicity

White

Black

Hispanic

Other/Unknown

Motive for Taking Drug1

Dependence

Suicide

Recreational Use

Other Psychic Effect

Unknown

Reason for Visit1

Unexpected Reaction

Overdose

Withdrawal

Chronic Effects

Seeking Detoxification

Other/Unknown

Drug Concomitance

Single Drug

Multiple Drugs

20

-

-

-

-

-

14

-

28

-

-

-

-

-

14

-

-

-

15

-

-

-

-

-

20

38

-

22

12

-

15

21

-

25

-

-

-

-

-

31

-

-

-

34

-

-

-

-

14

24

56

-

25

25

-

29

20

-

47

-

-

-

-

-

25

-

22

15

38

-

-

-

-

19

36

149

-

86

57

-

98

51

-

105

-

16

18

18

-

85

-

41

49

94

-

-

-

-

51

97

629

11

417

165

31

490

131

-

330

-

15

278

27

13

415

-

175

162

320

-

-

-

140

256

374

* Estimates for this time period are preliminary. Final estimates may be higher or lower due to nonresponse adjustment and other factors.

"-"Estimated quantity <10 or = zero.

1 Motive and Reason refers to the entire drug episode, not the particular drugs mentioned.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

Table 2:Estimated Number of Emergency Department GHB Mentions in the U.S. and In Selected Metropolitan Areas: 1992-1996

Metropolitan Area

1992

1993

1994

1995*

1996*

% Change

1995-1996

Total U.S.

Atlanta, GA

Baltimore, MD

Boston, MA

Chicago, IL

Dallas, TX

Detroit, MI

Los Angeles/Long Beach, CA

Miami/Hialeah, FL

Minneapolis/ St. Paul, MN

New Orleans, NO

New York, NY

San Diego, CA

San Francisco, CA

Seattle, WA

St. Louis, MO/IL

Washington, D.C.

20

-

-

-

-

20

-

-

-

-

-

-

-

-

-

-

-

38

-

-

-

-

-

-

-

-

-

-

-

-

33

-

-

-

56

-

-

-

-

11

-

27

-

-

-

-

-

11

-

-

-

148

10

-

-

-

40

-

47

-

-

-

-

21

19

-

-

-

618

33

-

-

29

79

-

103

-

-

-

-

32

83

-

-

-

322

230

-

-

-

98

-

119

-

-

-

-

52

337

-

-

-

* Estimates for this time period are preliminary. Final estimates may be higher or lower due to nonresponse adjustment and other factors.

"-"Estimated quantity <10 or = zero.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

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This page was last updated on June 03, 2008.