When You're Partying And This Happens

GHB OVERDOSE

 

First of all, if you have ever been in a situation where you were hanging and partying with someone and that person overdosed on GHB and you did not leave their side then I salute you. It is a scary situation, and a recent study by Freestone and colleagues (2023) uncovered some common interventions that people are using when responding to a GHB overdose.

 

 Their study revealed a need for education on how to handle these situations (Freestone et al, 2023), and here are some of their suggestions:

When first notice something is wrong.

 Are they so sleepy that it's hard to stay awake and think clearly?

Do Not Leave Them Alone 

• Check their breathing (Freestone et al, 2023):

• Look, Listen, and Feel for Breathing.

• If non-responsive and not normal breathing, then first aid recommendations are to call EMS and start CPR

 Call emergency medical services if someone is not responsive, assess breathing, and place in the recovery position. To manage airway open mouth and check for foreign material. If foreign material is present roll the patient onto their side and clear the airway. If there is no foreign material, leave the patient in the position found, and open the airway by tilting the head back with a chin lift.

 

References

  Freestone, J., Ezard, N., Bourne, A., Brett, J., Roberts, D., Hammoud, M., Nedanoski, A., Prestage, G., & Siefried, K. (2023). Understandings, attitudes, practices and responses to GHB overdose among GHB consumers [Review of Understandings, attitudes, practices and responses to GHB overdose among GHB consumers]. Harm Reduction Journal, 20(1). https://doi.org/10.1186/s12954-023-00857-z

GHB And What You Don't Know

 

GHB and the Brain

• GHB, found endogenously in the brain, is a precursor of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) (Le & Richards, 2019).
• GHB affects both GABA-B and GHB receptors.

GHB influences dopamine in a two-phase manner. At lower doses, it triggers the release of dopamine by interacting with GHB receptors. On the other hand, higher doses initially suppress dopamine release due to their agonist effects on GABA-B receptors, which results in neuro-inhibition and depression of the central nervous system (CNS). However, following this initial suppression, there is an increase in dopamine release via the GHB receptor.

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• This dual action of GHB explains its sedative and excitatory effects. The primary concern with GHB toxicity is the depression of the central nervous system and respiratory system.

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Substitutes for GHB, namely Gamma-butyrolactone and 1,4-butanediol, were previously marketed as industrial solvents or dietary supplements. Upon oral consumption, these substances quickly transform into GHB, thereby replicating the same clinical impacts associated with GHB toxicity. (Le & Richards, 2019)

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• GHB is rapidly absorbed into the body
• Average time of five to fifteen minutes for onset of action.
• Initially, The user experiences a wave of euphoria (Le & Richards, 2019).
• Symptoms typically peak within thirty to sixty minutes after administration.
• You can usually count on the effects lasting for two to four hours.
• Its half-life elimination ranges from twenty to sixty minutes.

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According to Le and Richards (2019) here are some dosing considerations:

• Lower doses of GHB (10 mg/kg) can cause memory loss and varying degrees of sedation.
•  Doses ranging from 20 mg/kg to 30 mg/kg induce cycles of rapid eye movement (REM) sleep.
• 
  Higher doses (50 mg/kg) can lead to slower heart rate, respiratory depression, and even coma. 
  
  The presence of other intoxicants, particularly alcohol, can enhance the effects and prolong the duration of symptoms.

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So how much are you actually taking??

The typical dosage of the substance falls between 1 and 5 grams, which equates to about 1-2 teaspoons mixed into a drink, depending on the purity of the compound. However, the concentrations in these homemade concoctions can vary significantly, often leaving users uncertain about the actual dosage they are consuming. (WHAT IS GHB?, n.d.)

Analogues

• Substances often used as alternatives to GHB include GBL (gamma-butyrolactone) and 1,4 BD (also known as “BD”), which stands for 1,4-butanediol.

 

These analogues are legally available as industrial solvents used in the production of various products such as polyurethane, pesticides, elastic fibers, pharmaceuticals, and coatings on metal or plastic.

• Illegally, they are also sold as supplements for purposes like bodybuilding, fat loss, reversing baldness, improving eyesight, and combating aging, depression, drug addiction, and insomnia. GBL and BD are marketed under innocuous labels like “fish tank cleaner,” “ink stain remover,” “ink cartridge cleaner,” and “nail enamel remover,” with a price tag of approximately $100 per bottle — a cost significantly higher than similar products. (WHAT IS GHB?, n.d.)

References

Le, J. K., & Richards, J. R. (2019, January 20). Gamma-Hydroxybutyrate (GHB, “G”, Liquid X, Liquid E, Juice, Mils, Fantasy) Toxicity. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430781/

‌WHAT IS GHB? (n.d.). https://www.dea.gov/sites/default/files/2020-06/GHB-2020.pdf

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Drug Overdose Statistics

 More than 932,000 people have died since 1999 from a drug overdose.1 In 2020, 91,799 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths increased by 31% from 2019 (21.6 per 100,000) to 2020 (28.3 per 100,000).

Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. 82.3% of opioid-involved overdose deaths involved synthetic opioids.

•  Opioids were involved in 68,630 overdose deaths in 2020 (74.8% of all drug overdose deaths).
• Drug overdose deaths involving psychostimulants such as methamphetamine are increasing with and without synthetic opioid involvement

References

CDC. (2021, June 23). Drug overdose deaths. Www.cdc.gov; CDC. https://www.cdc.gov/drugoverdose/deaths/index.html

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FACTS ABOUT FENTANYL

 Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine 

• There are two types of fentanyl:  
• pharmaceutical fentanyl 
• Illegally made fentanyl 

Illegally made fentanyl (IMF) is available on the drug market in different forms, including liquid and powder. 

In its liquid form, IMF can be found in nasal sprays, eye drops, and dropped onto paper or small candies. 

STREET NAMES FOR IMF INCLUDE: 

• Apache 
• Dance Fever 
• Friend 
• Goodfellas 
• Jackpot 
• Murder 8 
• Tango & Cash  

Fentanyl and Overdose 

• fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths.
• Even in small doses, it can be deadly.  

Over 150 people die every day from overdoses related to synthetic opioids like fentanyl 

• Drugs may contain deadly levels of fentanyl, and you wouldn’t be able to see it, taste it, or smell it. 
•  It is nearly impossible to tell if drugs have been laced with fentanyl unless you test your drugs with fentanyl test strips. 
• Test strips are inexpensive and typically give results within 5 minutes, which can be the difference between life or death.  
• Even if the test is negative, take caution as test strips might not detect more potent fentanyl-like drugs, like carfentanil 

References 

Fentanyl Facts. (2021, November 10). Www.cdc.gov. https://www.cdc.gov/stopoverdose/fentanyl/ 

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