GHB: grievous bodily harm.

After drinking some GHB at a party in the desert, a teenage boy began frothing blood, collapsed, and subsequently died.(1)

A former disc jockey slipped GHB into young women's drinks, then raped and took pornographic photographs of them.(2)

A high school student drank only two sodas while dancing at a local club but came home complaining of a severe headache and nausea and died later that night from cardiac arrest.(3)

What drug caused these tragedies? A hypnotic, anesthetic agent, gamma-hydroxybutyrate (GHB) has drawn considerable media attention for its recent rise in illicit use. Since 1990, party and nightclub attendees have abused GHB for its euphoric and sedative effects, while bodybuilders have misused it as an unproven anabolic steroid.(4) Additionally, police officers have linked GHB and such similar drugs as Rohypnol with sexual assault cases throughout the country.(5) In numerous incidents, suspects have slipped GHB into unsuspecting individuals' alcoholic beverages and then sexually assaulted the victims while they were unconscious or immobilized by the drug.

History

Although found in minute amounts in the human brain and other bodily tissues, GHB's exact physiological role remains unknown.(6) Researchers first produced GHB in Europe and later tested it for use as a short-term surgical anesthetic. However, the drug never grew in popularity due to its lack of painkilling properties.(7)

In the early 1980s, GHB emerged in U.S. health food stores as a "natural" aid to bodybuilding, weight loss, and sleep.(8) After a rash of illnesses and adverse effects, including nausea, uncontrolled shaking, coma, and even death, the Food and Drug Administration (FDA) took GHB off the market in 1990.(9) Except for research purposes, GHB is not approved for any use in the United States. Although possession of GHB is not illegal under federal law, the Food, Drug, and Cosmetic Act prohibits its sale and manufacture. Recently, several states have enacted legislation classifying GHB as a Schedule I drug,(10) and 27 states, particularly California, Texas, Georgia, and Florida, have documented the illicit distribution of GHB.(11)

Effects

The human body rapidly absorbs and metabolizes GHB. Peak concentration in the blood occurs 20 to 60 minutes after oral ingestion, but users can feel the effects in as little as 5 to 15 minutes.(12) Physical symptoms begin unpredictably, differ from user to user, and depend on the quantity consumed. At very low doses, GHB users report feeling effects similar to those associated with alcohol - euphoria, a reduction of social inhibitions, calmness or giddiness, and slight hallucinations. Acute GHB toxicity and a feeling of extreme intoxication can develop easily at higher dosages. Reported manifestations include dizziness, nausea, vomiting, weakness, seizures, loss of peripheral vision, confusion, agitation, hallucinations, slowed respiration, unconsciousness, and coma.(13) Moreover, no antidote exists for a GHB overdose, and medical treatment is restricted to supportive care, such as mechanical ventilation.(14)

Availability and Domestic Production

Individuals can obtain GHB in a variety of ways. Several firms based in the United Kingdom, Mexico, and South Africa sell high-quality GHB directly over the Internet. Additionally, several U.S. companies produce kits containing all of the necessary chemicals for producing GHB. Users order the noncontrolled substances through the mail and then combine them to produce GHB. However, the FDA has determined that clandestine domestic laboratories produce the great majority of GHB, accounting for the recent surge in illicit use in the United States.(15)

GHB requires only two ingredients - gamma-butyrolactone (a solvent sometimes used in paint removers, engine degreasers, and textile work) and a strong base (such as sodium or potassium hydroxide). For relatively little cost, manufacturers can obtain both from chemical supply houses. They can use a large pot, bowl, or even a bathtub to mix the two substances to produce GHB. Sometimes, manufacturers add hydrochloric acid or vinegar to help neutralize the caustic end product.

Instructions for making GHB are available through underground magazines and over the Internet. Several Web sites even provide different techniques that reportedly help optimize yields. However, these instructions often prove incomplete, incorrect, and oftentimes unsafe, leading to varying degrees of GHB purity. For example, poorly manufactured GHB may contain high levels of unneutralized sodium hydroxide. Ingestion of such a caustic liquid is akin to drinking drain cleaner and can have horrible consequences, as illustrated in the example of the teenage boy who died after consuming GHB at a party in the desert.

Methods of Abuse

GHB usually appears as a colorless, odorless, slightly salty liquid, or less commonly, as a white powder.(16) Users may offer GHB at parties by the capful, teaspoonful, dropperful, or unmeasured swig.

As illustrated in the example of the former disc jockey, individuals using GHB for sexual assault purposes commonly mix the drug directly into their victims' drinks because alcohol greatly magnifies GHB's effect. Due to GHB's slightly salty taste, such beverages as margaritas, long island ice teas, sweet liqueurs, or tart fruit juices help mask the flavor.(17)

Difficulties in Detection

GHB presents a number of problems in its detection both in the field and in laboratory examinations. As a clear, colorless liquid, it can be combined readily with water, alcohol, or a host of other common liquids and placed in any number of generic bottles. Investigators have found the liquid stored in plastic water bottles, sport bottles, mouthwash and shampoo containers, milk jugs, and small glass vials. Moreover, no field test currently exists for detecting GHB, but several groups are working on a solution to this dilemma.

GHB in the body presents an even greater problem. The body processes GHB in a manner similar to alcohol; it converts the drug almost completely into carbon dioxide within hours. Most state medical examiners cannot detect GHB through standard drug tests.(18) With routine screening largely unavailable in the United States, GHB detection relies heavily on the training and skill of the investigator, as illustrated in the example of the high school student who died from cardiac arrest. The student had no history of drug or alcohol use, and routine drug tests revealed no signs of either. Alert investigators, however, had specific tests for GHB run on some of the student's previously obtained blood serum and discovered a high level of the drug. Investigators speculated that someone had slipped GHB into the student's drink.(19)

Investigative Considerations

Investigators have called GHB a "stealth drug" due to the difficulty in detecting its use. In most states, only specialized testing can confirm GHB in blood or urine, and investigators may have to specifically request these tests. However, several signs exist that may alert investigators to the use of GHB or a similar substance.(20)

A feeling of extreme intoxication after only one or two drinks represents a common symptom reported by rape victims drugged with GHB. Friends or witnesses, such as waitresses, may describe the victim as getting "giddy" or wildly drunk after consuming an unusual beverage or after accepting a drink from a stranger. These same witnesses may even see the victim leave the club or party assisted by the suspect. Further, anecdotal evidence suggests that many victims become unconscious for approximately 4 hours before abruptly "snapping back." An unexplained lapse in memory for this amount of time also might suggest GHB use.

Additionally, investigators should look for GHB paraphernalia in a suspect's residence or vehicle. While the presence of precursory chemicals, such as gamma-butyrolactone, represents an obvious tip-off, the suspect also may have computer printouts, articles, or books on GHB. Further, boxes or shipping labels from chemical suppliers may indicate that the suspect used a mail-order kit to make GHB at home. If investigators suspect GHB, they should collect any suspicious containers, such as water bottles or other unlabeled receptacles. If at all possible, they also should retrieve the glass or container from which the victim drank.

Moreover, if investigators suspect the use of GHB, they should try to obtain a urine sample from the victim as quickly as possible. If the victim ingested the drug in the previous 5 to 7 hours, a blood test could reveal the presence of GHB, even if the victim has died. Although most state toxicology laboratories cannot routinely screen for GHB, investigators can submit the sample to a specialized laboratory capable of performing the analysis.

Investigators must bear in mind that the victim may not recall many of the facts regarding the incident because the drug causes unconsciousness. At the same time, victims of sexual assaults involving GHB often experience psychological trauma resulting from not knowing exactly what the suspect did to them while they were unconscious.(21) Investigators should provide victims with immediate professional counseling or refer them to an experienced rape treatment center.

Future Developments

To date, only 11 states have criminalized GHB possession, most recently, California.(22) Taking note of the resurgence of GHB, the FDA has renewed its warning that GHB remains an unapproved and potentially dangerous drug that cannot be legally marketed, sold, or manufactured in the United States. While it is still not illegal to possess GHB on the federal level, the DEA and several congressional representatives actively are considering placing GHB on the list of controlled substances.

GHB Overview

Chemical             Gamma-Hydroxybutyric Acid

Street Names         Cherry Menth, Easy Lay, Gamma 10, GBH,
                     Georgia Home Boy, GHB, G-Juice, Great
                     Hormones, Grievous Bodily Harm,
                     G-Riffick, Liquid E, Liquid X, Salty Water,
                     Scoop, Soap, Somatomax, Vita-G

Appearance           Colorless, odorless, slightly salty liquid or
                     white powder

Administration       Oral ingestion

Cost                 $5-$20 per dose (capful or ounce)

On the educational front, knowledgeable rape treatment professionals encourage law enforcement officials to advise citizens never to leave their drinks unattended and to refuse drinks offered by strangers. Moreover, police and community leaders should consider promoting a concept similar to the designated driver program where individuals assign a sober friend the task of ensuring their safety before going out to clubs, bars, or parties.(23)

Conclusion

As its popularity grows, Gamma-hydroxybutyrate will continue to present a serious challenge to law enforcement. Its relatively low cost, ease of manufacture, and difficulty in detection continue to fuel its abuse. The quality and availability of GHB testing methods should continue to improve and expand as more and more agencies begin to address the problem. Also, additional legislation to make the possession of GHB illegal should help law enforcement authorities confront the problem from all sides.

Until then, continued education on GHB will help both investigators and the public become better at recognizing and combating its use and proliferation. Working together, police officers and the communities they serve can reduce these tragic early deaths and heinous assaults resulting from the illicit use of such drugs as GHB.

Endnotes

1 Debra Rosenberg, "Death of the Party," Newsweek, October 27, 1997, 55.

2 KABC-TV 7 Eyewitness News, "Disc Jockey Sentenced in Rape Case," August 6, 1997.

3 Christine Gorman, "Liquid X," Time, September 30, 1996, 64.

4 Centers for Disease Control and Prevention, "Gamma-hydroxybutyrate Use - New York and Texas, 1995-1996," Journal of the American Medical Association 277 (1997): 1511.

5 National Institute on Drug Abuse, "Rohypnol and GHB," NIDA Infofax 021.

6 Gantt P. Galloway, et al, "Gamma-hydroxybutyrate: An Emerging Drug of Abuse That Causes Physical Dependence," Addiction 92, no. 1 (1997): 89-96.

7 Ibid.

8 Centers for Disease Control and Prevention, "Multistate Outbreak of Poisonings Associated with Illicit Use of Gamma-hydroxybutyrate," Journal of the American Medical Association 265 (1991): 447-448.

9 John Henkel, "Gym Owner Jailed for GHB Sales," FDA Consumer, April 1997, 34.

10 Under the Federal Controlled Substances Act, regulated drugs are divided into categories, know as schedules, according to their effects, medical use, and potential for abuse. Schedule I drugs, such as heroin and LSD, have unpredictable effects, including severe psychological or physical dependence or death; have the highest potential for abuse; and have no currently accepted medical use in treatment. Some are legal for limited research use only.

11 Supra note 4.

12 Supra note 8.

13 Supra note 8.

14 Supra note 4.

15 Food and Drug Administration, "FDA Reissues Warning on GHB," FDA Talk Paper, February 18, 1997, T97-10.

16 Detective Trinka Porrata, Los Angeles, California, Police Department, telephone interview by author, January 1998.

17 Ibid.

18 Pat Friel, Toxicologist, Washington State Toxicology Laboratory, telephone interview by author, December 1997.

19 Supra note 3.

20 Supra note 16.

21 Gail Abarbanel, director, Santa Monica-UCLA Rape Treatment Center, telephone interview by author, January 1998.

22 Illinois, Georgia, Hawaii, Louisiana, Nevada, and Rhode Island have placed GHB into Schedule I. California and Florida have assigned GHB as Schedule II (such drags as morphine and codeine with a high potential for abuse, severe psychological or physical dependence, and restricted medical use). Alaska and Tennessee categorize GHB as Schedule IV (such drugs as phenobarbital and diazepam with a low potential for abuse, limited psychological or physical dependence, and accepted, supervised medical use). New Jersey has outlawed GHB possession but has not scheduled the drug. Texas, Massachusetts, Michigan, Nebraska, and Virginia have GHB legislation pending.

23 Supra note 21.