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Uses. Although GHB is commercially manufactured, it is also produced within the bodies of mammals where it may promote hibernation and help the brain to withstand deficient oxygen supply. The substance was once widely available as a nutritional supplement in health food stores. People consumed it in hopes that the product would promote fat reduction and muscle development. Human experiments confirm that the drug can increase the body's levels of human growth hormone while the substance is circulating in the bloodstream, but the studies did not last long enough to show whether this GHB effect built muscles or reduced fat. The hope for muscle development has been tested in experiments with rats and dogs, but without success; the drug failed to increase the animals' growth hormone levels.

Where this drug is legal, its main medical use is for anesthesia and for treating drug abuse patients. It has been used experimentally to study epilepsy, to reduce damage from exposure to nuclear radiation, and to treat fi-bromyalgia (a rheumatic disease causing weariness, muscle pain, and stiff joints). Some efforts to help schizophrenics with the substance have been successful; some have not. Experiments with hamsters indicate the drug may have potential for reducing damage from bleeding. Animal experiments also suggest the drug may have potential in treating heart attack. Although GHB is a depressant that has been used successfully to treat insomnia, it has also been used to treat narcolepsy, a condition in which people have difficulty staying awake.

According to law enforcement authorities, rapists have exploited GHB's sedative effect to make victims pliable. From 1996 to 1999 a total of 22 such reports reached the U.S. Drug Enforcement Administration. From 1996 to 1999 a group of 2,003 urine samples were compiled from victims across the United States in sexual assault cases where drugs were a suspected weapon used by the assailant. Analysis found GHB or flunitrazepam in fewer than 2%, and the number of instances declined in each passing year. At about the same time, a 26-month study collected 1,179 samples from sexual assault cases nationwide in which a drug was suspected of playing a role and found 4% to be positive for GHB.

Persons wanting GHB sometimes obtain GBL instead (gamma butyrolac-tone, nicknamed Blue Nitro Vitality or Firewater). The body converts a dose of GBL into GHB, so their effects are about the same. Products containing GBL can be poisonous, a fact that some drug abusers learn in dramatic ways.

Recreational users take GHB for euphoria and hallucinations, to increase sociability, to promote interest in sexual activity, and to lower inhibitions. One drug misuser who used GBL likened its effects to alcohol. GBL is also marketed as a mood elevator, a quality that some GHB users ascribe to that substance as well. Researchers using various scientific measurements have confirmed that GHB promotes mental calmness but may simultaneously make a person feel discontented.

Drawbacks. Tests using medical-size doses (which may be smaller than ones taken by illicit users) reveal no impairment of mental or physical abilities; the researchers concluded that GHB does not hurt job performance or ability to drive a car. Nevertheless, GHB is suspected of causing an automobile driver to pass out, and the drug's sleep-inducing properties make it inadvisable to use while operating dangerous machinery. Supposedly the drug causes amnesia about events that occur while a person is intoxicated with the substance, although experiments using medical-size doses find no effect on short-term memory. A large-enough dose can slow heart rate and interfere with a person's ability to move and make a person vomit and fall asleep. Breathing difficulty can occur. Seizures have been reported, but some authorities believe those reports have misidentified various muscle contractions as seizures. In monkeys the drug lowers body temperature. In rats that effect depends on a dose's size, with small amounts raising body temperature and large amounts lowering it. An odd overdose effect has been observed in persons who temporarily stop breathing yet become violent despite that impairment. The drug reduces control of urination and defecation. Although GHB can cause blood to appear in urine, no damage to body organs has been observed. People can take medical doses for years without showing any psychotic symptoms.

Abuse factors. Experiments with monkeys show little abuse potential in the drug, but some medical personnel who treat drug abusers consider the potential to be high. GHB abusers, however, tend to have bad relationships with other drugs as well, so using such a population to evaluate GHB's particular abuse potential is treacherous.

GHB has been used successfully to reduce or even eliminate withdrawal symptoms in alcohol addicts. One alcohol withdrawal study found GHB as effective as diazepam, a standard drug given to aid alcohol withdrawal; in addition, GHB worked faster than diazepam at alleviating sadness, restlessness, and anxiety among patients. GHB has also reduced craving for alcohol on a long-term basis. One group of researchers administering GHB for this purpose observed no troublesome unwanted effects, and barely 1% of patients began abusing GHB—a disturbing percentage in a general population but a very low rate for a drug addict population. Tightly controlled dispensing conditions, however, may be the reason for that low rate; abuse might be heavier among persons with ready access to the drug. GHB is cross-tolerant enough with heroin and methadone to diminish their withdrawal symptoms. Animal experiments have found modest cross-tolerance with morphine, dextroamphetamine, and LSD.

In studies measuring GHB's usefulness for treating narcolepsy, no tolerance was observed even though some patients had been taking the drug for up to nine years. Dispute exists about whether tolerance develops in nonmedical usage. GHB dependence can emerge after taking large doses for a long time. Diazepam can ease GHB withdrawal symptoms. Tremors, uneasiness, difficulty with sleep, visual and auditory hallucinations, high blood pressure, faster heartbeat, sweating, nausea, and vomiting can be part of the withdrawal syndrome. Symptoms may last for over two weeks. GHB withdrawal can include psychosis so severe that people have to be restrained, but how much of that reaction is caused by the drug and how much is caused by the individual's underlying personality may be unclear. Dosage affects severity of withdrawal, with heavy users having the most trouble.

Drug interactions. The HIV (human immunodeficiency virus) drugs saqui-navir and ritonavir can have serious and potentially fatal interactions with GHB. Simultaneous use of alcohol or other depressants with GHB increases risk of overdose. The drug has a high sodium content, which might be a problem for persons needing to limit their intake of sodium.

Cancer. Tests on rats and mice indicate GHB does not cause cancer.

Pregnancy. Whether the drug causes birth defects is unknown. It passes into the fetus if a pregnant woman takes a dose and can reduce fetal respiration. When the substance was still a legal medical drug, GHB was used as an aid to childbirth.

Additional scientific information may be found in:

"Adverse Events Associated with Ingestion of Gamma-butyrolactone—Minnesota, New Mexico, and Texas, 1998-1999." MMWR. Morbidity and Mortality Weekly Report. 48 (1999): 137-40. Bernasconi, R., et al. "Gamma-hydroxybutyric Acid: An Endogenous Neuromodulator with Abuse Potential?" Trends in Pharmacological Sciences 20 (1999): 135-41. Dyer, J.E. "Gamma-hydroxybutyrate: A Health-Food Product Producing Coma and

Seizurelike Activity." American Journal of Emergency Medicine 9 (1991): 321-24. Ferrara, S.D., et al. "Effects of Single Dose of Gamma-hydroxybutyric Acid and Lora-

zepam on Psychomotor Performance and Subjective Feelings in Healthy Volunteers." European Journal of Clinical Pharmacology 54 (1999): 821-27.

Galloway, G.P., et al. "Gamma-hydroxybutyrate: An Emerging Drug of Abuse That Causes Physical Dependence." Addiction 92 (1997): 89-96.

Hernandez, M., et al. "GHB-Induced Delirium: A Case Report and Review of the Literature on Gamma Hydroxybutyric Acid." American Journal of Drug and Alcohol Abuse 24 (1998): 179-83.

Li, J., S.A. Stokes, and A. Woeckener. "A Tale of Novel Intoxication: A Review of the Effects of Gamma-hydroxybutyric Acid with Recommendations for Management." Annals of Emergency Medicine 31 (1998): 729-36.

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