GHB PDF - ZARQA University

Faculty of Pharmacy 1 11/30/2024 GHB  2 Outline  GHB, gamma-hydroxybutyric acid, is a depressant drug recently added to the list of illegal substan...

Faculty of Pharmacy 1 11/30/2024 GHB  2 Outline  GHB, gamma-hydroxybutyric acid, is a depressant drug recently added to the list of illegal substances. High doses cause a coma-like state that has resulted in fatalities.  GHB is a drug which is available as sodium oxybate (or under the brand name Xyrem) as a treatment for narcolepsy in adult patients 3 and has been used therapeutically in the treatment of alcohol and opiate dependency  Other names : Cherry meth, scoop, eclipse, fantasy, growth hormone booster, liquid ecstasy.  GHP + Amphetamine : Max Faculty of Pharmacy 11/30/2024  3 What does it look like?  GHB is usually sold as a liquid or as a white powder that is dissolved in a liquid, such as water, juice, or alcohol.  GHB dissolved in liquid has been packaged in small vials or small water bottles. In liquid form, GHB is clear and colorless and slightly salty in taste. Faculty of Pharmacy 11/30/2024  4 GBL and BD as alternative  When GHB became illegal, users turned to a related substance that had the same effect.  GBL is gamma-butyrolactone. is a pro-drug’ of GHB, which means that it converts to GHB within the body. It is a solvent available in floor cleaning products, nail polish, and glue removers.  It quickly became a popular substitute and was sold as an herbal remedy in “health” shops, in gyms.  “In December 1999, NBA basketball player Tom Gugliotta went into respiratory failure and almost died from an herbal remedy containing GBL.” Faculty of Pharmacy 11/30/2024  5 BD  BD—1,4-butanediol—is also an industrial solvent.  When it is ingested, it is quickly converted to GHB.  Because BD is metabolized by alcohol dehydrogenase, the same enzyme used to metabolize alcohol, taking BD together with alcohol increases the effects of both, and adds to the risk of damage to the liver or kidneys. Faculty of Pharmacy 11/30/2024  6 The Story of GHB  GHB was first synthesized in France in 1960 by Dr. Henri Laborit, a researcher looking for a better anesthetic. “Laborit knew that the major inhibitor of the central nervous system was GABA. He wanted to create a GABA-like substance that could be taken by mouth and penetrate the brain.”  GHB is very similar to GABA: GHB = gamma-hydroxy-butyric acid GABA = gamma-amino-butyric acid Faculty of Pharmacy 11/30/2024  7 Chemical Characteristics & M.O.A  GHB is a very simple substance with a chemical structure similar to the neurotransmitter GABA.  It is found naturally in all animal and human cells and also in cerebrospinal fluid. Most natural GHB in the body apparently is from the breakdown of GABA, and it is also reformed back into GABA.  In addition, GHB is made in the body from naturally occurring GBL. In the brain, the action of GHB is very complex.  It binds to GABA-B receptors and interferes with dopamine transmission, inhibits noradrenaline release in the hypothalamus, and mediates the release of an opiate-like substance in the striatum. Faculty of Pharmacy 11/30/2024  8 M.O.A  It produces a biphasic dopamine response, increasing its release at high doses and inhibiting its release at lower doses.  Binding sites are present in the cortex, midbrain, substantia nigra, basal ganglia, and, most predominantly, in the hippocampus—the location where memory is formed. The result of all this complex activity is that most of the 8 functions of GHB are still largely unknown. Faculty of Pharmacy 11/30/2024  9  The first studies of GHB showed that it might have some promise as an anesthetic. It rapidly put patients into a deep coma. Unfortunately, it did not prevent pain and it seemed to cause neurological problems, which dampened enthusiasm for its use in the operating room.  Its ability to cause deep sleep, however, made the drug attractive to those suffering from insomnia. GHB became popular in Europe as a non- addictive sleeping aid that was available without prescription. Faculty of Pharmacy 11/30/2024  10 Who is Abuse?  In the United States, GHB was sold at health food stores, gyms, and by mail order, as a “natural” sleeping aid and nutritional supplement.  Bodybuilders believed that GHB was an artificial variant of growth hormone that helped them increase muscle mass.  Others took it for its euphoric or dreamy effects, and it became a popular dance-club drug. It causes deep sleep such as flunitrazepam  Because of this, the DEA added GHB to the list of Schedule I drugs under the Controlled Substances Act on March 13, 2000, indicating that it has no acceptable medical use and a very high abuse potential. Faculty of Pharmacy 11/30/2024  11 MEDICAL USES  In 2002, the FDA approved GHB for the treatment of narcolepsy, renamed it sodium oxybate, and rescheduled it under Schedule III. The prescription drug is sold under the trade name Xyrem,  Xyrem® (which is sodium oxybate) is the trade name of the Food and Drug Administration (FDA)-approved prescription medication.  GHB does have a number of recognized medical applications. It continues to be used in Europe as a general anesthetic, sleeping aid, and as a treatment for anxiety and stress.  It is also a common treatment of alcohol and opiate addiction and withdrawal.  Perhaps most remarkable is its use in childbirth. In France and Italy, GHB is used to calm anxious mothers about to give birth, to accelerate the dilation of the cervix, and to protect the baby from hypoxic injury. Faculty of Pharmacy 11/30/2024  12 How it taken and dose?  The salty GHB powder is dissolved in water or juice and can be easily carried and passed around. Because it is odorless and colorless, it is difficult to detect.  The typical dose of pure GHB powder is one to three grams, taken as a drink when the powder is dissolved in water or fruit juice. Some people use as much as four or five grams, particularly if they use it often and have developed a tolerance to it. Faculty of Pharmacy 11/30/2024  13 PK  GHB is rapidly absorbed after swallowing, especially on an empty stomach. The maximum blood concentration is reached in 20 to 30 minutes with a typical dose, or longer with a larger dose or if it is mixed with food. The effect is usually felt within 15 minutes.  The major effects last for one to two hours, followed by an additional period of about two hours with more subtle effects. This pattern is much the same as alcohol,  The elimination half-life—the time it takes to decrease the amount in the blood by half—is 27 minutes. The body metabolizes GHB to carbon dioxide, which is then exhaled. Faculty of Pharmacy 11/30/2024  14 Effect on CNS  It is like alcohol or MDMA (ecstasy) it is often called “liquid ecstasy,” or “liquid X.  The hallmark of GHB use is central nervous system depression. The onset of action is very rapid. If too much is taken, unconsciousness can occur after 15 minutes and can lead to a coma within 30 to 40 minutes.  A moderate dose of two to three grams produces drowsiness and sleep. After swallowing a large dose of four to five grams (about one teaspoonful), a very deep sleep and coma can result.  The neurologic effects of GHB range from mild symptoms, such as blurred vision, dizziness, to severe impairment, including respiratory failure, coma, and death Faculty of Pharmacy 11/30/2024  15 Effect on CNS  Typically, the user experiences a short period of euphoria followed by a rapid and profound decline in the level of consciousness. Along with sleepiness, there may be spastic jerks and flailing limbs.  At higher doses, GHB produces light-headedness, vertigo, drowsiness, slurred speech, and muscle incoordination, which may progress to uncontrolled movements, a coma-like state, and arrested breathing.  Although most people recover within a few hours, GHB can be fatal, especially if combined with alcohol or other drugs that compound the effect. Faculty of Pharmacy 11/30/2024  16 Effect on Heart and lungs  In one study, about 70 percent of GHB users had U waves on the ECG, a condition thought to result from the effect of GHB on the blood potassium balance, which has a strong effect on the heart. Many of these characteristics may be due to the combination of GHB with alcohol or other drugs.  GHB slows and deepens respiration. This effect lasts about an hour, but if GHB has been mixed with alcohol or other drugs, the slowed breathing may last up to five hours or longer.  The decrease in breathing rate can be extreme, to the point that breathing stops entirely. In some unusual cases, mechanical ventilation has been required for up to 13 hours. At least five deaths have been reported due to respiratory failure Faculty of Pharmacy 11/30/2024  17 OTHER EFFECTS  Some users have caustic burns to the lips and mouth from the concentrated powder, or from poorly mixed GHB.  bowel movement effect due to muscle relaxation.  Finally, contamination of homemade GHB with other substances is common. Depending on the method used, the GHB may contain various amounts of unconverted GBL, solvents, heavy metals, and polyester derivatives, all of which are toxic and can cause serious illness Faculty of Pharmacy 11/30/2024  18 Using GHB/GBL with other drugs  Mixing GHB/GBL with other drugs can have unpredictable effects and increase the risk of harm. GHB/GBL and MDMA/methamphetamine: risk of heart strain and respiratory arrest. GHB/GBL and nitrous oxide (nangs): can cause impaired coordination, memory loss, passing out. GHB/GBL and alcohol/opioids/ketamine/benzodiazepines: can cause difficulty breathing, passing out, and possible death.6-8 Using GHB/GBL to help with the symptoms of the come down after using stimulants can lead to a dependence on both drugs. Faculty of Pharmacy 11/30/2024  19 Test  GHB can be detected in the urine and blood by a test using gas chromatography mass spectrometry. After ingestion, the test will be positive for about 4 to 8 hours in the blood and 12 hours in the urine. Faculty of Pharmacy 11/30/2024  20 Withdrawal Signs  GHB-dependent people may find it very hard to stop using or cut down because of withdrawal symptoms. Withdrawal from GHB may last two weeks or longer.  These can include: confusion, agitation, anxiety, panic insomnia shaking muscle cramps perspiration hallucinations tachycardia (rapid heartbeat) seizures/convulsions (fits) delusions or paranoia psychosis sweats hypertension (high blood pressure) nausea or vomiting.  Sudden withdrawal from high doses may also result in bowel and bladder incontinence and blackout to stop using or cut down because of withdrawal symptoms. Withdrawal from GHB may last two weeks or longer. Faculty of Pharmacy 11/30/2024  21 Addiction  Daily use of GHB can lead to addiction, with both physical and mental dependence in a small percentage of users. Faculty of Pharmacy 11/30/2024  22 Overdose  At higher overdose levels, GHB can produce both unconsciousness and vomiting—an extremely dangerous combination. Vomiting while unconscious can lead to inhaling the vomit and dying by suffocation.  The usual form of overdose of GHB is an unresponsive coma. Faculty of Pharmacy 11/30/2024  23 The END Faculty of Pharmacy 11/30/2024