What is GBH?

Gamma-hydroxy butyrate (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 other drugs that have depressant effects.

GBH 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 aesthetic, and for treatment of the sleep disorders, insomnia, and narcolepsy. More recently, GBH has been trialled as a treatment for alcohol and opiate (eg heroin) withdrawal.

What Does GBH Look Like?

GBH commonly comes as a colourless, odourless, bitter, or salty-tasting liquid, usually sold in small bottles or vials. It also occasionally appears in a bright blue liquid form as ,blue nitro, however the different name simply reflects the addition of blue food dye rather than any difference in the drug. GBH also comes as a crystal powder. It is mostly taken orally.

Generally, two broad groups of people have been known to take GBH. In the 1980's, body-builders used the drug 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 and club scene are using GBH for its euphoric and sedative effects.

GBH has also been used as a 'date-rape drug' because of its ability to impair movement and speech, to cause subsequent amnesia, and because it can be added to drinks without visible trace.

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 using it has eaten; and,
  

• The physical and psychological characteristics of the person.

The effects of GBH 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 GBH is the narrow margin between an amount that 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 has been manufactured correctly. Improperly made GBH can result in an extremely toxic mixture of GBH and the chemical sodium hydroxide.

Immediate effects

The effects of GBH are generally 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;
  

• Iincreased confidence;
  

• Reduced inhibitions;
  

• Dizziness;
  

• Headache;
  

• Increased sociability; and,
  

• Enhanced sense of touch.

An increase in the amount or strength of GBH used may result in the initial feelings of euphoria being replaced by effects including:

• Confusion;
  

• Agitation;
  

• Extreme drowsiness/grogginess;
  

• Hallucinations;
  

• Difficulty focusing eyes;
  

• Vomiting;
  

• Stiffening of muscles;
  

• Disorientation;
  

• Convulsions/seizures;
  

• Unconsciousness;
  

• Abrupt short-term coma;
  

• Respiratory collapse;
  

• Subsequent amnesia; and,
  

• Impaired movement and speech.

There appears to be a very fine line between the amount of GBH required to achieve the desired affect, and the amount that leads to coma. As there is usually no way of knowing its strength, the risk of overdosing is high. Combining GBH with other drugs will also increase the dangers.

For example, using GHB with other central nervous system depressants, such as alcohol, benzodiazepines (such as Valium), or opiates (such as heroin), will intensify the effects of GBH, and increase the risk of an overdose.

Deaths have been associated with the use of GBH in the United States. However, there is debate over whether death can result from using GBH alone, or whether it only occurs in combination with other drugs, particularly alcohol.

An added risk of overdose is that GBH 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 GBH. Apart from the potential to develop physical and psychological dependence, the health and social consequences of long-term use are largely unknown.

Dependence

Some reports suggest that some people can become both physically and psychologically dependent upon (addicted to) GBH.

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 experienced.

A sign of psychological dependence is when the use of a drug becomes increasingly important in a person's life, and begins to take priority over other activities and responsibilities.

A person who becomes dependent on a drug can find it difficult to cut down or stop using it.

Withdrawal

Although research to date has been limited, there have been reports that prolonged use of high doses of GBH may lead to withdrawal symptoms after abrupt cessation of GBH use. Withdrawal symptoms may include:

• Agitation and anxiety;
  

• Insomnia;
  

• Muscle cramping; and,
  

• Tremors.

Withdrawal symptoms can be experienced for three to twelve days before subsiding.

GBH interactions with treatments can increase the likelihood of an overdose by increasing the blood plasma level of GBH in the system, by up to five to ten times.

There have been documented instances where GBH will interact with some treatments to produce extreme adverse effects including coma. If you are taking HIV treatments and intend using GBH you should reduce the amount of GBH that you take.

(Source: "Risky Cocktails", Guy Pujol, AIDS Survival Project, April 2003)

Tips to Minimise Damage

Warnings from health care workers in late 1997 about GBH were generally well adhered to, with very low numbers of people using the drug in Australia prior to 2001. However, GBH is growing in popularity and consequently there have been increased amounts of people turning up to t hospital Emergency departments suffering from a GBH overdose.

Is There a Correct Dose?

Effects can be different from solution to solution, and from person to person. A dose that works for others may not work for you. The right amount one night may be too much the next. The only way to avoid harm from GBH is to not use it at all.

Before You Take More

Wait long enough to feel the effects of what you have taken before deciding to take more. Taking that little bit extra could result in overdose. Remember, your decision to take more could be affected by what you have already taken.

Mixing With Other Drugs

Mixing GBH with other drugs can cause complicated cross-reactions. Avoid combining GBH with 'K' (examine), alcohol, painkillers, tranquilisers, antihistamines', and opiates. Like GBH, these drugs have a sedative effect, mixing them with GBH can lead to deep unconsciousness, coma, and even death.

Feeling Strange?

Let your friends know what you’re taking. Symptoms of GBH overdose include:

• Confusion;
  

• Nausea;
  

• Visual disturbances;
  

• Incoherent speech;
  

• Memory loss;
  

• Vomiting;
  

• Drowsiness;
  

• Uncontrolled body movements;
  

• Coma; and,
  

• Respiratory arrest.

If you are feeling unwell, tell a friend or a friendly face. Seek assistance immediately from first aid personnel or security staff.

Someone who displays uncontrolled body movements, cannot be woken, or is incoherent needs immediate medical attention. Attract the attention of first aid personnel or security staff.

Driving after taking GBH

Driving under the influence of GBH is considered more dangerous than driving under the influence of alcohol. If under the influence or coming down from GBH, take a taxi or public transport.

GBH can affect your behaviour, and your ability to make sound decisions about your health and well-being, and that of others. Keep condoms and water-based lube handy.

Other Important GBH Information

Batches of GBH in circulation during special community events or dance parties can vary greatly in strength from those usually available. If you accept GBH from someone you don't know, there is an even greater risk of overdose. Think about this before going out as your judgement may be clouded if you have already taken something else at the party.

If a friend is getting drowsy from GBH, don’t let them fall asleep because they may not wake up. Try to keep them awake and moving until the effects have worn off. The unconscious state caused by using GBH is call 'G-sleep' and is similar to being in a coma.