Harm Reduction: GHB/GBL harm reduction guide (1)

GHB (gamma-hydroxybutyrate, sodium oxybate), sometimes called liquid ecstasy, is a substance with depressant effects. In this first chapter we will address general aspects of the effects, presentation, dosage and risks of GHB/GBL. The next two chapters will be devoted to GHB intoxication and dependence/addiction.

General aspects

GHB (gamma-hydroxybutyrate, sodium oxybate) is a substance that can be found in powder form, or more commonly as a colorless, transparent liquid with a slightly salty taste. It can be naturally found in the Central Nervous System of animals, as well as in some fruits. As a recreational drug, it is often used in the form of a salt (sodium or potassium GHB). Other chemicals (1,4-butanediol, gamma-butyrolactone-GBL) that can be obtained through the internet have effects equivalent to those of GHB.

GHB was developed during the 1960s as an anesthetic but was discarded due to its adverse effects. During the 1980s and 1990s, it was used as a bodybuilding supplement because it facilitates the release of growth hormone. Currently, it is marketed for the treatment of narcolepsy and has shown some effectiveness in treating alcohol dependence.

It is also often associated with the phenomenon of date rape drugs or chemical submission. However, the administration of GHB or other substances with similar properties to a person without their knowledge for the purpose of subjecting them to sexual abuse is extraordinarily rare from a statistical point of view and has been sensationalized by the media.

Routes of administration

The most common form of use is orally, either directly or dissolved in a drink or beverage. Other methods of administration are extremely dangerous.

Effects

The desired effects are relatively similar to alcohol (euphoria, disinhibition, talkativeness, relaxation, etc.). The effects usually start around 20-30 minutes after intake and can last for about two hours.

GHB appears to have some effect on the [/b]sexual sphere[/b] (increases tactile sensitivity, facilitates and enhances orgasm, etc.), although these properties have not been scientifically studied. Its detection in biological fluids (blood, urine, hair, etc.) is very complicated and not possible through regular tests.

Dosage

GHB or GBL is typically found in liquid form (measured in milliliters), although the active ingredient is calculated in weight (grams). The density of GHB is 1.0-1.2 g/ml. This means that approximately 1 milliliter (volume unit) of pure GHB contains about 1 gram of GHB. The sample can be adulterated (simply diluted with water). Thus, 1 ml of GHB may contain less than 1.2 gram (but never more).

GBL is a lactone that converts to GHB within the human body. Once ingested, GBL is rapidly converted to GHB in the liver and other tissues, and it is this latter compound that exerts effects on the central nervous system. The density of GBL is 1.13. As shown in the previous case, 1 ml of GBL can contain a maximum of 1.13 gr of GBL. In the body, 1 ml of GBL (1.13 gr of GBL) transforms into 1.35 gr of GHB.

• In doses below 1 gram, GHB produces mild relaxation accompanied by a decrease in anxiety and moderate disinhibition.
• Quantities between 1 and 2 grams result in significant relaxation with feelings of disinhibition and euphoria. Positive changes in mood can also occur, as well as an enhanced appreciation for music or dancing. However, side effects such as loss of coordination or difficulties in speech may arise.
• Doses of 2 to 4 grams produce deep relaxation, leading in most cases to the user falling asleep for a period of 2 to 4 hours.
• Quantities exceeding 4 grams usually induce deep sleep, making it nearly impossible to wake the person for 3 to 4 hours.

Health problems associated with GHB

Overdose:
GHB has a smaller margin of safety than other substances. Small increases in dosage can result in disproportionately high effects and the difference between the recreational dose and the toxic dose is narrow. GHB intoxication is characterized by a decreased level of consciousness, which can lead to deep coma.

The simultaneous use of other depressants such as alcohol, even in small doses, facilitates the appearance of this type of problem. It should also be taken into account that the fact that the substance is diluted in water makes it difficult to calculate the recreational dose, so that intoxications are frequent

GHB dependence:
In high doses, GHB can cause loss of consciousness and vomiting, which can be a very dangerous combination. Vomiting while unconscious leads to aspiration (inhalation) of vomit, which can cause asphyxiation and lung damage. In the event of GHB intoxication, the first measure to take is always to lay the person down with the head tilted to one side to prevent aspiration of vomit. We will develop this aspect in Chapter 2.

Regular use of GHB can lead to physical dependence. With a use of 4-6 times per week for several weeks some people report that they need to increase the dose to achieve the same effects and some people need a small dose of GHB to be able to function normally.

In these people, stopping GHB abruptly can trigger a withdrawal syndrome (characterized by tremor, hallucinations, tachycardia, insomnia...) which in severe cases can be accompanied by seizures and delirium. There are effective pharmacological treatments for these cases. We will develop this aspect in Chapter 3.

Interactions with drugs:
Any substance with depressant effects can multiply the toxic effects of GHB. This includes prescription drugs (benzodiazepines, opiates, barbiturates) as well as other legal (alcohol) or illegal drugs.Topiramate is an antiepileptic used in the treatment of cocaine dependence that also interacts with GHB, facilitating intoxication.Mixing with stimulants (speed, cocaine, MDMA...) can mask the effects of GHB, making it easier to over-consume it and, consequently, causing adverse reactions.

Damage to esophagus and stomach:
The synthesis of GHB can be carried out by combining the immediate precursor (gamma-butyrolactone) with sodium hydroxide (caustic soda). When producing this reaction it is necessary to control the pH of the final product, as it could be too acidic or basic and cause burns, erosions or perforations of the digestive tract when drunk.

Credits

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