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B4: 4 Ecstasy and
Party Drugs HO2
What is Fantasy?
Gamma-hydroxybutyrate (GHB) is also known as ‘fantasy’, ‘grievous bodily harm’
(‘GBH’), ‘liquid ecstasy’ and ‘liquid E’. It is classed as a depressant drug that contains
sedative and, at sufficient doses, anaesthetic properties. Depressant drugs slow down
the activity of the brain and other parts of the central nervous system. Alcohol, heroin
and benzodiazepines are drugs that also have depressant effects.
GHB occurs in the body naturally, as a neurochemical compound. It was first
manufactured in 1960, and has been used in several countries as a general anaesthetic,
and for treatment of the sleep disorders insomnia and narcolepsy. More recently, GHB
has been trialled as a treatment for alcohol and opiate (e.g. heroin) withdrawal.
What does it look like?
GHB commonly comes as a colourless, odourless, bitter or salty-tasting liquid, usually
sold in small bottles or vials. It also comes as a crystal powder. It is mostly taken orally,
but there have been reports of people injecting the drug. Some media reports have
implied that GHB also comes in a bright blue liquid form (‘blue nitro’); however, it is
important to note that manufacturers can change the colour of GHB by adding a different
colour food dye.
Generally, two broad groups of people have been known to take GHB. In the 1980s,
bodybuilders used it to promote the kind of sleep known as 'slow wave sleep', during
which a growth hormone is released. More recently, an increasing number of people in
the dance/club scene are using GHB for its euphoric and sedative effects. GHB has also
been identified as a ‘date-rape drug’ due to effects of amnesia, impairing movement and
speech, and because it can be added to drinks without visible trace.
Effects: Immediate and long-term
The effects of any drug can vary from person to person, and depend on
many factors, including:
 how much of the drug is used
 the strength of the drug
 how it is used
 how often the person uses it
 how recently the person has eaten
 the physical and psychological characteristics of the person.
The effects of GHB appear to vary greatly according to the amount used—a small
increase in amount can result in a dramatic increase in effect. One of the most
dangerous aspects of using GHB is the small difference between an amount that
Resource Kit for GP Trainers on Illicit Drug Issues
Part B4 Drugs: GHB
produces the desired effect and the amount that results in overdose. A further risk is that
there is often no way to be sure that the drug is manufactured correctly. Improperly
made GHB may result in an extremely toxic mixture of GHB and the chemical sodium
Immediate effects
Generally, the effects of GHB are experienced within 15 minutes of use, and last for
approximately 3 hours. Effects of lower amounts may include:
 a sense of well-being
 relaxation
 drowsiness
 induced sleep
 nausea
 increased confidence, reduced inhibitions
 dizziness
 headache
 increased sociability
 enhanced sense of touch.
An increase in the amount or strength of GHB used may result in the initial feelings of
euphoria being replaced by effects including:
 confusion
 agitation
 extreme drowsiness/grogginess
 hallucinations
 difficulty focussing eyes
 vomiting
 stiffening of muscles
 disorientation
 convulsions/seizures
 unconsciousness/abrupt short-term coma
 respiratory collapse
 amnesia (afterwards)
 impaired movement and speech.
There appears to be a very fine line between the amount of GHB required to achieve the
desired effect and that which leads to coma. As there is usually no way of knowing the
strength of GHB, the risk of overdosing is high. Combining GHB with other drugs will
also increase the dangers. For example, using GHB with another central nervous system
depressant, such as alcohol.
Benzodiazepines (such as Valium) or opiates (such as heroin) will intensify the effects
and increase the risk of overdosing. Deaths have been associated with the use of GHB
in the United States. However, there is debate over whether death can result from using
GHB alone or using GHB with other drugs, particularly alcohol.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B4 Drugs: GHB
An added risk of overdose is that GHB can cause both unconsciousness and vomiting,
which increases the risk of choking on vomit.
Long-term effects
Little research has been conducted on the effects of long-term use of GHB. Apart from
the potential to develop physical and psychological dependence, the health and social
consequences of long-term use are largely unknown.
Although this is not widely known, some reports suggest that some people can become
both physically and psychologically dependent (addicted) on GHB.
Physical dependence occurs when a person's body becomes used to functioning with
the drug present. If the person suddenly stops their drug use, withdrawal symptoms are
A sign of psychological dependence is when the use of a drug becomes increasingly
important in a person's life—the drug use may take priority over other activities and
A person who becomes dependent on a drug may find it difficult to cut down or stop
using it.
Although research to date has been limited, there have been reports that prolonged use
of high doses of GHB may lead to withdrawal symptoms after abrupt cessation of GHB
use. Symptoms may include agitation/anxiety, insomnia, muscle cramping and tremors.
Withdrawal symptoms may be experienced from 3 to 12 days before subsiding.
Pregnancy and GHB
Little is known about GHB use during pregnancy. As is the case with many other licit and
illegal drugs, GHB use during pregnancy is not recommended. Drug use during
pregnancy can increase the incidence of premature labour, resulting in low birth weight
babies. If the mother continues to use GHB while breastfeeding, it is possible that the
drug will be present in the mother's milk and possibly can cause adverse effects on the
( is GHB?
Accessed 10 February 2004)
Resource Kit for GP Trainers on Illicit Drug Issues
Part B4 Drugs: GHB