GHB

GHB (gamma-hydroxybutyric acid) was formerly used as an anaesthetic and as an agent for sleep disorders. GHB is a substance with a damping effect (a downer). GHB is made from GBL (= cleaning agent) and corrosive soda (sink drain cleaner). These ingredients are easy to get via the internet. GHB comes on the market as a clear / slightly viscous liquid and is usually kept in plastic tubes about 5 cm in size. The tube usually contains between 3 and 4.5 ml of liquid and usually contains 2 to 3 grams of GHB. Passing out or becoming unconscious is possible from 3 grams. However, the purity can vary. The liquid tastes very salty.

GHB is mainly taken as a drug among party people (before, during or after passing out), marginalized groups, men who have sex with men (MSM) and home users. GHB use presents a risk of “passing out” and can lead to addiction after a few weeks of daily use (1).

Source: NDM 2018, Trimbos-instituut

Other names for GHB

G, salt, Gina, liquid E, liquid X, scoop

GHB has been sold as “liquid XTC” in the past. However, it has little to do with XTC.

GHB was isolated in 1960 by the French researcher Laborit (1). It is still used as a medicine against narcolepsy. In the 80s the drug became popular among bodybuilders. GHB is sold in smart shops from 1993 to 1996. From that period GHB also becomes popular in the nightlife. In 2002 GHB is placed on list 2 of the Opium Act, in 2012 GHB is moved to list 1.

GHB is isolated

GHB was isolated from mammalian tissues in 1960 by French researcher Laborit. Laborit was looking for a substance that has a similar effect to the neurotransmitter* GABA. GABA ensures that the brain works slower.

After GHB was isolated, it could also be copied chemically. That happened for the first time in 1961.

GHB as a medicine

GHB appears on the market as a sleeping aid, as an anaesthetic and as an anti-narcolepsy remedy. Because of side effects, GHB has never been used extensively. GHB is still in use only for narcolepsy*. Medical GHB is nowadays also used by addiction care institutions to reduce GHB dependence.

Bodybuilders and GHB

In the 1980s, GHB became popular among bodybuilders as a dietary supplement for a while. GHB would be good for muscle growth and it would stimulate the release of the growth hormone. However, this appears not to be true.

GHB in the smart shops

In 1993 the first smart shop was opened in the Netherlands. Smart shops quickly sell GHB. At that time, GHB is offered in the smart shops as Liquid XTC. Of course GHB has nothing to do with XTC.

In 1996 in Rotterdam on Queen’s Day a number of people became unconscious of GHB. The Healthcare Inspectorate responds immediately. On May 8, 1996, smartshop is told that they cannot sell the drug.

GHB in the entertainment circuit

Although GHB penetrates further into the entertainment circuit, the drug never reaches the popularity of XTC or cocaine. In 2016, 14% of the outsiders from The Big Nightlife survey had experience with GHB. 3% had used GHB in the last month. At the moment you also see that GHB is used in marginalized groups (2).

GHB in the Opium Act

Since 2002, GHB is not only subject to the Medicines Act but also to the Opium Act. For a long time it was on list 2 of the Opium Act. On 6 September 2011, the minister informed Schippers that she wanted to put GHB on list 1 of the Opium Act. This happened on 9 May 2012. All other hard drugs are also on list 1.

Sources

Niesink, R. Other narcotics. In drugs and alcohol. use, abuse and addiction.

NDM 2018, Trimbos Institute

* Neurotransmitters are substances that provide the signal transmitted from one nerve to another. There are neurotransmitters that cause the brain to work slower or faster. GABA therefore ensures a slow operation.

* narcolepsy is a disease in which people are sleepy during the day and suddenly have sleep attacks.

GHB is a fluid one can drink. Users mix (part of) a tube of GHB with another drink and drink it in one drink. Sometimes GHB is also drunk directly. Because of the bad taste, users usually drink a drink with taste afterwards.

Usually alcohol is mixed with non-alcoholic drinks. The combination with alcohol is dangerous because alcohol and GHB enhance each other’s effects and increase the risk of overdose.

Some users use a syringe to accurately dose the GHB.

GHB and GBL

GHB is also called G or tube. In smart shops, after GHB was banned, GBL (Gamma-butyrolactone) was sold for a while. This is now also prohibited. GBL is converted into GHB in the body. GBL is one of the two chemical components of GHB. The effects of GBL and GHB are very similar, but GBL is stronger than GHB and therefore even harder to dose.

Purity / percentage of active substance

GHB is very cheap. Cutting is almost impossible. In the Netherlands there is the possibility to have drugs tested. This is possible at a large number of institutions, including the Jellinek. Links?

The results of the test service in 2016 show that 87% of all submitted GHB samples indeed contain GHB. 99 liquids were tested (1). 55 (87%) samples contained GHB. The concentration of GHB was on average 376.9 mg GHB per ml of liquid (1).

However, the spread can be large. For a substance that is so difficult to dose and where the difference between a dose with desired effects and becoming unconscious is so small, a spread is risky. The pH of the samples is always measured on the test service. If this is too basic, this can lead to blistering when ingested.

Sources

1. NDM 2016, Trimbos-instituut
2. Antenne 2016, Bonger Instituut (2017)

The effect of a substance has to do with a number of factors. The drug (the drug itself, the dosage and the way it is taken), the set (factors in the person taking it, such as gender, weight, mental condition, et cetera) and the setting (factors in the physical and social environment) together determine the effect of a certain substance. Read more about this at: What are the effects of drugs?

GHB starts working after 5 to 30 minutes. The effects last for approximately 3 hours. The effect of GHB can vary greatly per person and is strongly dependent on the dose.

With a small dose, the user feels relaxed and calm. Some people get sexually excited. Touches are also felt more strongly. The effects resemble an alcohol rush, but it can also have a stimulating effect. Hallucinations sometimes occur. Unwanted effects are: forgetfulness, nausea, vomiting and convulsions.

At high doses a user may be surprised by sleep. The problem with GHB is that the amount that produces pleasant effects is very close to the amounts at which unconsciousness can occur. Someone takes too much quickly. It is striking that many users think easily about becoming unconscious and passing out. Remember that sleeping involuntary is the same as passing out.

Psychic effects

• Happy feeling, cheerful, relaxed
• Disappearance of fears and inhibitions
• Talking
• Sexually excited
• Confusion
• Temporary memory loss

Physical effects

• Sensitive to touch
• Dizziness
• Headache
• Nauseous, vomiting
• Vibrate
• Feeling weak in the muscles
• Being assailed by an uncontrollable sleep
• Unconsciousness
• Convulsions in the limbs and face

Overdose: Breathing disorders, unconsciousness, breathing stops

GHB is difficult to dose. The difference between a dose with pleasant effects and the dose at which someone becomes overwhelmed by sleep and becomes unconscious is very small. People quickly take too much GHB. The combination with alcohol enhances the effects of GHB. This means that people can become unconscious even with a small dose of GHB.

An overdose can be fatal. Too high a dose of GHB can disrupt breathing and even stop it. When you combine with alcohol, the chance of this increases.

The combination with alcohol can also cause people to vomit. People can then choke on their own vomit.

GHB is usually drunk. GHB reaches the blood and brain via the stomach and intestines. GHB starts working after 5 to 30 minutes. The effects last for approximately 3 hours.

Effects in the brain

GHB is absorbed through the blood into the brain. In the brain, GHB mainly influences the transfer agents GABA, glutamate and dopamine. Transmission substances are substances (neurotransmitters) in the brain that transmit signals from one nerve to another, causing the brain to work slower or faster. There are so-called receptors on the nerve that receives the signal. They collect the transfer substances after which the signal can be passed on. GHB receptors are mainly found in the cerebral cortex and hippocampus. The hippocampus plays an important role in memory. GHB can lead to memory loss. Users often do not know what happened under the influence of GHB.

GABA

GHB acts on the GABA receptor. The GABA system has an inhibitory effect. This is why you feel relaxed and uninhibited.

Glutamate

GHB also influences the glutamate transfer substance. Glutamate is mainly activated when GHB degradation reduces the amount of GHB in your body.

Glutamate has an activating effect. Reason why some people feel active and alert after a while. This also explains why some people wake up with an alert feeling after being out.

Dopamine

This can also be related to the dopamine transfer substance. GHB would initially inhibit the release of dopamine. In the next phase, the stored dopamine would be released sooner, making you alert and having a feeling of reward. See also the animation “Drugs in the brain” on this website.

Serotonin

GHB increases the presence of serotonin. This creates a euphoric feeling.

GHB breakdown

GHB is rapidly broken down in the body. Even after high doses, it is no longer detectable in the blood after 8 hours.

How long is GHB visible in the body?

GHB is rapidly broken down in the body. The degradation substances are not detectable in blood or urine. Even after high doses, it is no longer detectable after 8 hours in blood and after 12 hours in urine. GHB drug testing is therefore only conducted if there is acute poisoning.

Short-term risks of GHB

There are the following short-term risks:

• unpleasant experience
• unconscious or passing out

Unpleasant experiences

GHB can have both pleasant and annoying effects, both at high and low doses, such as fatigue, forgetfulness, nausea, aggressive behaviour, convulsions and speech problems.

Becoming unconscious or passing out

Passing out (losing consciousness / accidentally falling asleep) can easily happen because there is little difference between the amount of GHB that gives the effect the user wants and the amount he / she goes out of.

Dosing is difficult because:

• you do not know exactly how much GHB is in the liquid (how strong the GHB is);
• people differ in what they can tolerate; if you are a woman or small you can tolerate less.

Dosing also goes wrong because people sometimes (too quickly) add or combine with alcohol or drugs.

There is a stacking effect at GHB. If users have taken one dose, they feel that it has been worked out after a while. However, the GHB is still active in the body. If users then add the same dose, there is a greater chance of passing out because there is more GHB in the body.

Passing out is risky

Users think far too easily about the risks of passing out. Passing out at GHB is risky because:

• It can end fatally. Your breathing is then suppressed. Because of this you can die. You can also choke on your tongue or vomit. Every year users end up in Intensive Care (IC) because they have used too much GHB. Their breathing is disturbed or threatens to stop. Breathing is supported or adopted at the IC.
• You depend on others.
• It is still unknown whether passing out frequently is harmful to the brain.

Mental dependence

dependence can already occur after a few weeks of intensive use.

Tolerance development

Frequent use can quickly lead to habituation. Users then need more to feel the same effects.

Withdrawal symptoms

Yes, the withdrawal symptoms are heavy. People suffer from perspiration, insomnia (for a few days) trembling and fears. Some daily users use every few hours to prevent such symptoms. Often withdrawal under professional supervision is necessary.

GHB falls under the Medicines Act and the Opium Act in the Netherlands.

Medicines Act

For certain conditions (narcolepsy), GHB may only be used under medical supervision and is only available on prescription.

Opium law

Internationally GHB is on list IV of the treaty on Psychotropic substances. Since 2002, GHB has been on list 2 of the Opium Act in the Netherlands. Since May 2012, GHB has been on list 1 of the Opium Act.

This means that possession, production and trade are punishable. All other hard drugs are also on this list. The risks of GHB for addiction and public health (loss of consciousness) justify a listing on list 1 of the Opium Act. The minister hopes that this will have a warning effect. The minister hopes that this will have a warning effect.

Moreover, by placing on list 1 of the Opium Act, the preparatory acts for the production of GHB become punishable. Producers can therefore be prosecuted. The government is strongly opposed to the trade in GHB. There are heavy penalties for illegal sales. Users are not actively prosecuted.

Driving under the influence of GHB is very risky. Driving under the influence of drugs, including GHB, is punishable.

Between 2007 and 2009, 180 seriously injured drivers were admitted to hospitals in Enschede, Tilburg and Nijmegen. 5 people (2.8%) were found to have used GHB.

Source

SWOV-factsheet: Rijden onder invloed van drugs en geneesmiddelen, SWOV (2011)