By
Trinka D. Porrata
(Retired
Narcotics Detective)
Rave
& Rape Drug Consultant
556 S.
Fair Oaks #101-178
Pasadena CA 91105
www.trendydrugs.org
www.projectghb.org
This
may be reprinted & distributed
June
24, 2000
Introduction
By
Trinka D. Porrata
In
June of 1996, I was already involved with the drug flunitrazepam (Rohypnol, aka
roofies) and working on legislation to control it in California.
One summer night, four young men collapsed in the streets of Hollywood.
Two died and were brought back to life by paramedics.
I was assigned to this then-uncontrolled drug too.
I was horrified and captivated. What
if this had been unwitnessed and paramedics hadn't been called?
Would JR and his friend be alive today?
For that matter, had JR died that night, would the coroner have figured
out the cause of his death? Very
few coroners then---and still shockingly few today---had a clue about GHB or how
and when to test for it. How many
had already died....and no one knew?
At
that time, the Drug Enforcement Administration knew of six or seven GHB deaths.
DEA's Dr. Jim Tolliver, who was tracking GHB, and I both agreed that
there had undoubtedly been many more that went unnoticed.
When I went to testify in Sacramento for the GHB legislation, Dennis
Fraga came forward on his own to testify............clutching the autopsy report
from his son, Jeffery Fraga, who died from GHB.
Obviously there were deaths out there that had been recognized, but there
was no reporting mechanism in place. We
would later learn that Dr. Jo Ellen Dyer from the San Francisco Poison Control
Center had attempted to report two GHB deaths a few years earlier, but the Drug
Abuse Warning Network (DAWN) wouldn't take them.
There was no room for that data in their system.
Dr. Tolliver then made a series of random phone calls to coroners around
the country and, within a short period of time, the death toll jumped to 21.
The DEA count now stands at 66. And,
Dr. Christine Sannerud, who now handles this topic, has a lot more to track down
if she is ever given time to do so. The
death count on my database is over 120 at this time.
During
the past four years, I've learned something new about GHB with absolute
regularity and nothing I've learned has made me feel any different---This is one
terrifying drug.
After
Caleb Shortridge died from a GHB overdose on April 30, 1998, in San Diego,
California, his parents were stunned to find the internet swamped with bogus
information about how safe and wonderful GHB is supposed to be.
If so, how could their son be dead?
The internet also said, over and over and over, "Do NOT call 911.
Just let them sleep it off." They
set up their own website to help counter this overwhelming flood of lies.
That website has been the most incredible resource for two years.
The "Viewer Comments" section of www.ashesonthesea.com/ghb
should be mandatory reading for everyone involved in GHB research or politics or
enforcement in anyway. The normal
patterns of an abused drug's growth and spread have been broken. GHB, the bastard child of the internet, is every where.
Then
we heard the stories of Matt in Pennsylvania and Josh in Northern California.
The internet abounds with statements that GHB is not addictive, ignoring
the works of Gantt Galloway who said otherwise.
Withdrawal wasn't of concern to anyone.
Yet Matt and Josh had pleaded for help escaping from the depths of GHB
addiction for months. Their
mothers, one a nurse, had taken them everywhere over and over, begging for help
in saving their sons. Matt and Josh
are dead. Their deaths will not be
counted in the official DEA death toll. They
died from overdoses of other drugs during their struggle to free themselves from
GHB. But, in reality, it was GHB
that killed them, and it was slow and tortured death.
Haunted
by their deaths, Anya Shortridge and I made a decision that would forever change
my life. On December 23, 1999, we
launched a GHB helpline via www.ashesonthesea.com/ghb.
Within an hour, the addiction help requests started coming in and have
never abated.
What
we have learned since then is indeed incredible, but there is so much more to be
learned. Six months later, I have
detoxed addicts who remain terrified of what long-term damage they have done.
Some still report tingling and numbness in their extremities.
Some still have periodic shakes in their limbs.
The depression and irregular sleep hangs on for many.
They are trying to be hopeful that this too shall pass.
I don't have answers for them, and I'm worried for them.
We have noticed that an unusual number of those who died from GHB and who
were chronic users seem to have enlarged hearts.
Often this has been dismissed as possible steroid use, if the deceased
looked like he worked out a lot. I'm
not a doctor, but it begs the question, is numbness in the fingertips a result
of an enlarged heart and thus reduced circulation? Chronic episodes of pulmonary edema cannot be good for anyone
of any age.
And,
yes, I'm quite aware of the research into GHB for narcolepsy and cataplexy.
It is still my heartfelt opinion that it is not GHB, but some safer,
longer acting cousin to GHB, yet to be discovered, that these people need.
Dr. Mortimer Mamelak, who researched GHB for nine years for narcolepsy,
agrees with me. Another narcolepsy
research doctor also agreed, until someone convinced him to deny his statements.
So, tragically, the research focus seems to have been shifted toward
stopping right here with this horrid drug.
I'm deeply concerned that the drug company and researchers do not seem to
realize or care that while GHB may help reduce cataplexy in those suffering from
that rare disease, people all over this country are literally giving themselves
a cataplexy-like syndrome from using GHB-it's called "carpeting out"
or "scooping out" or "throwing down" or "the head
snap."
As
for any consideration for using GHB in treatment for alcoholism-I've read about
the Italian studies and was absolutely amazed that not once did I read the word
"impairment" or anything related to it. GHB users are as impaired or more so behind the wheel than an
alcohol user. Also, a rather
dramatic number of the participants increased their dosage on their own.
Ironically, the GHB narcolepsy research studies do NOT track possible
increased dosage by their patients. While
the drug company maintains that their product usage is intensely tracked, I know
for a fact that there is nothing built into the program that keeps a patient
from buying additional GHB and upping their dose on their own.
Their levels are not being testing.
Of course, they'd have to be tested at least twice a day to be
meaningful! Furthermore, I'm not at
all confident that the doctors don't just up their official dose at their
request, making it look legitimate rather than admitting that it is the patient
increasing the dosage. I must
confess that I've lost a lot of faith in the integrity and reliability of
medical research procedures over the past few years.
There
is so much more to be done.
GHB
& Its Analogs:
The
Hidden Curse of Addiction
Since
December 23, 1999, our GHB addiction hotline via www.ashesonthesea.com/ghb has
received inquiries from 148 people in at least 33 states (we don't know the
location of 18 of them) and three foreign countries. Most are males, from 19-48 (mostly 20-37); about 22 are
females. Beyond that, the doctors
we have been working with have been contacted regarding other cases as a result
of their names being passed around by those who have contacted us and from the
website, as well as during their normal course of business.
To
give an idea of how intense this has been for all involved: Drs. Deborah Zvosec
and Stephen Smith in Minnesota in one five-day period had handled seven
referrals through the hotline from Arkansas, New York, Alabama and Wisconsin.
On that Wednesday, Dr. Smith was walking into the hospital when he saw
three men pulling a fourth man out of the car.
He was unconscious. He was
intubated and shortly after became bradycardic and they lost his pulse---but he
was then stabilized. Dr. Smith asked the patient's his buddy to call Dr. Zvosec
because of their research; she interviewed him extensively over the phone.
When asked if he thought any of his friends were addicted, he said, yes,
probably the guy at whose house the party was being held.
She urged him to pass their names around, for people to contact for help.
A few hours later, a second young man turned up---the host of the party, who was
in withdrawal. The intake counselor reported that this was the second withdrawal
case of the week. While he was being admitted and worked up in the Crisis
Center, his buddy was found down in the room, unconscious, with seizure-like
activity. He was subsequently also intubated and admitted to the ICU.
A rather busy week in Minneapolis for GHB.
Bear
in mind, there has been no advertising of the hotline, and it doesn't even
appear highlighted over other topics on the website.
Additionally,
we have heard from several doctors throughout the country who stated they have
been seeing GBH addiction and were seeking more information about it.
Their cases are not included in our figures.
Plus, we are aware that some doctors are saying that they have treated
GHB addiction; but that sometimes means that they have given the usual 3-4 day
non-medical detox, which isn't generally enough. That's like the doctors who saw
Matt and Josh saying they treated GHB addiction.
Not really. We need to make
the information about GHB withdrawal risks common knowledge among medical
practitioners to stop the deaths of young men like Matt and Josh.
Many of our patients say they approached doctors or clinics and either
left because it was obvious they had no clue about GHB or went through the 3-5
day detox and never returned because they knew that the doctors didn't
comprehend the issue.
Unfortunately,
because the hotline is just me and my parttime assistant, our clients have not
been given adequate supportive follow up. The
ones who had family and friends involved with them and close to them fared the
best overall, with some notable exceptions. Those with histories of other drug abuse have had the most
trouble and some have gone back to GHB or binges on other drugs. Those without
family or close friends or who refused to tell anyone got most of our attention.
Though we pleaded with all to get medical supervision, some got only
initial help or none at all. There
are some we never heard from again after providing initial information.
When we occasionally get a moment to inquire about them, some never
sought help and are still on G and some are just fine.
Needless
to say, those who wrote us saying, "Just tell me what drugs to take and
I'll get some and do it at home alone" were told NO.
We plead with them to seek medical guidance.
Those who refuse, we still monitor as best we can, often becoming their
focal point. We also use some of
the detoxed clients to provide encouragement to seek medical help and
encouragement to get through this. We
have not had the opportunity to adequately document their cases. I hate to see this important data last, but I have been
unable to interest anyone in the FDA in following up on it. The doctors we have been working with, who all have articles
pending, would also love to do it, but are extremely busy just keeping up with
their own work and the referrals and inquiries they get as a result of our
hotline. But someone really needs
to be following the long-term effects on these people as they continue to
experience shakes, depression and other physical issues.
We have proven the need, but we don't even have time or the knowledge to
pursue a grant.
Some
of the things we've noted:
GHB
addiction is not measured by quantity of GHB consumed, but rather by frequency.
A GHB addict MUST have GHB within two to three hours in order to
maintain. Beyond that, withdrawal symptoms begin, whether they
recognize what they are experiencing or not.
Many take specific doses at specific intervals, but others merely
"sip" from a bottle of GHB throughout the day and night.
While
some of our inquiries have prior and/or other drug issues, the majority seem to
have stumbled into this addiction quite by accident. Most believed they were taking something as safe as melatonin
(is supposed to be).
Virtually
all of them report that initially GHB seems to be god's gift, giving everything
they were promised. You sleep well,
you become more outgoing (anti-depressant), your sex life improves, you lose
body fat, you get muscled really easily, etc., etc.
And, then one day it turns on you. It
can be just two months or a few years before they realize that they are in
trouble. The biggest group seems to
have been using four to twelve months before realizing they were addicted.
This does NOT mean that they weren't having trouble before that.
Because of the dissociation, they do not realize when the trouble begins.
They typically have episodes that they don't remember.
Interviews with roommates, wives, girlfriends, even their children prove
that the troubles were there much earlier.
Once
GHB reverses on them, they typically gain weight, are unable to discipline
themselves to keep up their workout schedule, become introverted and become
unable to deal with the public (one young man in Oregon hadn't been out of his
house for more than 3 weeks and was paying a neighbor to bring him groceries),
have psychotic episodes and are unable to sleep. Everything it gave them is taken away.
Most
of the inquiries are from bodybuilders, gym owners, personal trainers, young
businessmen who work out regularly, health food store owners and employees.
There are also airline employees (it bypasses the testing) and some
general drug abusers.
Bodybuilders
are introduced to GHB in one of two ways, as a sleep aid or a direct workout
aid. Some started taking it as a
sleep aid. You sleep four hours
very soundly, and then stay awake easily for the next 20 hours, not even getting
drowsy after lunch, they say. Then
one day they begin taking it to wake up in the morning and then again in the
afternoon, etc., until they are at the 2-3 hour point.
They typically say they don't know why---it just happened.
Or, bodybuilders are started into GHB by taking it in the morning, along
with caffeine and ephedrine pills. This
keeps them from going to sleep but still gives the dissociated aspect.
Thus their workouts are like watching themselves on tv.
First
stage of chronic GHB use is the honeymoon.
The second phase, whether the addict recognizes or remembers it, involves
a down side though they may think all is well.
Marriages and businesses begin to fail.
Wives are confused and miserable and ponder leaving them.
Some have left. Children
find their fathers passed out naked in the front room, urinating all over
themselves or passed out in the car in the driveway or, worse yet, experience
their father passing out at the wheel of the car with the child in the car.
Wives live in hell wondering what is going on, finding their husbands
asleep in the bathtub, for example. They
learn to hang around to turn off the water or to drag him out of the tub to keep
him from drowning. For a woman in
Utah, after months of tub monitoring, well, she doesn't have to do that anymore.
He's dead. A lady in
California started videotaping her husband's bizarre incidents.
She wasn't sure what they were caused by, but she knew something was
wrong. She woke up at 2 a.m.
recently and he wasn't still in bed. She
searched the house and then went outside to see if the car was still there.
It was, but she found him asleep in the middle of the street in front of
their house. She videotaped him and
showed him the tape. He dumped more than 70 bottles of GHB analog that he had
stashed and went to the ER in withdrawal. They
were determined to do a mental evaluation on him though she tried to tell them
what was wrong. Even in a top-rated
hospital, they had no clue and persisted in the mental evaluation until she got
in contact with me and information about GHB withdrawal and our doctors names
were provided. He was pulled out of
the psych ward and put into intensive care where he remained for several days,
strapped down most of them. He
remembers very little of it, but was hallucinating (he loves boats) that he was
strapped to the deck of a ship adrift at sea for days.
During
withdrawal, there are at least three stages.
Withdrawal starts within 2-3 hours of the last dose.
First there is profuse sweating, which many describe as beginning in the
palms of their hands and soles of their feet.
They feel sick and anxious. Blood
pressure and pulse soar to dangerous levels (stroke level documented).
The first two or three days are most critical in terms of medical issues,
re BP, etc. Unfortunately, once
this stabilizes, doctors who don't realize what they are dealing with believe
them to be "OK." They may
talk in complete sentences and say the right things to doctors, but they are not
usually OK. The second stage, which
generally runs around 8-12 days, is just beginning. They will experience high anxiety, hallucinations and days
without sleep, which will only exacerbate the hallucinations.
They are simply NOT safe to be home alone with medication.
During this phase they may not recognize friends or family and may say
crazy and hurtful things. We always
warn friends and family not to be offended by anything that is said during this
phase. After this, phase three, they will feel better, but will
likely face depression. This too
should pass, but it may take weeks and weeks or even months.
Ironically,
we have also noted that patients who rely heavily on us during their first 10-14
days, especially when not in the hospital, literally "forget" about
us, just as they forget what went on during that period.
We have gotten as many as 15-20 emails a day from patients at home but
deep into self withdrawal, just checking in, just trying to stay "OK."
It's scary for us, but at least we have a handle on what is going on with
them. Suddenly, they disappear.
We've come to learn that if it has been at least 8-10 days, that may be
OK, just a sign that they are out of the fuzz. I'm sure many don't even realize
how many times they emailed us.
We
also noted that their first emails are often full of misspellings, drastic
grammar errors, incomplete sentences and thoughts, etc. Bear in mind, these people generally are not in withdrawal at
this stage, but are now functioning at this level!!!! About 30-45 days later, this often improves significantly,
and you get a better picture of their normal functioning level.
We
have also had some inquiries from suicidal people.
Others have said that they truly could understand committing suicide
while addicted to GHB and even while trying to detox. The levels of pain and anxiety are incredible.
Those who have used other drugs, especially those who have been addicted
to other drugs, swear that GHB is the worst by far. One young man did attempt
suicide while his mother and I tried to set up treatment.
Fortunately he failed and got treatment and is one of our best
"counselors" for others pondering detox or struggling with it.
I've never forgotten the frantic message I got from a guy in Connecticut
saying that he had tried everything and couldn't get away from GHB. We were his last hope and if we didn't help him, he would put
a bullet in his brain because he couldn't live like this.
He was quite paranoid, and instead of giving us the City he lived in or a
phone number, he wrote in that it was none of our business and he wasn't giving
it out. The typing errors were
rampant. Tragically, his email
address didn't work. In his anxiety and paranoia, he seems to have forgotten that
his email is blocked to all outside mail, unless he clears it for a specific
incoming address. We were unable to
reach him. Anya put a pop up screen
on the website for a few weeks, asking him to call us because of the email
problem. We never heard from him.
We have no idea if he is dead or alive.
The
women who are addicted are also typically those who work out regularly.
Their range from women who just work out to be in shape to dancers and
bodybuilders. They have endured the
same syndrome and have put husbands and boyfriends through the same stress and
concerns. One lady had tallied
$12,000 in credit card debts behind her $100 bottle every three-day habit.
When she contacted us, her husband hadn't spoken to her for about two
weeks and was ready to leave. I
asked her to print out my emails and hand them to her husband, requesting only
that he read them, and then to walk out of the house and go to her mother and
tell her the whole story. She did.
He joined her there and they got her into treatment.
Their marriage in now back on track and they are working on the credit
card debt. One female from Texas
had died twice from GHB but was brought back by paramedics.
She had been raped, but had not reported it because she figured she'd be
told it was her fault. Her
boyfriend was very supportive and rushed her to the ER in withdrawal and stayed
with her. She promised to seek
counseling re the rape.
Most
of the addicts report rapid, easy weight loss (body fat) and easy muscle gain.
No one seemed to have a real explanation for it.
Even Dr. Mamelak told me that narcolepsy research patients also lose
weight. I recently spoke to Dr.
Wallace Winters (retired FDA) who has researched GHB decades ago as a
dissociative anesthetic. Dr.
Winters considers GHB a CNS excitant and believes that may have something to do
with it. Furthermore, in our
discussion, we noted that the narcolepsy patients are on stimulants during the
day. And, the bodybuilders are extremely likely to be taking ephedrine and
caffeine products during the day as well; most of the ones I interviewed with
also taking a variety of such substances (virtually all of them without any
understanding of the risks involved in those products as well).
Thus Dr. Winters believes this may be explained by an interaction between
the GHB excitant effect and the stimulants they are on.
The fact that this effect later rolls back on them is consistent with
what happens with many diet drugs, including ephedrine based products or things
like phen-fen.
Virtually
all of the addicts we have dealt with report numerous impaired driving
incidents, whether or not police were involved. In some cases they merely woke up to find damage to their
cars or found themselves at the wheel of the car in strange places.
In other cases, they awoke to find police standing all around them and
were able to explain it as having been working hard and just fell asleep.
Others were booked for drunk driving because of alcohol involvement, etc.
They ALL describe multiple impaired driving incidents among their
friends. They all describe knowing
numerous other GHB addicts and even more GHB abusers.
GHB-impaired
drivers have killed their share, though GHB goes undetected in many cases
because of still limited awareness by law enforcement and coroners.
In S. Carolina a GHB-impaired driver killed a three-year-old in an
oncoming vehicle. In Toledo, Ohio,
a similar fatal accident. In Los Angeles, California, Jeffery Dodley was killed by a
GHB-impaired man who hit him at 80 miles per hour, killing him instantly and
causing his car to explode in flames. Scott
Brockman was a chronic user who had made it through the system twice already
without the GHB being detected by law enforcement.
He did have a conviction for one incident, based on his relatively low
blood alcohol. This time the term
"GHB" surfaced during preparation for his second-degree murder trial.
Tests established ingested levels of GHB.
He is now serving 14 years plus 14 months time served.
Typically
these people find it hard to view themselves as "addicts" and do not
seek follow up counseling. Those
who did attend AA or NA meetings said they felt like outsiders.
No one even comprehended the drug they were addicted to in the first
place. They found it hard to
consider themselves in the same boat as the people they found at these meetings
because they didn't relate to those who were alcoholics or tweakers or coke
heads. They NEED to comprehend that
they do need follow up therapy, either one-on-one or in carefully selected
groups.
John's
story is all too common. At 37 and
with a lifetime of bodybuilding as a base, he wanted to personify health and
fitness for the members of his new gym. Adverse
to drugs in general, he used a number of sports supplements, thoughtfully
selecting the chemicals he introduced into his body. (We agreed to talk later-after detox-about the ephedrine
products he was taking.) In the
spring of 1999 he was introduced to gamma hydroxy butyrate (GHB) and its
analogs. Today he feels that at
that moment, he signed a pact with the devil himself.
He
started with a product containing gamma butyl lactone (precursor to GHB and an
active analog). The impact, he
says, was awesome. Everything in
his life got better. Sex was great.
Eating was even better. He
felt he could see the muscle gain and fat loss happen right before his eyes.
He was awestruck that when he slept on GHB, he no longer felt sleepy
during the daytime. He thought he
would be taking GHB products for the rest of his life.
What he didn't know was that some people have indeed taken GHB "for
the rest of their lives," lives ended all too soon by this unpredictable
and fickle drug.
John's
customers were impressed at his looks and his demeanor.
This was a happy, healthy guy. He
couldn't say enough good things about G. He
told everyone around him. He
shouted it from the highest steeples. He
encouraged everyone to take GHB.
There
were red flags, but easily overshadowed by the wonder of it all.
There were a couple of episodes when he felt he had stopped breathing or
at least skipped a few breathes at night and woke up in a panic, trying to force
himself to breath regularly again. But
he really didn't blame the G. He
noticed the "head snap" (similar to the "carpeting out" or
"throwing down" experience of the recreational users but less severe)
it can cause. Brushing his teeth
after taking it, the head snap occasionally made him smack the mirror with his
head, for example. He had crashed
into a couple of things, breaking off the oven door handle as he passed by and
suddenly "snapped."
He
recounts an incident when a friend was flying high in his convertible and
feeling good on his GHB. He passed
out while stopped at a stoplight. The
car started coasting forward, right through three red lights.
Fortunately the roadway was flat and the top down.
A passing motorist was able to jump out of his car, catch up to the slow
moving car and slam it into park.
Yes,
there had been red flags. After
nine months of use, John was now taking it day and night.
It put him to bed, and it kept him on track all day long.
It just somehow happened. Then
one day he had taken a combination of vitamins and supplements and hadn't taken
his usual dose of GHB analog. He
suddenly began sweating in a most unusual way.
The palms of his hands and soles of his feet were oozing a thick, waxy
sweat. His heart was racing.
His blood pressure soared. Blaming
it on the combination of additives he'd taken so close together, he went ahead
with the GBL dose and felt better. The
wonder drug had cured, whatever was wrong.
GHB
proponents love to claim that only the "irresponsible" users, the
ravers, the careless, etc., fall victim to any problems with GHB.
John would have said exactly the same just a few short months ago.
Being an intelligent, responsible person, he now experimented. He was careful not to take anything that might cause a
reaction. And then he skipped the
usual dose of G. The withdrawal
symptoms began. The racing heart. The soaring blood pressure.
He had proudly noticed that his veins stood right up when on GHB.
He now noticed that they seemed to disappear when he didn't take it.
He had also noticed that if you put 1,4 butanediol-another GHB analog
that he had been using interchangeably with GBL-in a styrofoam cup, it ate the
styrofoam. He now wondered what it
might be doing to his body. Once he
realized he was addicted, it was like the grip of GHB tightened on him,
threatening that it could kill him if he tried to stop.
He
searched the internet again and found www.ashesonthesea.com/ghb.
He talked with us at length but was scared and playing the waiting game.
He said he dreaded every drink of GHB and was gradually cutting back, but
just wanted to get everything in order before he went in for treatment.
First it was, I just want to wait until my transfer to another insurance
company is complete. Then it was, I just want to wait til I move into my new
house. Then it
was................... He waited too long.
He hadn't told me that he had barely been out in the public (or even in
his gym to keep things running) for weeks.
He was becoming quite introverted and experiencing bizarre behavior,
intensified by his efforts to cut back on doses.
His terrified wife finally called 911, and he went to the hospital
escorted by ambulances and police cars. The
cops didn't want to tackle his muscle and bulk and prayed that the paramedics
could put him down with medication. Despite
our best efforts (his doctor did contact one of ours), his doctor kicked him out
the door just three days later with a prescription for lithium.
He called me right away and I recognized the shakiness in his voice.
I pleaded with him to hand the medication off to his wife.
Fortunately, the lithium (various protocols are used by our various
doctors) worked well for him, putting him in a lethargic fuzz for eight to ten
days and keeping him out of trouble with hallucinations and wild behavior that
many experience during that phase. He
said he feels incredibly better to be free of it but is frustrated by the sense
of "doom and gloom" that prevails.
A few months later, it is dwindling, but isn't over and he has yet to
establish good sleep patterns.
More
than 6,600 overdoses have been documented in emergency rooms nationwide and more
than 66 deaths are now considered GHB-related, according to the Drug Enforcement
Administration. There are more than
50 other deaths being reviewed by the DEA at this time, many, many of those
deaths coming from our website. This
means the death rate more than doubled in 1999 and many have died already in the
year 2000. Experts agree that this
is likely just the tip of the iceberg since neither law enforcement nor medical
examiners have known enough about it to recognize it in many cases.
Results of a UCLA survey of GHB users indicated that although 67 percent
reported loss of consciousness, only seven percent had gone to the ER.
If that statistic is at all representative, then the 6,600 cases reported
by ERs may reflect only seven percent of actual overdoses. I have one young man who claims to have overdosed 50 times
and has never seen an ER.
Effects
- Unpredictable
Little
is known about how GHB works and especially how it selects its victims.
It is extremely dose sensitive and very unpredictable (no matter what the
"quality" of the product). Users,
especially beginners or the unsuspecting victims, often vomit and experience
body jerking. Users may lose
control of bodily functions or wet themselves during the night, unable to wake
up and go to the bathroom. They may
pass out (called "carpeting out" or "throwing down" among
the ravers and club goers) and, while most "sleep it off," the
unconscious state is risky. For
those taking lighter doses, there may be incidents of the "head snap,"
when GHB takes effect. One user
described the head snap as an involuntary snap forward of the head; brief but
dangerous. He had experienced this
while brushing his teeth and had broken mirrors with his forehead on occasion.
Another addict reported the same sensation and indicated he had broken
several sets of glasses from the head snap.
Breathing may slow to as few as six breathes per minute.
They cannot hear phones ringing, horns blaring, fire alarms, etc.
At some point, the individual may be without a protective "gag"
reflex, allowing death to come easy. Others have been killed by those driving under the influence
of GHB or GHB/alcohol.
A
victim can die from direct effects of the drug, simply forgetting to keep
breathing, having seizures that block the airway. A person in a GHB coma left lying on his (or her) back with
gum in the mouth could die simply because the gum happened to fall into a
position blocking the airway (it has happened).
A person can go into a GHB coma while sitting in the bathtub and simply
slide down into the water and drown without even a whimper (it has happened).
A user can die from simply taking a dose, as directed for a sleep aid,
and going to bed, face down on a pillow. There
is no "safe, responsible" use level.
GHB
is commonly listed as a central nervous system (CNS) depressant, but really
belongs in a class of its own. It
produces symptoms somewhat similar to alcohol intoxication in general, but with
a few twists of its own. Extreme
cases of intoxication will appear similar to PCP.
For example, a young man in Los Angeles, unknowingly dosed with GHB in a
Hollywood club, ran through the club, grabbing women's breasts and was thrown
out. He ran from the location,
tearing off his shirt (common to PCP users), screaming that the world was coming
to an end and that he was on fire. Somehow
he climbed on top of a Burger King restaurant and held LAPD SWAT officers at bay
for two hours, hurling cans of paints and other objects from the rooftop.
He was ultimately knocked down with a beanbag round.
Four hours after taking the drink, the episode ended suddenly.
He had no recall of what he had done.
Club
owners often recognize that this is a "new" drug when it hits their
facility. Common indicators that
GHB has indeed arrived include:
--increase
in rapes (typically noted via the rape treatment centers-but commonly
--sudden
increase in problems at the location (more disturbance calls, vomit in the
Addiction
Nightmare
Those
who become addicted are in serious trouble, as detoxification from GHB is
difficult and even life threatening. Bodybuilders
are the ones more likely to become addicted since they are most likely to take
it on a regular basis, while partygoers "may" last longer with just
occasional use.
Several
months ago I got to know a man who had been addicted to GHB for eight years. A
former bodybuilder (who even modeled workout clothing with some awesome abs) and
a contractor, GHB had taken over his life. His ability to discipline himself and
work out was long gone. His body was clearly that of an EX-body builder. When I
interviewed him on camera for French TV, he struggled to stay focused and finish
sentences, something he attributed to the prolonged abuse of GHB. He'd lose his
train of thought and in frustration say, "Trinka, I'm telling you. I wasn't
like this. It's the GHB." He was working as a contractor on a small scale.
His marriage was falling apart.
I
had met him through a doctor at UCLA (Dr. Karen Miotto) who was studying GHB,
and interviewing users around the campus. She had introduced me to Dave and was
planning to help him detox, but UCLA, like most facilities, had little exposure
to the withdrawal syndrome from GHB. After talking with other GHB experts (and
learning that it's more likely a 10-14 day, intensive care situation than the
usual 3-5 day detox), they proceeded with his detox---and what an experience it
was for them all. By the time he actually went into the hospital, he had gotten
even more confused and frustrated. He would somehow remember or be able to find
my phone number, but would lose the UCLA phone numbers. He would call me, asking
for his doctor's number (remember--he knew HER before meeting ME). About eight
to ten days later, he would call me again, asking for her number and oblivious
to the prior conversation. Sometimes he remembered his doctor's name and
sometimes he didn't. This happened three or four times. His wife had given up on
him and was ready to leave; her three children didn't need any more of this
mess.
Then
one day I got a call that he was in the hospital in detox. They were in Day 4,
and the doctors were worried. He was experiencing bizarre episodes, despite
heavy medication, and they were actually worried that he might not live through
it. He did survive. Detox took 12
days plus psychiatric care follow up. For UCLA Doctor Karen Miotto it the worst
drug withdrawal she had seen. His experience--which he does not remember at
all-is the subject of a paper that will be published soon.
The
doctor had told me he was doing well and working at getting his life back
together and back to work. Then she
lost contact with him. We both left messages for him and got no replies. The
various numbers did or didn't work from time to time, but we weren't making
contact. Some of the numbers were disconnected. We really became concerned as
the weeks passed that he had either started using again and didn't want to admit
it to us---or worse. Frankly, I was ready to call the LA Coroner's Office to
check. But a couple of days ago I ran across his number in an old note and
called it one more time, just in case. To my amazement, his wife answered. Yes,
he was still alive, and yes, they are still together. He's doing well, but just
busy. She was thrilled to have her husband and father of her kids back.
Later he called, and what a difference. This wasn't the fuzzed,
disorganized conversation of the past. This was a man with clarity and life,
back among the living. He said his body still needed some
"reconstruction" to see those washboard abs again, but he was on his
way.
Tragically,
after several months of doing great, the quick profit from manufacturing and
selling GHB called to him. He went
back into producing it and fell victim to consuming it again.
He was recently busted by a S. California agency and, of course, went
through withdrawal in the jail ward where doctors were unfamiliar with his
condition. He literally died on
them, but was brought back, spending two days on a ventilator.
The detective was in fact notified that he was dead and didn't know until
two weeks later that he had survived. His
marriage will probably not survive this time.
Not
everyone will have such a tough time in detox, but neither is his experience
that unusual. During
the past few months I've learned a lot about a couple of young men who were
addicted to GHB, lived several months of hell trying to escape from it and paid
the ultimate price, overdosing on other drugs trying to stay off the G.
GHB
Withdrawal is Life-Endangering
Joshua
Josh
in Northern California and Matt in Pittsburgh, Pennsylvania, didn't make it.
For months their frantic mothers went with them from ER to ER and
treatment facility to treatment facility, pleading for help for their sons and
waving bottles of GHB analog products. No
one seemed to comprehend the severity of the battle.
No one had the right answers to their quest for relief from GHB
addiction. Three- to five-day detox and out the door is NOT the answer
to a GHB addiction.
From
March 1999 until his death July 4, 1999, Myrna Parks struggled to help him.
He resisted help at first, buying into the nonsense of the GHB gurus of
the internet that GHB is totally safe. "Mom,
it can't be bad for me. I bought it
at a health food store." By
March of 1999 when Josh came home to live with his folks, he was sick.
He had lost ten pounds in just four days and his saliva glands were no
longer working. He had severe
diarrhea, vomiting and a white ring around his mouth.
He was unable to sleep with body tremors and a high pulse rate.
She describes the ambulance run this way, "He became rigid, unable
to sit or talk. We could not lay
him down in the ambulance because he had lost the ability to swallow his own
saliva and began to choke on it. He
had to leave him sitting up so that he could drool down his chest.
His eye would roll to the back of his head. He could not follow commands,
hold or squeeze my hand. He was in
a complete vegetative state. I
prayed. I couldn't let go."
Somehow Josh survived that day.
Still,
he was angry when his mother rushed him to the ER. She had overreacted as far as he was concerned.
Remember, the internet gurus say not to call 911, not to take anyone to
the ER; just let them sleep it off. That
is potentially deadly advice in a GHB overdose and certainly not helpful to the
person in withdrawal from GHB, for whom sleep does not come for days.
GHB withdrawal is now known to be life endangering.
This
was but the first of many episodes for Josh in the final months of his battle.
Then on July 4, 1999, Josh pleaded for something to help ease the pain
and sleep. His mother urged him to
try hard to sleep with just his prescribed medication and dosage. Unable to do so, Josh apparently acquired someone else's
medication and died of an overdose of a mixture of drugs, seeking only a night's
peace from the withdrawals from GHB.
Matt
On
September 1, 1999, a similar battle--18 months in duration--ended for
26-year-old Matthew Michael in Pittsburgh, the youngest of four.
A registered nurse with experience in drug and alcohol rehab, Matt's
mother literally watched him die over 18 months of hell. He
was hospitalized ten to 15 times during that year and a half.
She advised paramedics and doctors that he had been taking Renewtrient
and NRG3 (GHB analogs) to no avail. Experience
with GHB was and still is limited. He
struggled through numerous driving under the influence arrests.
She saw him fall asleep standing up.
When not on it, he endured sleeplessness, abdominal pain, rapid heart
rate, soaring blood pressure, profuse sweating, tremors, eating disorder,
inability to concentrate and depression. At
the end, he would complete one more brief detox program, report to jail for a
72-hour lock up re a previous DUI and go home to die of multiple drugs, trying
not to take GHB again.
What
Help for the Addicted?
Most
of those asking for help have gone to ER for overdose or withdrawal symptoms.
Withdrawal symptoms may be mistaken for a drug overdose at the ER.
Many have sought help with their addiction but were met by total
disbelief from those who had never heard of GHB addiction or were turned off to
the system by what they felt was inadequate treatment.
Many said that they spent only three or four days in treatment and then
were sent home at a point when they recognized that they needed further
treatment. They said that they
realized that the doctors were ill informed or had no clue at all what they were
dealing with, and that they would not subject themselves to such torture again.
It was very difficult to convince them that proper referrals and medical
treatment were possible. It was often difficult to convince them that
"weaning" oneself from GHB is virtually impossible for most people,
and that home detox just won't work.
They
typically asked us to "just tell me what drugs to take and let me do it at
home." Such information was,
of course, not an option. We
pointed out that GHB withdrawal is life endangering.
That doctors needed to monitor them and treat their condition as it
changed. First the doctors would
likely have to deal with racing pulse and soaring blood pressure.
Then they'd have to deal with the bouts of anxiety, sleeplessness,
overall pain, hallucinations, depression, etc.
A 10-14 day medical detox would be the best route, according to our
experts, getting the worst of it behind them.
Some facilities working with GHB withdrawal sedate heavily during that
10-14 day period, allowing them to "miss" the worst of the experience.
In any case, doctor supervision and immediate medical care is the key.
Those who chose that path are now thankful.
Those who persisted with trying to wean themselves off or doing it at
home with or without doctor supervision, typically found it a much longer,
tougher method and some failed. Those
who confided in supportive friends or relatives fared the best. Those who faced it alone suffered the most.
If
they lived near one of the handful of experts we were working with, we referred
them directly to our doctors. If
not, we tried to help them locate treatment facilities and doctors capable of
doing a medical detox and willing to learn.
We then linked their doctors with our experts for advice.
Most Poison Control Centers were very helpful in identifying medical
detox facilities. Most treatment centers were helpful and willing to learn.
We were shocked at those few who said they didn't want to "be
bothered" by anything new and potentially dangerous (even though they were
set up to do a severe delirium tremens detox which is quite similar).
Our
expert doctors use a variety of treatment plans and everyone is still trying to
learn what works best. Frankly, the
most important thing is SUPERVISION and SUPPORT for at least two weeks followed
by ongoing counseling and monitoring. I'm
indeed not a doctor, but have had the opportunity to view it all from a unique
perspective. The ideal seems to be
10-14 days inpatient care, sedated through the worst of it so that medications
can be changed as conditions change. Second choice seems to be intensive care through the first
few days, the more the better, followed by at least residential care.
Third choice is intensive care for the first days and then someone with
them at all times at home or wherever so that the patient is NOT handling his or
her own medication.
It
is our hope to alert all treatment facilities and ERs to the life endangering
quality of GHB withdrawal so that proper treatment will become the norm, not the
exception. We also hope to alert
everyone to the fact that it is often used to beat drug testing, sometimes by
people in key public safety jobs.
One
of the saddest inquiries we had was from a young man whose father is a doctor.
He had gone to his father and confessed all, explaining that he was
addicted to GHB, this product he was buying at a health food store and that he
believed it would kill him. His
father looked at him blankly and said, "How stupid can you be?
If you bought it in a health food store, how dangerous could it be?
Just STOP taking it!" That
advice could have indeed been deadly.
Analogs
- Chemical Cousins
We
actually may continue to see less real GHB, and more and more analog products.
Analog product names surfacing so far have included: Blue Nitro,
Renewtrient, Revivarant, Remforce, Firewater, Enliven, Serenity, ZEN, Revitalize
Plus, Thunder Nectar, Weight Belt Cleaner, SomatoPro, Verve, Jolt, Eclipse,
Regenerize, Remedy GH, NRG3, GHRE, GHGold and G3 (being sold in some franchise
GNC stores). They may appear in any
color, including clear, light amber, red or blue.
Anyone driving a vehicle under the influence of these substances presents
a potential safety hazard. They are
used in rapes in exactly the same way GHB is used.
Many of the documented GHB-related deaths involve these products.
Many
of them list the main ingredient as 2(3H)-furanone di-hydro and claim that it
does not contain GHB or any other illegal substance. This ingredient is simply gamma butyrolactone (GBL), the
precursor of GHB, being listed by a chemical synonym. Though a precursor to GHB, it is also an active
"analog" of GHB. Several
of the products list the primary ingredient as 1,4 butanediol (BD) or its other
chemical synonyms, tetramethylene glycol or sucol-B. These products may also surface labeled as degreasing or
cleaning products that are in reality being used for human consumption.
Or, the bottle (Revitalize Plus, for example) may say simply
"proprietary polyhydroxyl complex, a blend of amino acid metabolites."
A third analog has been referenced on the internet.
At this point, I'm not aware of any agency identifying it in a product,
but I'm also unaware of any agency capable of testing for it!
Mere
possession of the precursor/analog GBL or the analog 1,4 butanediol or other
analogs is not illegal in and of itself at this time. But, any action that converts the product to "human
consumption" (such as sticking a straw in the bottle, pouring it into human
consumption type water or vitamin or mouthwash bottles, or labeling it as a
sleep aid or nutritional supplement, etc.) makes it an analog.
As of January 1, 2000, GBL is a listed precursor chemical federally.
Federal legislation to make GHB and its analogs a federal Schedule I drug
passed in January 2000 and went into effect on March 13, 2000. An analog is a substance that has or is represented to
have or is intended to have effects on the central nervous system which are
substantially similar to or greater than, the controlled substance itself. Some
state laws require that the analog also have "substantially similar
chemical structure," which can add confusion to the issue.
While
the vast majority of GHB products are seen as liquids, they may appear in powder
and capsule form. Teens have also
been seen with a putty like substance (GHB is hydroscopic and thus hard to keep
dry as a powder). Some of the
Internet sites promoting these products admit that there is no scientific
evidence to back up the safety and beneficial effects claimed by them.
Some even note that their product is being manufactured in an FDA
approved lab; they further admit that this does not mean the FDA has approved
the product itself. Labels
notations such as "Does not contain GHB" or "legal (or herbal)
GHB" are literally your first clue that the product is an analog of GHB!
Most of them also foolishly discourage calling 911 when someone overdoses
on these products, a deadly recommendation.
When cases identify the Internet as the source of the product and when
the physical location of the Internet source can be determined, prosecution may
be possible either under state laws or under federal provisions through the
Department of Justice, Office of Consumer Litigation.
The
Doctors Who Have Been Helping Us:
NOTE:
All have published on the subject of GHB and/or have manuscripts pending
publication. Other doctors/clinics
with experience with GHB withdrawal treatment are encouraged to contact
www.ashesonthesea.com/ghb and add their names as referral resources.
Dr.
Jo Ellen Dyer
Associate
Clinical Professor of Pharmacy,UCSF
California
Poison Control System
San
Francisco General Hospital
1001
Potrero Ave Room 1E86
San
Francisco CA 94110
Phone:
415 502 2058
Fax:
415 502 6060
Dr.
Karen Miotto
760
Westwood Plaza
NPI
A7-384
Los
Angeles CA 90024
Phone:
310 206 2782
Deborah
L. Zvosec
Hennepin
County Medical Center
Emergency
Department
Minneapolis,
Minnesota
Voice
mail (612) 347-3963
Fax
(612) 904-4470
University
of Minnesota School of Medicine
Faculty Physician
Hennepin
County Medical Center
Emergency Department
Minneapolis,
Minnesota
Voice
mail (612) 347-3963
Fax
(612) 904-4470
Drs.
Alex and Janice Stalcup
2151
Salvio St. Suite T
Concord
CA 94520
Phone:
800 636 8050 or 925 688 0500
GAMMA
HYDROXY BUTYRATE (GHB)
GAMMA
BUTYL LACTONE (GBL) or 2(3H)-FURANONE DI-HYDRO
1,4
BUTANEDIOL (BD) or TETRAMETHYLENE
GLYCOL or SUCOL-B
NOTE:
There are other active analogs. A
third one has been referenced on the internet but hasn't yet been identified in
products (possibly from lack of awareness by labs)
Reported
Product Names
AMINO
FLEX (BD)
BLUE
NITRO or BLUE NITRO VITALITY
BORAMETZ
(BD)
BVM
(BD)
DORMIR
(BD)
DREAM
ON (BD and/or GBL)
ENLIVEN
(BD)
FIREWATER
FX
(BD)---ORANGE FX RUSH, LEMON FX DROP, CHERRY FX BOMB
G3
GH-GOLD
(May be referred to as GHG)
GAMMA
G
GHRE
(BD)-(GROWTH HORMONE RELEASE EXTRACT)
GH
REVITALIZER
INNERG
(BD)
INVIGORATE
JOLT
NRG3
(BD)--
PINE
NEEDLE EXTRACT (BD)
PROMUSOL
(BD)
REACTIVE
REGENERIZE
RENEWTRIENT
REMFORCE
REST-EZE
REST-Q
(BD)
REVIVARANT
or REVIVARANT G or REVITALIZE PLUS
SERENITY
(BD)
SOMATO
PRO (BD)
THUNDER
THUNDER
NECTAR (BD)
WEIGHT
BELT CLEANER (BD)
WHITE
MAGIC (BD)
X-12
ZEN
(BD)
NOTE:
New names surface on a regular basis.
Also, Revitalize Plus lists only "proprietary polyhydroxyl
complex." Dream On also does
not list any of the chemical names.
GHB
& Its Analogs: The Secret Dangers
Copyright
( 2000 Trinka Porrata. May be reprinted and distributed without permission