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CORK Bibliography: GHB (Gamma Hydroxybutyric Acid)

65 citations. January 2007 to present

Prepared: September 2009

Abanades S; Farre M; Segura M; Pichini S; Barral D; Pacifici R et al. gamma-Hydroxybutyrate (GHB) in humans - Pharmacodynamics and pharmacokinetics. Annals of the New York Academy of Sciences. Cellular and molecular mechanisms of drugs of abuse and neurotoxicity. 1074: 559-576, 2006. (40 refs.)

Despite gamma-hydroxybutyrate (GHB) therapeutic uses and the increasing concern about its toxicity, few studies have addressed GHB dose-related effects under controlled administration and their relationship with its pharmacokinetics. The study design was double-blind, randomized, crossover, and controlled. As a pilot pharmacology phase I study, increasing doses of GHB were given. Single oral sodium GHB doses (40, 50, 60, and 72 mg/kg) were administered to eight volunteers. Plasma and urine were analyzed for GHB by gas chromatography-mass spectrometry. Physiological effects, psychomotor performance, and subjective effects were examined simultaneously. GHB produced dose-related changes in subjective effects as measured by questionnaires and VAS. GHB showed a mixed stimulant-sedative pattern, with initially increased scores in subjective feeling of euphoria, high, and liking followed by mild-moderate symptoms of sedation with impairment of performance and balance. Mean peak GHB plasma concentrations were 79.1, 83.1, 113.5, and 130.1 mu g/L for 40, 50, 60, and 72 mg/kg, respectively. GHB-mediated physiological and subjective effects were dose dependent and related to GHB plasma concentrations. GHB urinary excretion was mainly related to administered doses. GHB-mediated subjective and physiological effects seem dose dependent and related to GHB plasma concentrations. Results suggest a high abuse liability of GHB in the range of dose usually consumed.

Carter LP; Pardi D; Gorsline J; Griffiths RR. Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem (R)): Differences in characteristics and misuse. (review). Drug and Alcohol Dependence 104(1-2): 1-10, 2009. (101 refs.)

There are distinct differences in the accessibility, purity, dosing, and misuse associated with illicit gamma-hydroxybutyrate (GHB) compared to pharmaceutical sodium oxybate. Gamma-hydroxybutyrate sodium and sodium oxybate are the chemical and drug names, respectively, for the pharmaceutical product Xyrem (R) (sodium oxybate) oral solution. However, the acronym GHB is also used to refer to illicit formulations that are used for non-medical purposes. This review highlights important differences between illicit GHB and sodium oxybate with regard to their relative abuse liability, which includes the likelihood and consequences of abuse. Data are summarized from the scientific literature; from national surveillance systems in the U.S., Europe, and Australia (for illicit GHB); and from clinical trials and post-marketing surveillance with sodium oxybate (Xyrem). In the U.S., the prevalence of illicit GHB use, abuse, intoxication, and overdose has declined from 2000, the year that GHB was scheduled, to the present and is lower than that of most other licit and illicit drugs. Abuse and misuse of the pharmaceutical product, sodium oxybate, has been rare over the 5 years since its introduction to the market, which is likely due in part to the risk management program associated with this product. Differences in the accessibility, purity, dosing, and misuse of illicit GHB and sodium oxybate suggest that risks associated with illicit GHB are greater than those associated with the pharmaceutical product sodium oxybate.

Abanades S; Farre M; Barral D; Torrens M; Closas N; Langohr K et al. Relative abuse liability of gamma-hydroxybutyric acid, flunitrazepam, and ethanol in club drug users. Journal of Clinical Psychopharmacology 27(6): 625-638, 2007. (62 refs.)

Objectives: Despite the increasing concern about gamma-hydroxybutyric acid (GHB) toxicity, there are few studies examining the clinical pharmacology of GHB and its abuse potential. To evaluate GHB-induced subjective and physiological effects, its relative abuse liability and its impact on psychomotor performance in club drug users. Materials and Methods: Twelve healthy male recreational users of GHB participated in 5 experimental sessions in the framework of a clinical trial. The study was randomized, double-blind, double-dummy, and crossover. Drug conditions were a single oral dose of GHB (40 or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg), and placebo. Study variables included vital signs (blood pressure, heart rate, oral temperature, pupil diameter), psychomotor performance (digit symbol substitution test, balance, Maddox-Wing), subjective effects (a set of 13 visual analogue scales, Addiction Research Center Inventory-49 items, and Evaluation of the Subjective Effects of Substanceances with Potential of Abuse questionnaires), and pharmacokinetics. Results: All active conditions induced positive effects related to their abuse potential. The administration of GHB produced euphoria and pleasurable effects with slightly higher ratings than those observed for flunitrazepam and ethanol. gamma-Hydroxybutyric acid induced a biphasic time profile with an initial stimulantlike effect related to the simultaneous rise of plasma concentrations and a latter sedative effect not related to GHB kinetics. gamma-Hydroxybutyric acid increased blood pressure and pupil diameter. Ethanol induced its prototypical effects, and flunitrazepam produced marked sedation. gamma-Hydroxybutyric acid and flunitrazepam impaired psychomotor performance, digit symbol substitution test, and balance task, whereas ethanol, at the dose tested, induced only mild effects exclusively affecting the balance task. Conclusions: Our results suggest a high abuse liability of GHB and flunitrazepam in club drug users.

Anacker P; Imwinkelried E. Controlled Substance Analogue Enforcement Act criminal defense. Southwestern University Law Review 37: 267-301, 2008. (255 refs.)

Summary: ... The District Court judge detailed the state of the evidentiary record at trial: Each of the three experts agreed that the two substances in question contain a different "functional group": 1,4-butanediol has an alcohol major functional group while GHB has a carboxlyic acid major functional group. ... In some cases, defense experts have relied on Tanimoto Coefficient computations as a basis for arguing that the alleged analogue is dissimilar to the controlled substance in chemical structure. ... And, again, as emphasized during the discussion of the general acceptance test for admissibility, these diagrams convey very little information about the chemical structure of the molecules depicted. ii. ... Stick and letter diagrams are such incomplete depictions of substances and the comparison of such diagrams is so subjective that there is a strong case that those opinions do not pass muster under Daubert. iii. ... Suppose, for example, the prosecution relies heavily on the superficial similarity between stick and letter diagrams of features of a Controlled Substance and an alleged CSAEA analogue.

Anderson IB; Kim SY; Dyer JE; Burkhardt CB; Iknoian JC; Walsh MJ et al. Trends in gamma-hydroxybutyrate (GHB) and related drug intoxication: 1999 to 2003. Annals of Emergency Medicine 47(2): 177-183, 2006. (16 refs.)

Study objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Barker JC; Harris SL; Dyer JE. Experiences of gamma hydroxybutyrate (GHB) ingestion: A focus group study. Journal of Psychoactive Drugs 39(2): 115-129, 2007. (37 refs.)

GHB (gamma hydroxybutyrate) is a significant new drug of abuse added to the United States Controlled Substance Act in 2000. The majority of the published literature on GHB consists of clinical case reports, mainly from emergency departments, and a collection of laboratory-based studies, focused mainly on anesthesia. While comments about the various experiences and behaviors of human users are often included in such studies or reports, these aspects of GHB are only just beginning to be systematically investigated or detailed. Reported here are data from a qualitative study using focus group methods on the consumption habits, experiences, and beliefs of GHB users. A total of 51 people, 30 men and 21 women, mean age of 31.1 +/- 7.6 years (range 18 to 52 years), who report having used GHB for an average of 4.3 +/- 2.5 years (range one to I I years), were interviewed in 10 separate groups held in 2004. This article discusses broadly the general experience of the GHB high, major perceived benefits including sexual responses to the drug, perceived risks and dangers of ingestion, co-ingestion, and various contexts of use. It concludes with a discussion of the implications drawn from this information for clinicians treating patients who use GHB.

Barker JC; Karsoho H. Hazardous use of gamma hydroxybutyrate: Driving under the influence. Substance Use & Misuse 43(11): 1495-1508, 2008. (45 refs.)

Focus group discussions elicited descriptive experiences of driving under the influence of gamma hydroxybutyrate (GHB), and uncovered motivations that led participants to decide whether to get behind the wheel after ingesting this illegal psychoactive substance. Of the 51 current and past users interviewed, average age 31.1 +/- 7.7 years, 40% were female. All were recruited from the San Francisco Bay Area, in 2004. Factors making users vulnerable to adverse complications of driving while under the influence of GHB are also examined. Study limitations were noted. Implications for various law enforcement agencies and health professionals are derived from the data.

Bennett WRM; Wilson LG; Roy-Byrne PP. Gamma-hydroxybutyric acid (GHB) withdrawal: A case report. Journal of Psychoactive Drugs 39(3): 293-296, 2007. (22 refs.)

GHB is an increasingly popular drug of abuse that can be associated in select cases with growing dependence and a severe withdrawal syndrome. While benzodiazepines are recommended for treatment of the withdrawal syndrome, some cases have been described as benzodiazepine-resistant. The authors describe treatment of such a case, which was unsuccessfully treated initially with benzodiazepines, then successfully treated with adjuvant atypical neuroleptics, and offer a possible neurochemical explanation for why such agents may be theoretically more effective than benzodiazepines in treating GHB withdrawal.

Bodson Q; Denooz R; Serpe P; Charlier C. Gamma-hydroxybutyric acid (GHB) measurement by GC-MS in blood, urine and gastric contents, following an acute intoxication in Belgium. Acta Clinica Belgica 63(3): 200-208, 2008. (65 refs.)

Gamma-hydroxybutyrate (GHB, sodium oxybate) is a compound related to neuromodulator gamma-aminobutyric acid (GABA), emerging as a recreational drug of abuse and as a rape drug. GHB-related emergencies have dramatically increased in the 1990s, but a decrease is observed since 2000. We describe the case of an acute GHB intoxication in a 28-year-old male who fell unconscious after ingestion of a mouthful of an unknown beverage, and required medical support for 2 days. A cocaine abuse was also detected by preliminary toxicological screening, but the clinical presentation was not typical of cocaine intoxication. A simple liquid-liquid extraction was used for quantitation of GHB, followed by disityl-derivatization and analysis in selective ion monitoring (SIM) mode by gas chromatography-mass spectrometry (GC-MS), using GHB-d6 as internal standard. High concentrations of GHB were detected in urine (3020 mg/L) and gastric contents (71487 mg/L) at admission. After a 6-hours delay, GHB was still present in urine at 2324 mg/L and in blood at 43 mg/L. The clinical symptoms of cocaine intoxication were diminished by GHB consumption, and the cerebral scan was modified. Attention must thus be paid to acute intoxications with surprising clinical symptoms, and GHB has probably to be added to the preliminary toxicological screening. Data available regarding GHB are briefly reviewed, and our results are compared with previously published reports of non-fatal GHB intoxication.

Caputo F; Addolorato G; Stoppo M; Francini S; Vignoli T; Lorenzini F; Alcohol Treatment Study Group. Comparing and combining gamma-hydroxybutyric acid (GHB) and naltrexone in maintaining abstinence from alcohol: An open randomised comparative study. European Neuropsychopharmacology 17(12): 781-789, 2007. (53 refs.)

Maintaining abstinence from alcohol is the main goat in treating alcohol dependence. Our aim was to evaluate the efficacy of gamma-hydroxybutyric acid (GHB) and naltrexone (NTX), and their combination in maintaining abstinence. Fifty-five alcoholics were randomly enrolled in three groups and treated for 3 months with GHB, GHB plus NTX, and NTX, respectively. At the end of treatments, abstinence was maintained by 13 patients (72.2%) in combination group, 8 patients (40%; P=0.03) in GHB group, and one patient (5.9%; P=0.0001) in NTX group. Relapses in heavy drinking tended to occur more frequently in GHB group (15%) than in either combination group (no cases) or NTX group (5.9%), but such differences were not statistically significant. The GHB/NTX combination was more effective than either drug given atone; this suggests that the two drugs combine their different actions synergistically without suppressing the favourable effects of each other.

Caputo F; Stoppo M; Vignoli T; Francini S; Lorenzini F; Bernardi M. Use of alcohol during the treatment of alcohol dependence with gamma-hydroxybutyric acid. (letter). Journal of Clinical Psychopharmacology 27(4): 418, 2007. (10 refs.)

Carter LP; Richards BD; Mintzer MZ; Griffiths RR. Relative abuse liability of GHB in humans: A comparison of psychomotor, subjective, and cognitive effects of supratherapeutic doses of triazolam, pentobarbital, and GHB. Neuropsychopharmacology 31(11): 2537-2551, 2006. (57 refs.)

Although preclinical studies suggest that GHB has low likelihood for abuse, case reports indicate that GHB is abused. This study evaluated the relative abuse liability of GHB in 14 volunteers with histories of drug abuse. Psychomotor, subjective, and cognitive effects of a broad range of GHB doses ( 2-18 g/70 kg), up to a dose that produced severe behavioral impairment in each participant, were compared to placebo and two abused sedative/hypnotic drugs, triazolam ( 0.5 and 1 mg/70 kg) and pentobarbital ( 200 and 400 mg/70 kg), under double-blind, double-dummy conditions at a residential research facility. In general, GHB produced effects similar to triazolam and pentobarbital, although GHB was not identified as a benzodiazepine or barbiturate by participants that correctly identified triazolam and pentobarbital as such. On most measures of likelihood of abuse ( eg ratings of liking, reinforcing effects), effects of pentobarbital were significantly greater than those of triazolam, with GHB being intermediate. GHB produced significantly greater negative subjective effects, including nausea, than the other drugs. Memory impairment after GHB was less than that after triazolam and pentobarbital. Within participants, the dose-effect function for sedation was steeper for GHB than for triazolam and pentobarbital. Also, at higher doses, GHB was associated with greater sedation and more variability across participants in sedation. Taken together, these data suggest that the profile of effects of GHB only partially overlaps with that of triazolam and pentobarbital. Although the likelihood for GHB to be abused is intermediate to triazolam and pentobarbital, the possibility of accidental overdose (i.e. greater sedation than intended) with GHB appears to be greater.

Castelli MP. Multi-faceted aspects of gamma-hydroxybutyric acid: A neurotransmitter, therapeutic agent and drug of abuse. (review). Mini Reviews in Medicinal Chemistry 8(12): 1188-1202, 2008. (141 refs.)

Gamma hydroxybutyric acid (GHB), an endogenous constituent of the mammalian brain, acts as i) a neurotransmitter or neuromodulator, ii) a medicine used for the treatment of narcolepsy and alcoholism, and iii) a drug illicitly used for its psychotropic effects. GHB is thought to act as a specific GHB receptor agonist as well as a weak gamma-aminobutyric acid type B (GABA(B)) receptor agonist. Here, I review the in vivo and in vitro pharmacological properties of GHB and its interaction with GHB and GABAB receptors. When exogenously administered, GHB is rapidly absorbed, crosses the blood-brain barrier, penetrates into the brain and exerts a number of pharmacological effects including anxiolysis, sedation/hypnosis and anesthesia. Due to its effects on the central nervous system, GHB has been used for the treatment of narcolepsy and as an anesthetic adjuvant. More recently, a role for GHB in the pharmacotherapy of alcohol dependence has been described. In this review, I also focus on the abuse liability and reinforcing properties of GHB in humans and laboratory animals.

Degenhardt L; Dunn M. The epidemiology of GHB and ketamine use in an Australian household survey. International Journal of Drug Policy 19(4): 311-316, 2008. (45 refs.)

There have been apparent increases in recent years in the illicit use of ketamine and gamma-hydroxybutyrate (GHB), but to date there has been no examination of the epidemiology of use in the general population. This paper provides the first such Australian data on the patterns and correlates of GHB and ketamine use. Method: Data were analysed from the 2004 National Drug Strategy Household Survey, a multistage probability sample of Australians aged 14 years or older. Associations between GHB and ketamine use, and core demographic and other drug use variables, were examined. Results: 0.5% of Australians aged 14 years or older reported ever using GHB, and 0.1% reported recent use, with the prevalence of use being highest amongst those aged 20-29 years. Lifetime use of ketamine was reported by 1% of Australians aged 14 years or older, with 0.3% reporting recent use. Again, prevalence of ketamine use was highest amongst those aged 20-29 years. Those who reported ever using these drugs described a pattern of occasional use, with the large majority not using these drugs in the past year. Multiple regression analyses suggested that compared to non-users, GHB and ketamine users were more likely to report the recent use of a wide range of other drugs. Conclusions: The prevalence of GHB and ketamine use in Australia appears to be quite low. The present study found high rates of polydrug use, as have been documented in convenience samples of GHB and ketamine users in previous work. As for other illegal drugs used by small proportions of the population, detailed data on patterns of use and associated risks of use are probably best derived from targeted samples of users: household survey data allow comparisons of the relative prevalence of use compared to other illicit drugs and future work will provide the opportunity to consider changes in the extent of use in the general population.

Dietze PM; Cvetkovski S; Barrat MJ; Clemens S. Patterns and incidence of gamma-hydroxybutyrate (GHB)-related ambulance attendances in Melbourne, Victoria. Medical Journal of Australia 188(12): 709-711, 2008. (23 refs.)

Objective: To examine the nature and extent of ambulance attendances involving gamma-hydroxybutyrate (GHB) and to compare these with heroin-related attendances in Melbourne, Victoria. Design: Retrospective analysis of a database of ambulance service records on attendances at non-fatal drug overdoses, March 2001 - October 2005. Participants and setting: Patients who took GHB and were attended to by an ambulance, as recorded by Metropolitan Ambulance Service (Melbourne) paramedics. Main outcome measures: Transportation to hospital by ambulance; other outcomes included number, age, sex and Glasgow Coma Score (GCS) of patients, characteristics of attendances (in public or private space, others present, police co-attendance). Results: There were 618 GHB-related ambulance attendances across the 46 months of data collection; 362 involving GHB only and 256 involving the concurrent use of GHB and other drugs. These figures compare to 3723 heroin overdoses observed during the same period. The number of GHB-related attendances increased by around 4% per month, which was a higher rate of increase than that found for heroin overdose attendances. Most patients were younger than 25 years, were attended in public spaces, and had a GCS < 10. Around 90% of patients were transported to hospital, compared with 21% of heroin overdose attendances. Conclusions: Ambulance attendance data can be used to index GHB-associated harms. The clear increases in GHB-related ambulance attendances over time highlights the need for further research on how best to respond to this emergent drug-related harm.

Drasbek KR; Christensen J; Jensen K. Gamma-hydroxybutyrate - a drug of abuse. (review). Acta Neurologica Scandinavica 114(3): 145-156, 2006. (96 refs.)

Gamma-Hydroxybutyrate (GHB) is a drug of abuse that causes euphoria, anxiolysis, and hypnosis. The recent rise in the recreational intake of GHB, as well as its association with 'drug rape', has turned the attention to GHB in acute hospital settings. Acutely admitted GHB intoxicated patients may display various levels of sedation or coma, but may also show paradoxical agitation, combativeness, or self-injurious behaviors. The symptoms can be nonspecific and the definite diagnosis therefore normally relies on the detection of GHB in blood or body fluids, which is an analysis that may not be promptly available. As a basis for understanding the clinical features of GHB intoxication and abuse, we here review the pharmacological and neurophysiological knowledge about GHB, which stems from decades of clinical and basic GHB research. In addition, we discuss the latest discoveries in the quest for distinct GHB receptors in the brain, and their possible implications for future therapies of GHB abuse.

Dresen S; Kempf J; Weinmann W. Prevalence of gamma-hydroxybutyrate (GHB) in serum samples of amphetamine, metamphetamine and ecstasy impaired drivers. Forensic Science International 173(2/3): 112-116, 2007. (19 refs.)

Two hundred and forty-seven serum samples which have been collected by police during roadside testing and have been found positive for amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA) and/or 3,4-methylenedioxyethamphetarnine (MDE) were analyzed for y-hydroxybutyrate (GHB). Serum samples were spiked with deuterated GHB as internal standard and acetonitrile was added to achieve dilution and protein precipitation. Samples were analyzed with a LC-MS/MS system operated in the multiple reaction monitoring mode (MRM) using a TurbolonSpray source. Chromatographic separation was achieved using a Synergi Polar RP column applying a gradient elution with a runtime of 15 min. To differentiate between endogenous and exogenously administered GHB a cut-off concentration of 10 mu g/mL was applied. Five samples exceeded this concentration and were found positive for GHB. These samples were only found positive for amphetamine but no other amphetamine derivatives were detected, while in three samples THC and in one sample cocaine, benzoylecgonine and ethanol were found.

Elsing C; Stremmel W; Grenda U; Herrmann T. Gamma-hydroxybutyric acid versus clomethiazole for the treatment of alcohol withdrawal syndrome in a medical intensive care unit: An open, single-center randomized study. American Journal of Drug and Alcohol Abuse 35(3): 189-192, 2009. (30 refs.)

Background: Clomethiazole (CLO) has been shown to be effective in treating alcohol withdrawal syndrome (AWS). Gamma-Hydroxybutyric acid (GHB) has also been introduced in the treatment of alcoholic patients and is effective in surgical intensive care unit (ICU) patients in preventing and treating AWS. There are no comparative studies between CLO and GHB in a medical ICU setting. Methods: Twenty-six alcoholic patients with severe AWS and concomitant medical diseases were randomally enrolled in the study. CLO was given orally to 12 patients in a dosage of 250 mg every 4 hours as a liquid; GHB (initially 30 mg/kg body weight (BW) followed by 15 mg/kg BW) was administered intravenously to 14 patients. Four major AWS symptoms (tremor, sweating, nausea, restlessness) were scored, and the administration of additional medication was registered. Results: GHB was more effective in treating AWS symptoms. In the GHB group, AWS score dropped from 6.6 2.6 to 1.8 2.1 (p .01), while in the CLO group, the score dropped from 6 2.5 to 4.1 2.4 (n. s.). Differences between groups were significant (p =.021, two-way ANOVA). The treatment did not alter outcome or the duration of ICU stay. No serious side effects were detected. Conclusion: GHB effectively controls AWS symptoms in medical ICU patients. The rapid initial treatment response of GHB in contrast to CLO has no influence on duration of patient withdrawal.

George J; Lenton S. West Australian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initivative (PDI). NDARC Technical Report No. 253. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (14 refs.)

This report presents the results of an ongoing study monitoring ecstasy and related drug markets within WA. It begins with a description of the demographic characterisitcs of regular ecstasy users and patterns of use. The price, purity and availability of ecstasy, the markets, patterns of purchasing, and sources of information about purity and content of drugs, risk behavior, health related issues, criminal activity and market changes. Less but similar information is also provided for methamphetamine, cocaine, LSD, ketamine, MDMA, GHB, and drinking patterns. Data is presented in 35 tables and 46 figures.

Grov C; Bimbi DS; Nanin JE; Parsons JT. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2): 105-123, 2006. (57 refs.)

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxymethamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.

Grov C; Kelly BC; Parsons JT. Polydrug use among club-going young adults recruited through time-space sampling. Substance Use & Misuse 44(6): 848-864, 2009

Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18-29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the universal compliment as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.

Halkitis PN; Green KA. Sildenafil (Viagra) and club drug use in gay and bisexual men: The role of drug combinations and context. American Journal of Men's Health 1(2): 139-147, 2007. (38 refs.)

Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

Halkitis PN; Palamar JJ. GHB use among gay and bisexual men. Addictive Behaviors 31(11): 2135-2139, 2006. (26 refs.)

The recreational use of gamma-hydroxybutyrate (GHB) has been relatively understudied, despite its popularity in gay communities. We examined the use of GHB in a sample of 450 club drug using gay and bisexual men. Of these, 29% indicated use of the substance in the recent past. GHB users were similar to those in the sample who reported no use along key demographic factors, although GHB users were more likely to identify as gay than bisexual and were slightly older. Poly-drug use was common, with close to half of GHB users combining with methamphetamine, MDMA, or ketamine; approximately one quarter also used GHB with alcohol. Participants reported that GHB was often used at nightclubs, circuit parties, sex parties, and sex clubs, with HIV-positive men more likely to use the substance in sexual contexts. Use of GHB is common among a certain subset of gay men despite warnings within the community about the potentially fatal effects of the substance, suggesting that more effort be given to educate drug using gay men about GHB.

Halkitis PN; Palamar JJ. Multivariate modeling of club drug use initiation among gay and bisexual men. Substance Use & Misuse 43(7): 871-879, 2008. (23 refs.)

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a yearlong longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs - cocaine, GHB, ketamine, ecstasy, and methamphetamine - using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.

Halkitis PN; Palamar JJ; Mukherjee PP. Poly-club-drug use among gay and bisexual men: A longitudinal analysis. Drug and Alcohol Dependence 89(2/3): 153-160, 2007. (43 refs.)

Objective: We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City. Methods: Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period. Results: Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB. Conclusions: The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered.

Henderson DL; Ginsberg JP. Withdrawal, recovery, and long-term sequelae of gamma-butyrolactone dependence: A case report. American Journal on Addictions 17(5): 456-457, 2008. (4 refs.)

Hopfer C; Mendelson B; Van Leeuwen JM; Kelly S; Hooks S. Club drug use among youths in treatment for substance abuse. American Journal on Addictions 15(1): 94-99, 2006. (16 refs.)

We describe lifetime rates of club drug use among 782 youths in treatment for substance abuse. Rates (%) for youths under eighteen (N=486) were methylenedioxymethamphetamine ( MDMA), 32.3; gamma-hydroxybutyrate (GHB), 7.0; lysergic acid diethylamide ( LSD), 48.6; ketamine, 18.3; and methamphetamine, 30.2. For youths 18-32 (N=289) rates (%) were MDMA, 37.0; GHB, 13.1; LSD, 42.9; ketamine, 17.0; and methamphetamine, 31.5. Older youths reported significantly more use of GHB than younger youths (p <.01). Youths reported using club drugs frequently outside of rave settings. Club drug use is common among youths in treatment for substance abuse and has spread beyond the rave culture.

Horowitz A; Galanter M; Dermatis H; Franklin J. Use of and attitudes toward club drugs by medical students. Journal of Addictive Diseases 27(4): 35-42, 2008. (12 refs.)

This study assesses medical students' use of and attitudes towards club drugs, classified as "Generation I" (i.e., cocaine and lysergic acid diethylamide), and "Generation II" (ie, methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in club settings. An anonymous questionnaire was administered to 340 medical students. The prevalence of any club drug use was 16.8%, with MDMA (11.8%) and cocaine (5.9%) the most commonly used. Results discussed also include the relationship of age and gender to having ever used club drugs and to their attitudes regarding use. Additionally, the study identifies differences in patterns of use and attitudes toward Generation I versus Generation II club drugs based on age, gender, and participants' prior club drug use. Findings are compared to those of earlier studies about medical students and those in a similar age group in the general population.

Hovda KE; Bjornaas MA; Skog K; Opdahl A; Drottning P; Ekeberg O et al. Acute poisonings treated in hospitals in Oslo: A one-year prospective study (I): Pattern of poisoning. Clinical Toxicology 46(1): 35-41, 2008. (25 refs.)

Objectives. Prospective design is mandatory to study pattern of poisoning and suicidal intention of patients. Material and Methods. Prospective cross-sectional multi-center study of all patients contacting health care services because of acute poisoning during one year in Oslo, irrespective of intention. Data on the adult hospitalized patients ( :16 years) are presented here. Results. Of a total of 3,775 such adult contacts (3,025 episodes), there were 947 (31%) hospitalizations; annual incidence 1.9 (per 1,000) in males and 2.1 in females. Median age was 36 years (range 16 - 89); 54% females. Benzodiazepines (18%), ethanol (17%), paracetamol (12%), opioids (7%), and gamma hydroxybutyric acid (GHB) (7%) were most frequently taken. Patients stated suicidal intention in 29% of the admissions; physicians in 10%. Conclusion. Benzodiazepines and ethanol were the most common agents, but newer illicit drugs were frequent, especially GHB. Males often took ethanol and drugs of abuse; females often used prescription drugs with suicidal intention.

Johnston J; Jenkinson R. Victorian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 246. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (26 refs.)

This report presents the results of an ongoing study monitoring ecstasy and related drug markets within Victoria Australia. It opens with a description of the demographic characterisitcs of regular ecstasy users and patterns of use, including use of the other drugs. The price, purity and availability of ecstasy, the markets, patterns of purchasing, and sources of information about purity and content of drugs, the associated risk behavior, health related issues, criminal activity and market changes are also discussed. Similar data is presented in respect to other drugs commonly used: methamphetamine, cocaine, LSD, ketamine, GHB, and drinking patterns. Data is presented in 40 tables and 35 figures.

Jones AW; Holmgren A; Kugelberg FC. Driving under the influence of gamma-hydroxybutyrate (GHB). Forensic Science, Medicine and Pathology 4(4): 205-211, 2008. (39 refs.)

We used an in-house forensic toxicology database (TOXBASE) to evaluate the occurrences of gamma-hydroxybutyrate (GHB) in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID) between 1998 and 2007. Age, gender, and concentrations of GHB in blood were compared and contrasted when GHB was the only drug present and when it occurred along with other drugs. GHB was determined in blood by gas chromatography (GC) after conversion to gamma-butyrolactone (GBL) and analysis of the latter with a flame ionization detector. The cut-off concentration of GHB in blood for reporting a positive result was 8 mg/l, which served as limit of quantitation. The mean and median GHB concentrations were 89 mg/l and 82 mg/l, respectively (2 1/2 and 97 1/2 percentiles 12 and 220 mg/l) in 548 arrested drivers. These individuals were predominantly men (95%) with an average age of 26 +/- 5.5 years (range 15-50 years) and women (5%) were several years older with an average age of 32 +/- 8.0 years (range 19-47). There were 102 individuals (29%) who were arrested more than once with GHB in blood (average similar to 3 times per person) and one as many as 10 times. GHB was the only psychoactive substance detected in 215 cases (39%) at mean and median blood-concentrations of 91 mg/l and 83 mg/l, respectively. These concentrations were not significantly different from poly-drug users. A weak but statistically significant correlation existed between the concentration of GHB in blood and the person's age (N = 548, r = 0.135, P < 0.01). The signs of drug influence noted by arresting police officers included sedation, agitation, unsteady gait, slurred speech, irrational behavior, jerky body movements, dilated pupils, and spitting. The blood concentrations reported here are probably appreciably less than at time of driving (30-90 min earlier) owing to the short elimination half-life of GHB (t1/2 = 30-40 min).

Kankaanpaa A; Liukkonen R; Ariniemi K. Determination of gamma-hydroxybutyrate (GHB) and its precursors in blood and urine samples: A salting-out approach. Forensic Science International 170(2/3, Special Issue): 133-138, 2007. (30 refs.)

gamma-Hydroxybutyrate (GHB) is an increasingly popular drug of abuse that causes stimulation, euphoria, anxiolysis or hypnosis, depending on the dose used. Low doses of the drug are used recreationally, and also implicated in drug-facilitated sexual assaults. Because of the unusually steep dose-response curves, accidental GHB overdosing, leading to coma, seizures or death can occur. Being a controlled substance, GHB is often substituted with its non-scheduled precursors gamma-butyrolactone (GBL) and 1,4-butanediol (131)), which are rapidly metabolized into GHB in the body. Here we describe an assay for GHB, GBL and BD in blood and/or urine samples. GHB and BD were extracted from diluted 200 mu L aliquots of samples with t-butylmethylether (plus internal standard benzyl alcohol) in test tubes preloaded with NaCl. After acidification and centrifugation the solvent phase was transferred to a test tube preloaded with Na2SO4, incubated for 30 min, centrifuged again, and evaporated in vacuum. The residue was mixed with N-methyl-N-trimethylsilyl-trifluoroacetamide (MSTFA) in acetonitrile, and injected into a GC-MS. When analyzing GBL, the salting-out step was omitted, and analysis was performed with a GC-FID apparatus. As revealed by the validation data this procedure is suitable for quantitative determination of GHB and its precursors in blood and/or urine samples.

Kelly BC; Parsons JT; Wells BE. Prevalence and predictors of club drug use among club-going young adults in New York City. Journal of Urban Health 83(5): 884-895, 2006. (36 refs.)

"Club drugs" encompass a diverse range of substances. Although efforts have been made to determine the extent of club drug use among the general population, it is equally important to assess patterns of use among key target populations from which drug trends typically diffuse. This paper describes the results of a survey focused upon club drug use among club-going young adults in NYC. Time-space sampling generated a sample of 1, 914 club-going young adults (ages 18-29) who provided data on their use of six key club drugs: ecstasy, ketamine, cocaine, methamphetamine, GHB, and LSD, as well as data on their gender, sexual orientation, race/etimicity, and other demographic variables. Club-going young adults report drug use at high rates-70% report lifetime illicit drug use and 22% report recent club drug use. Rates of club drug use differ by gender, sexual orientation and race/ethnicity. Male gender is predictive of ketamine, GHB, and methamphetamine use, while female gender is predictive of cocaine use. Gay/ bisexual orientation and White race are predictive of the use of several club drugs. Greater health promotion efforts are warranted among this population. Intervention programs and campaigns should tailor specific drug messages to differentially target various segments of dance club patrons.

Kim SY; Anderson IB; Dyer JE; Barker JC; Blanc PD. High-risk behaviors and hospitalizations among gamma hydroxybutyrate (GHB) users. American Journal of Drug and Alcohol Abuse 33(3): 429-438, 2007. (21 refs.)

Introduction: Little is known about behaviors linked to gamma hydroxybutyrate (GHB) morbidity. Methods: We surveyed 131 GHB users, using logistic regression to test the associations between the high risk behaviors and hospital treatment for GHB (26 [20%] of subjects). Results: Increased risk of GHB hospital treatment was associated with: co-ingestion of ethanol (OR 5.2; 95% CI 1.7-16), driving under the influence of GHB (OR 3.2; 95%, CI 1.3-7.8), use of GHB to treat withdrawal symptoms (OR 2.9; 95% CI 1.1-7.9), and co-ingestion of ketamine (OR 2.7; 95% CI 1.1-6.7). Conclusion: Targeted prevention activities could focus on selected high-risk behaviors.

Kim SY; Barker JC; Anderson IB; Dyer JE; Earnest G; Blanc PD. Systematic assessment of gamma hydroxybutyrate (GHB) effects during and after acute intoxication. American Journal on Addictions 17(4): 312-318, 2008. (17 refs.)

We adapted and tested a previously published questionnaire battery eliciting sensory and cognitive symptoms during (acute) and immediately after (post-acute) GHB intoxication. Studying 125 GHB users, we assessed the instrument's internal consistency using Cronbach's alpha (CA) and responsiveness to change comparing acute and post-acute symptoms. The final 14-item battery demonstrated good internal consistency (CA 0.85, both acute and post-acute). The median symptom score (possible range 0-64) was 30 (acute) and 6 (post-acute; difference p 0.001). This modified substance-specific symptom battery, which is easily administered, demonstrated excellent performance characteristics. It can be used to study GHB and, potentially, related drugs of abuse.

Knudsen K; Greter J; Verdicchio M. High mortality rates among GHB abusers in Western Sweden. Clinical Toxicology 46(3): 187-192, 2008. (24 refs.)

Background. GHB is a drug of abuse and acute poisonings have been an increasing medical problem over the last decade in Sweden. Objectives. To document all cases of GHB poisonings in Gothenburg during 1995-2004 and to record drug-related deaths to compare the toxicity of GHB with other illicit drugs, such as heroin and amphetamine. Methods. The number of GHB-poisoned patients treated at the Sahlgrenska University Hospitalital has been recorded with the help of an in-house database. The number of deaths by illicit drugs was recorded during 2004. Seizures of the drugs GHB, 1,4-butanediol, and GBL were registered between 1996 and 2004. Results. The number of poisoned patients was 259. The number of seizures with GHB was 743, GBL 343, and 1,4-butanediol 236. In 2004 the number of deaths was 6 with heroin, 7 with GHB, 32 with amphetamine, 6 with cocaine, and one with methadone. One patient with GHB poisoning died during hospital care. Conclusions. Intoxication by GHB has substantial morbidity and abuse of GHB has substantial mortality. The acute prognosis is good but long-term prognosis is insecure with an increased risk for drug dependency and an early death.

LeBeau MA; Montgomery MA; Morris-Kukoski C; Schaff JE; Deakin A. Further evidence of in vitro production of gamma-hydroxybutyrate (GHB) in urine samples. Forensic Science International 169(2/3 special issure): 152-156, 2007. (31 refs.)

This study was designed to supplement previous studies that documented in vitro production of gamma-hydroxybutyrate (GHB) in urine samples. Urine samples were provided by subjects who reported that they had never used GHB (n = 3 1). The specimens were stored under standard conditions of refrigeration (5 degrees C) without any preservatives added. All specimens were repeatedly analyzed for the presence of endogenous GHB over a 6-month period using a previously reported headspace GC-MS method. Significant elevations in GHB were observed in many of the urine samples as storage time increased. As a result, the in vitro production of GHB may increase the apparent GHB concentrations in urine during storage. This potential for an artificial increase in GHB concentration must be appreciated when establishing the threshold between endogenous and exogenous concentrations of GHB.

LeTourneau JL; Hagg DS; Smith SM. Baclofen and gamma-hydroxybutyrate withdrawal. Neurocritical Care 8(3): 430-433, 2008. (26 refs.)

Introduction: Benzodiazepine treatment of life-threatening gamma-hydroxybutyrate (GHB) withdrawal is frequently unsatisfactory. Animal studies suggest strongly that treatment with GABA(B) agonists, such as baclofen, will be a more effective strategy. Methods A case report from the medical intensive care unit (ICU) of the university tertiary care hospital. Results: A 61-year-old woman was admitted to the medical ICU for severe withdrawal symptoms from chronic GHB use. This manifested as delirium, tremor, and seizures despite only small decreases in GHB dose and treatment with benzodiazepines. The addition of baclofen allowed the rapid sequential decreases in the GHB dose without seizure or delirium and resulted in long-term improvement of her tremor. Conclusions: Baclofen, a GABA(B) agonist, may be a useful agent in the treatment of severe GHB withdrawal.

Liechti ME; Kunz I; Greminger P; Speich R; Kupferschmidt H. Clinical features of gamma-hydroxybutyrate and gamma-butyrolactone toxicity and concomitant drug and alcohol use. Drug and Alcohol Dependence 81(3): 323-326, 2006. (17 refs.)

Objective: To describe the clinical features of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) toxicity. Methods: Retrospective case-study of 65 GHB and GBL intoxications seen in an urban emergency department. Results: 63% of intoxications occurred in male patients. The median age was 24 years (range 16-41 years). 65% co-ingested alcohol or illicit drugs, mostly MDMA and cocaine. 83% presented with coma. The mean +/- S.D. time to regain consciousness among comatose patients was 111 +/- 61 min and was significantly longer in patients who co-abused illicit drugs such as cocaine or MDMA (155 +/- 60 min). Bradycardia occurred in 38%, hypotension in 6% and hypotherinia in 48%. Agitation was observed in 17% of all patients and was significantly more frequent in patients with alcohol co-use (29%). Vomiting occurred in 31% of all patients and tended to be more frequent in patients who co-used alcohol (39%). Management of GHB and GBL overdose was supportive. Four patients needed admission to an intensive care unit for mechanical ventilation (6%). Conclusions: Overdosing of GHB and GBL frequently results in non-reactive coma reflecting the severity of poisoning. Multiple drug use is common and significantly influences the clinical presentation.

Madea B; Musshoff F. Knock-out drugs: Their prevalence, modes of action, and means of detection. (review). Deutsches Arzteblatt International 106(20): 341-U12, 2009. (25 refs.)

Background: Knock-out drugs are used to facilitate the commission of a crime, generally either robbery or sexual assault. Although media reports on the use of knock-out drugs have become more frequent, there are no robust epidemiological data on the incidence of drug-facilitated robbery or sexual assault, presumably because many crimes of these types do not enter into official statistics. Methods: The authors describe the modes of action and toxicological means of detection of the substances most frequently used as knock-out drugs on the basis of a selective literature research on the terms "drug-facilitated sexual assaults" (DFSA) and "drug-facilitated crimes" (DFC). Results: The most frequently used drug in cases of sexual assault is still alcohol (ca. 40% to 60%), followed by illegal drugs (cannabis, cocaine). The presence of involuntarily consumed medications and drugs of abuse is demonstrated by routine toxicological analysis only in relatively few cases (ca. 2%). The substances most commonly found are benzodiazepines, followed by other hypnotics. In Europe, the illegal substance gamma-hydroxybutyric acid (GHB, "Liquid Ecstasy"), often mentioned as a "date-rape drug," is only rarely detected with sufficient medicolegal certainty. This may be due to its rapid elimination (it is detectable in blood for up to 8 hours, in urine for up to 12 hours) as well as its physiological occurrence in the body. If the toxicological analysis of blood and urine is negative in a case of suspected DFSA, then the analysis of a hair sample about four weeks after the assault can detect the presence of drugs consumed at that time. If the victim has long hair, it may be possible to detect knock-out drugs taken more than four weeks earlier. In Europe, convictions for drug-facilitated crimes are comparatively rare, mainly because of the difficulty of demonstrating conclusive evidence. Conclusions: A careful medical history and physical examination and the careful taking of biological samples for toxicological analysis form the basis for the detection of drug-facilitated crimes.

Maremmani I; Pacini M. Use of sodium gamma-hydroxybutyrate (GHB) in alcoholic heroin addicts and polydrug-abusers. (review). Heroin Addiction and Related Clinical Problems 9(1): 55-76, 2007

Sodium gamma-hydroxybutyrate (GHB) in one of the most effective options available for the treatment of hard-core alcoholism in maintenance programmes that aim to achieve relapse prevention and rehabilitation. Polysubstance abuse and multiple addiction have become quite common in alcoholic youths and former heroin addicts receiving inadequate or no specific treatment. In approaching these categories, GHB is usually neglected, on the basis of the idea that its abuse potential must be amplified in abuse-prone individuals. However, the normalizing effects of anticraving treatment on the behaviour of heroin addicts may make GHB a suitable remedy for the heroin-alcohol polyabuse picture. The same cannot be said of cocaine abusers, due to the lack of anticraving treatments possessing major, reliable effectiveness. After reviewing the data in the literature on the use of GHB in alcoholics and other kinds of abusers, we describe 13 cases of alcohol-abusing heroin addicts, in which GHB proved to possess some effectiveness, even if there were major limitations regarding compliance and completeness of response.

Matthews A; Bruno R. Tasmanian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drug Initiative (PDI). NDARC Technical Report No. 251. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (35 refs.)

This report presents the results of an ongoing study monitoring ecstasy and related drug markets within Tasmania. It begins with a description of the demographic characterisitcs of regular ecstasy users and patterns of use. The price, purity and availability of ecstasy, the markets, patterns of purchasing, and sources of information about purity and content of drugs, risk behavior, health related issues, criminal activity and market changes. Similar information is also provided for methamphetamine, cocaine, LSD, ketamine, MDMA, GHB, and drinking patterns. Data is presented in 66 tables and 29 figures.

McCambridge J; Winstock A; Hunt N; Mitcheson L. 5-year trends in use of hallucinogens and other adjunct drugs among UK dance drug users. European Addiction Research 13(1): 57-64, 2007. (33 refs.)

Aims: To describe and assess trends in the use of hallucinogens and other adjunct drugs over a 5-year period. Design: Repeated-measures cross-sectional survey. Setting and Participants: Annual magazine-based survey targeting people who use drugs in dance contexts. Measurements: Lifetime use prevalence (ever used); age of first use; current use prevalence (any use within the last month), and extent of use within the last month (number of days used) for LSD, psilocybin, ketamine, GHB and nitrates. Findings: Prevalence increases for psilocybin, ketamine, GHB and nitrates use have been detected, with a sharp recent rise in current psilocybin use in 2002-2003 contrasting with more gradual and comprehensive evidence of increased ketamine use throughout the period 1999-2003. The declining prevalence of LSD use in general population surveys is replicated in this sentinel population study. Conclusions: The rise in prevalence of hallucinogen and other adjunct drugs identified among dance drug users may be mirrored by wider prevalence increases among young people with a consequent need to study these trends carefully and to develop effective interventions, where required.

Nava F; Premi S; Manzato E; Campagnola W; Lucchini A; Gessa GL et al. Gamma-hydroxybutyrate reduces both withdrawal syndrome and hypercortisolism in severe abstinent alcoholics: An open study vs. diazepam. American Journal of Drug and Alcohol Abuse 33(3): 379-392, 2007. (72 refs.)

In 42 alcoholic inpatients we performed an open randomized study to compare the effects of diazepam and gamma-hydroxybutyrate (GHB) on the suppression of severe alcohol withdrawal syndrome and hypercortisolism. Both diazepam (.5mg/kg bodyweight, q.i.d.) and GHB (50 mg/kg bodyweight, q.i.d.) were orally administered for three weeks. During all study period, GHB was more able than diazepam in reducing both withdrawal syndrome and hypercortisolism. These effects were evident during the first week of treatment and persisted throughout the study period. The results confirm a strict correlation between high levels of plasma cortisol and alcohol withdrawal symptoms and they show a slight superiority of GHB over diazepam in the suppression of both ethanol withdrawal and hypercortisolism. Taken together, our data suggest that GHB may act as potent anti-withdrawal agent in severe abstinent alcoholics.

Nava F; Premi S; Manzato E; Lucchini A. Comparing treatments of alcoholism on craving and biochemical measures of alcohol consumptions. Journal of Psychoactive Drugs 38(3): 211-217, 2006. (39 refs.)

An open randomized study was conducted to compare different treatments of alcoholism on ethanol intake, craving, and on biochemical measures of alcohol consumptions. Eighty-six alcoholics were abstinent for a mean of two weeks prior to random assignment to g-hydroxybutyrate (GHB, 50 mg/kg of body weight t.i.d), naltrexone (NTX, 50 mg/day) or disulfiram (DSF, 200 mg/day) treatment for 12 months. All treatments were equally effective in reducing alcohol intake and in maintaining abstinence. In all patients, the treatments were able to reduce both craving and the altered biological markers of alcohol abuse. The maximum effects were observed in GHB-treated patients. The results of the present study suggest that GHB might act both as anticraving and cellular protector agent.

Newman J; Moon C. Northern Territory Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 244. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (33 refs.)

This report presents the results of an ongoing study monitoring ecstasy and related drug markets within the Northern Territory (Australia). It opens with a description of the demographic characterisitcs of regular ecstasy users and patterns of use, including use of the other drugs. The price, purity and availability of ecstasy, the markets, patterns of purchasing, and sources of information about purity and content of drugs, the associated risk behavior, health related issues, criminal activity and market changes are also discussed. Similar data is presented in respect to other drugs commonly used: methamphetamine, cocaine, LSD, ketamine, GHB, and drinking patterns. Data is presented in 75 tables and 62 figures.

Palamar JJ; Halkitis PN. A qualitative analysis of GHB use among gay men: Reasons for use despite potential adverse outcomes. International Journal of Drug Policy 17(1): 23-28, 2006. (35 refs.)

This paper examines the use of gamma-hydroxybutyrate (GHB) among a sample of gay men in New York City, who identify GHB as their most frequently used club drug. The sample was drawn from a larger longitudinal investigation of club drug using men. Thematic analysis yielded findings regarding perceived stigma for GHB use, tolerance of potential adverse side effects, and reasons for why some prefer this substance to other club drugs. Specifically, our findings suggest that GHB is viewed unfavorably in many social circles, that side effects are tolerated by frequent GHB users, and that the drug is chosen over other substances because the short duration of action, energy boost, sleep assistance, increase in libido, and limited after-effects. Examining the reasons why men use this substance will lead to the development of GHB specific prevention strategies, which accurately address the consequences of use as well as the motivations that individuals possess for using the substance.

Parsons JT; Grov C; Kelly BC. Club drug use and dependence among young adults recruited through time-space sampling. Public Health Reports 124(2): 246-254, 2009. (46 refs.)

Objectives. Ketamine, methylenedioxymethamphetamine (MDMA/ecstasy), cocaine, gamma-hydroxybutyrate (GHB), methamphetamine, and cl-lysergic acid diethylamide (LSD/acid) have been identified as "club drugs" because of their link to club culture among young adults. Yet little is known about users' demographic differences in the prevalence of club drugs. This study sought to provide a comprehensive profile of users' demographic differences in prevalence of club drug use and dependence. Methods. Using time-space sampling, a stratified sample of 400 18- to 29-year-old club-going young adults was recruited into the Club Drugs and Health Project. Results. Though participants reported using an array of club drugs, almost all participants (90.0%) were cocaine users. Although there were several sexual orientation and gender differences in recent drug exposure, patterns of use (measured in days) were fairly similar across gender, sexual orientation, and age. Finally, a majority of individuals (58.5%) met or exceeded criteria for club drug dependence, with most (61.7%) indicating cocaine was the one drug causing them significant problems. Conclusions. Cocaine is a major drug in club culture. It is essential to develop culturally appropriate drug education and prevention initiatives for young adults using club drugs.

Parsons JT; Halkitis PN; Bimbi DS. Club drug use among young adults frequenting dance clubs and other social venues in New York City. Journal of Child & Adolescent Substance Abuse 15(3): 1-14, 2006. (38 refs.)

A convenience sample of young adults (ages 18-25) in New York City was recruited to complete anonymous surveys in social venues (either dance clubs or other social settings, such as coffee shops and university "hangouts") regarding their use of "club drugs" (e.g., MDMA/Ecstasy, GHB, ketamine, crystal methamphetamine, cocaine, and LSD). Participants indicated their frequency of use for each drug and whether or not they had used each drug for the first time in the past six months. A total of 566 surveys were collected and 38.9% of participants reported the use of at least one club drug. Overall, males were significantly more likely than females to report club drug use. There were some differences in club drug use based on sexual orientation, comparing heterosexually identified youth to gay/bisexually identified youth. There were no differences in use among those recruited at dance clubs compared with those recruited from other social venues. The use of club drugs is a growing problem among young adults, as evidenced by the number of participants reporting having tried club drugs for the first time in the past six months. Educational interventions, 'particularly those designed to reach young adults who are just initiating the use of club drugs, are needed.

Parsons JT; Kelly BC; Wells BE. Differences in club drug use between heterosexual and lesbian/bisexual females. Addictive Behaviors 31(12): 2344-2349, 2006. (15 refs.)

Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time-space sampling from dance clubs in New York City during 2005 (N = 1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.

Proudfoot P; Ward J; Staniforth A; Buckingham K. Australian Capital Territory Drug Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 247. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (23 refs.)

This report presents the results of an ongoing study monitoring ecstasy and related drug markets within the Australian Capital Territory. It opens with a description of the demographic characterisitcs of regular ecstasy users and patterns of use, including use of the other drugs. The price, purity and availability of ecstasy, the markets, patterns of purchasing, and sources of information about purity and content of drugs, the associated risk behavior, health related issues, criminal activity and market changes are also discussed. Similar data is presented in respect to other drugs commonly used: methamphetamine, cocaine, LSD, ketamine, MDMA, GHB, and drinking patterns. Data is presented in 54 tables and 17 figures.

Royal Canadian Mounted Police. Drug Situation Report 2005. Ottawa: Royal Canadian Mounted Police, 2006. (0 refs.)

This report deals provides a strategic overview of the illicit drug trade in Canada. Separate sections are directed to cocaine, heroin, opium, cannabis derivatives, ecstasy/MDMA, methamphetamine, other synthetic drugs (ketamine and GHB, and other controlled drugs), khat. It also includes a section on precursor chemicals, concludes with a summary of drug offenses. Drug seizure data is provided in an appendix. For each of the sections on drugs, key findings related to the substances are outlined, along with the level of demand, the drug source, the means of smuggling, trafficking patterns within the country, and major seizures.

Sellman JD; Robinson GM; Beasley R. Should ethanol be scheduled as a drug of high risk to public health? (review). Journal of Psychopharmacology 23(1): 94-100, 2009. (51 refs.)

Six criteria described in the New Zealand Misuse of Drugs Act and used by the Expert Advisory Committee on Drugs (EACD) for determining the risk of a drug to public health were examined in relation to ethanol, using gamma-hydroxybutyric acid (GHB) as a comparator drug. GHB is an ideal candidate for use as a comparator because it is a sedative substance very similar to ethanol and has been previously investigated by the EACD using these six criteria. GHB was subsequently classified as a Class B1 drug under the Misuse of Drugs Act, that is, as a prohibited drug of high risk to public health. The dangerousness level of ethanol was found to be at least similar to that of GHB in this analysis. This highlights a major discrepancy in public policy.

Semple S; Strathdee S; Zians J; Patterson T. Sexual risk behavior associated with co-administration of methamphetamine and other drugs in a sample of HIV-positive men who have sex with men. American Journal on Addictions 18(1): 65-72, 2009. (43 refs.)

This study examined the association between sexual risk behavior and co-administration of methamphetamine with other drugs in a sample of 341 HIV-positive MSM. Those who reported methamphetamine co-administration in the past two months (65%) reported significantly more unprotected anal and oral sex and a greater number of casual, anonymous, and paid sex partners in this timeframe compared to men who used methamphetamine alone. Two primary patterns of co-administration were identified: 1) drug combinations motivated by sexual performance and enhancement (eg, methamphetamine, poppers, sildenafil); and 2) party drug combinations (eg, methamphetamine, GHB, ketamine). Implications for further research and possible applications to risk-reduction interventions are discussed.

Summers SA; Glynne PA. Acute poisoning on the medical admissions unit. (editorial). Clinical Medicine 7(3): 277-279, 2007. (19 refs.)

Alcohol intoxication, deliberate medicinal overdoses and ingestion of (illegal) substances are common reasons for admission to emergency departments in the UK, particularly in inner city hospitals. This review discusses problems related to the ingestion of selected toxins. In terms of alcohol, attention here is directed to ethylene glycol, methanol and isopropyl alcohol - each of which can produce fatal intoxication through the ingestion of relatively small doses. The most common medicinal agents involved in overdose are paracetamol and salicylate. As for illicit recreational drugs, the problems of securing an accurate history are noted, along with the limitations of drug testing. The most prominent recreational agents are 3,4-methylenedioxymethamphetamine (MDMA or ecstasy); gamma-hydroxybutyrate (GHB or liquid ecstasy); flunitrazepam (Rohypnol); and ketamine (Ketalar). Each is described, including its presentation and management.

Sumnall AR; Woolfall K; Edwards S; Cole JC; Beynon CM. Use, function, and subjective experiences of gamma-hydroxybutyrate (GHB). Drug and Alcohol Dependence 92(1/3): 286-290, 2008. (35 refs.)

Self-reported use of gamma-hydroxybutyrate (GHB) among clubbers has increased over the last decade, and is often reported in the scientific literature in association with negative events such as amnesia, overdose, and use in drug facilitated sexual assault. However, there has been relatively little work investigating the phenomenology, of GHB intoxication, and the reasons underlying use. In this study, 189 individuals reporting at least one lifetime use of GHB completed an online questionnaire recording GHB use behaviours, GHB use function, and subjective GHB effects. The. most frequently reported primary GHB use functions were for recreation (but not in nightclubs) (18.3%); to enhance sex (18.3%); to be sociable (13.1%); and to explore altered states of consciousness (13.1%). GHB was more commonly used within the home (67%) compared to nightlife environments (26.1%) such as clubs, although this differed on the basis of respondent's sexuality. Principle components analysis of GHB user responses to the subjective questionnaire revealed six components: general intoxication effects, positive intoxication effects, negative intoxication effects, negative physiological effects, positive sexual effects and negative sexual effects. Component scores predicted function of use.

Thai D; Dyer JE; Benowitz NL; Haller CA. Gamma-hydroxybutyrate and ethanol effects and interactions in humans. Journal of Clinical Psychopharmacology 26(5): 524-529, 2006. (24 refs.)

Background: Gamma-hydroxybutyrate (GHB) is a common drug of abuse that can produce serious toxicity, particularly when used with other sedatives. We examined the individual and combined effects of GHB and ethanol in human volunteers. Methods: Sixteen healthy adults (7 men) were given 50 mg/kg GHB (Xyrem), 0.6 g/kg ethanol in 2 doses, alone and combined in a double-blind, placebo-controlled, crossover study. Plasma concentrations, heart rate (HR), blood pressure (BP), and oxygen saturation (O(2)sat) were serially monitored for 24 hours. Results: Adverse events included 2 instances of hypotension and 6 episodes of vomiting with GHB-plus-ethanol ingestion. Oxygen saturation was decreased by GHB and ethanol individually, and maximally decreased by the drugs combined (max -2.1% +/- 0.3%, P < 0.0001 vs placebo). Compared with baseline, systolic and diastolic BP were significantly decreased, and HR was increased by ethanol but not affected by GHB alone (maximum systolic BP change -15.7 +/- 3.0 mm Hg, P = 0.0006; maximum HR change 13.5 +/- 2.3 beats per minute, P = 0.006). Ethanol coingestion resulted in 16% higher GHB maximal plasma concentration and 29% longer elimination half-life, indicating possible enhanced bioavailability or reduced clearance of GHB caused by ethanol, however, these effects were not statistically significant. Conclusions: Modest doses of GHB do not affect hemodynamic function, but O(2)sat was decreased. Gamma-hydroxybutyrate-plus-ethanol resulted in more adverse effects, including gastrointestinal disturbances, hypotension, and decreased O(2)sat, but only minimal pharmacokinetic interactions were observed.

van Nieuwenhuijzen PS; McGregor IS. Sedative and hypothermic effects of gamma-hydroxybutyrate (GHB) in rats alone and in combination with other drugs: Assessment using biotelemetry. Drug and Alcohol Dependence 103(3): 137-147, 2009. (80 refs.)

The recreational drug gamma-hydroxybutyrate (GHB) has euphoric effects and can induce sedation and body temperature changes. GHB is frequently combined with other recreational drugs although these interactions are not well characterised. The present study used biotelemetry to provide a fine-grained analysis of the effects of GHB on body temperature and locomotor activity in freely moving rats, and investigated interactions between GHB and 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine (METH) and various antagonist drugs. GHB (1000 mg/kg) caused profound sedation for more than 2 h and a complex triphasic effect on body temperature: an initial hypothermia (5-40 min), followed by hyperthermia (40-140 min), followed again by hypothermia (140-360 min). A lower GHB close (500 mg/kg) also caused sedation but only a hypothermic effect that lasted up to 6 h. The dopamine D-1 receptor antagonist SCH 23390 (1 mg/kg), the opioid antagonist naltrexone (1 mg/kg), the benzodiazepine antagonist flumazenil (10 mg/kg), and the 5-HT2A/2C receptor antagonist ritanserin (1 mg/kg) did not prevent the overall sedative or body temperature effects of GHB (1000 mg/kg). However the GABA(B) antagonist SCH 50911 (50 mg/kg) prevented the hyperthermia induced by GHB (1000 mg/kg). Repeated daily administration of GHB (1000 mg/kg) produced tolerance to the sedative and hyperthermic effects of the drug and cross-tolerance to the sedative effects of the GABA(B) receptor agonist baclofen (10 mg/kg). A high ambient temperature of 28 degrees C prevented the hypothermia obtained with GHB (500 mg/kg) at 20 degrees C, while GHB (500 mg/kg) reduced the hyperthermia and hyperactivity produced by co-administered doses of MDMA (5 mg/kg) or METH (1 mg/kg) at 28 degrees C. These results further confirm a role for GABA(B) receptors in the hypothermic and sedative effects of GHB and show an interaction between GHB and MDMA, and GHB and METH, that may be relevant to the experience of recreational users who mix these drugs.

Van Sassenbroeck DK; De Neve N; De Paepe P; Belpaire FM; Verstraete AG; Calle PA et al. Abrupt awakening phenomenon associated with gamma-hydroxybutyrate use: A case series. Clinical Toxicology 45(5): 533-538, 2007. (43 refs.)

Case reports mention a sudden awakening from GHB-associated coma but do not specify its time course. The aim of the present case series was to investigate the time course of the awakening from GHB intoxication and the relationship to plasma concentrations of GHB and the presence of other drugs. Unconscious (GCS <= 8) participants at six large rave parties who were treated at medical stations were included. Serial blood samples were taken every 10 to 30 minutes for toxicological analysis. At the same time-points, the depth of coma was scored with the Glasgow Coma Score (GCS). Fifteen out of 21 unconscious patients proved to be positive for GHB. Fourteen of these had ingested one or more other drugs. The median GHB plasma concentration upon arrival in the medical station was 212 mu g/ml (range 112 to 430 mu g/ml). In 10 patients the GCS was scored more than twice, allowing study of the time course. The GCS of these patients remained <= 8 for a median time of 90 minutes (range 30 to 105 minutes). The duration of the transition between GCS of <= 8 and >= 12 was 30 minutes (range 10 to 50 minutes). A subgroup of five patients had a GCS of 3 upon arrival and remained at 3 for a median time of 60 minutes (range 30 to 110 minutes), while the median time for the transition between the last point with GCS 3 and the first with GCS 15 was 30 minutes (range 20 to 60 minutes). This case series illustrates that patients with GHB intoxications remain in a deep coma for a relatively long period of time, after which they awaken over about 30 minutes. This awakening is accompanied by a small change in GHB concentrations. A confounding factor in these observations is co-ingested illicit drugs.

Vroegop MP; Franssen EJ; van der Voort PHJ; van den Berg TNA; Langeweg RJ; Kramers C. The emergency care of cocaine intoxications. (review). Netherlands Journal of Medicine 67(4): 122-126, 2009. (30 refs.)

Cocaine is frequently used, especially among adolescents and by men between the age of 25 and 44. Many of them are able to use cocaine in normal day-to-day life, without any problems. Reduced prices of cocaine and other recreational drugs such as MDMA (ecstasy) and gamma hydroxybutyrate (GHB) has led to an increased incidence of intoxications with these drugs.' Since the production of cocaine is illegal, it may be impure and mixtures with other drugs such as atropine may occur. The treatment of patients with an acute cocaine intoxication can be complicated. Combination of cocaine with other drugs results in clinical pictures which are difficult to discriminate and that may have important consequences for treatment.

Weekley J; Simmonds L; Ali R. South Australian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 255. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (15 refs.)

The report, part of a national Australian survey, deals with patterns and nature of ecstasy use. It begins with an overview of the demographic characteristics of regular ecstasy users and its use in the general population. The drug trade is also described -- price, purity, availability, ecstasy markets and patterns of purchase -- as well as discussion of ecstasy-related harm, and users perceptions of risks and benefits. There is also discussion of other drug use among regular ecstasy users, with attention to methamphetamine, cocaine, ketamine, GHB, LSD, MDA, as well as ecstasy users use of "other drugs" (alcohol, marijuana, tobacco, inhalants, pharmaceutical stimulants, benzodiazepines, anti-depressants, and magic mushrooms.) In addition there are separate sections that provide information of health-related issues, such as overdose, self-reported symptoms of dependence, help-seeking efforts; criminal activity and perceptions of policing. It concludes with discussion of policy implications of the findings.

Whittingham JRD; Ruiter RAC; Bolier L; Lemmers L; Hasselt N; Kok G. Avoiding counterproductive results: An experimental pretest of a harm reduction intervention on attitude toward party drugs among users and nonusers. Substance Use & Misuse 44(4): 532-547, 2009. (31 refs.)

In two experimental studies, the authors tested written health education materials on the personal acceptance of party drug use. Following a harm reduction strategy, the materials provided information on minimizing potential hazards associated with drug use. Among users and nonusers, potential aversive effects of these materials were examined on measures of attitude, intention, and outcome expectancy toward party drug use. Participants were recruited in the city center of Maastricht, The Netherlands, in nightlife settings that were popular among young people. In the first experiment, a leaflet on ecstasy use was evaluated among ecstasy users and nonusers. Results showed neither health promoting effects, nor counterproductive results on the outcome measures. In the second experiment, the effects of two different formats (leaflet vs. infocard) about two different kinds of party drugs (ecstasy vs. GHB) were compared within a nonusing population. Again, results showed no positive changes on the outcome measures toward ecstasy use as a result of exposure to the ecstasy materials. However, exposure to the GHB materials resulted into a more negative attitude toward GHB use (leaflet and infocard) and lower estimates of the likelihood of positive outcomes of use (infocard). The study's limitations and implications are discussed, including the need for experimental pretesting.

Winger G; Galuska CM; Hursh SR. Modification of ethanol's reinforcing effectiveness in rhesus monkeys by cocaine, flunitrazepam, or gamma-hydroxybutyrate. Psychopharmacology 193(4): 587-598, 2007. (16 refs.)

Background: Although ethanol is frequently used in combination with other psychoactive drugs, the behavioral and pharmacological reasons for this form of polydrug abuse have not been well described. Materials and methods Rhesus monkeys with indwelling intravenous catheters produced intravenous injections of ethanol (50, 100, or 200 mg/kg/inj), flunitrazepam (0.001-0.03 mg/kg/inj), cocaine (0.01 or 0.03 mg/kg/inj), or combinations of ethanol and these drugs or gammahydroxybutyrate (GHB) (1.0 or 3.2 mg/kg/inj) by lever pressing according to a fixed-ratio schedule. The response requirement for each drug or drug combination was increased across sessions (10, 32, 100, 320, or 1,000). The dependent variables were rates of responding maintained by the drug or drug combination and the elasticity of drug demand when consumption was expressed as a function of price. Results Elasticity (P-max) values for each drug varied among the monkeys but retained the same rank order for the monkeys, suggesting a fundamental difference in the animals' apparent sensitivities to the reinforcing effects of the drugs. Combining ethanol with the other drugs did not increase their reinforcing effectiveness. GHB (ineffective in previous studies) did not modify ethanol's reinforcing effects; demand functions for the combination of ethanol and flunitrazepam were slightly less elastic than for ethanol alone, but no different from that for flunitrazepam alone; adding ethanol to cocaine detracted from the reinforcing effectiveness of cocaine. Conclusions: The hypothesis that use of ethanol in combination with sedative and stimulant drugs is due to an ability of ethanol to enhance the reinforcing effects of these drugs is not supported.

Wood DM; Warren-Gash C; Ashraf T; Greene SL; Shather Z; Trivedy C et al. Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD). QJM. An International Journal of Medicine 101(1): 23-29, 2008. (33 refs.)

Background: Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects. Aim: The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs. Design and methods: Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present. Results: In 2006, there were a total of 158 ED presentations, of which 150 (94.9) and 8 (5.1) were GHB and GBL self-reported ingestions respectively; 96.8 (153) were recreational use. Of the 418 samples seized, 225 (53.8) were in liquid form; 85 (37.8) contained GHB and 140 (62.2) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions. Conclusions: Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.

Wu LT; Schlenger WE; Galvin DM. Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths. Drug and Alcohol Dependence 84(1): 102-113, 2006. (101 refs.)

Background: The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N = 19,084). Methods: Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs. Results: Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence. Conclusions: Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.