INTRODUCTION TO GHB
Gamma hydroxybutyric acid (GHB) is commonly occurring small chain fatty acid that has been described as a possible neurotransmitter. From 1990, GHB has been abused on the street in the names such as "Liquid Ecstasy," "Soap," "Easy Lay," and "Georgia Home Boy." GHB and its precursors, gamma butyrolactone and 1, 4 butanediol, have been involved in poisonings, overdoses, date rapes, and deaths. GHB emergency room visits increased from 55 in 1994 to 2.973 in 1999. In 1999, GHB accounted for 32% of illicit drug-related poison center calls in Boston. These products, obtainable over the Internet and sometimes still sold in health food stores, are also available at some gyms, raves, nightclubs, college campuses, and are particularly popular among gay men. The products are commonly mixed with alcohol, have a short duration of action, and are not easily detectable on routine hospital toxicology screens.
GHB is a popular recreational drug used by young adults. It appears to have a high abuse potential because it produces euphoria, hallucinogenic effects, relaxation, tolerance, and severe withdrawal symptoms. In the United States, GHB compounds have been marketed illicitly to body builders as a growth hormone stimulant to build muscular mass. They have also been promoted as a replacement for L-tryptophan to improve sleep (16, 17). Two GHB precursors, gamma-butyrolactone and 1,4 butenadiol also have been marketed to improve athletic performance, enhance sexual activity, and release growth hormone. Dietary supplements containing these precursors are widely available through the Internet under different names such as Serenity, Growth Hormone Release Extract (GHRE), Thunder Nectar, and Revitalize Plus among others. This article describes the pattern of use and knowledge about GHB compounds among college students, who are frequently the "cutting edge" of new patterns of drug abuse.
METHODS
A survey was distributed in the student health clinic of a large university from July 2002 until January 2003. Anonymous surveys were placed for distribution at patient registration areas. Students were asked to complete only one questionnaire, even if they made multiple visits to the student health clinic during the period of study. Students who answered the survey placed them in a secured box. The investigators collected the surveys from the boxes on a weekly basis. During that period, a total of 18,744 students attended the clinic; 37% were male and 63% were female. Their age distribution was as follows: 13,339 patients between ages of ages 18-25, 4,812 patients between ages of 26-35, and 988 patients older than 35.
The participants were asked about the use of the following compounds: Serenity, Revitalize-Plus. Growth Hormone Release Extract (GHRE), Somato-Pro, Enliven, NRG-3, Thunder Nectar, White Belt Cleaner, GBL, Butenadiol, and GHB. They were also asked about their amount of use over the last 6 months, as well as their knowledge of GHB compounds' addictive potential, GHB legal status, and effects experienced when using any of these compounds. The study was approved by the University of California, San Diego Human Subjects Protection Program.
RESULTS
A total of 215 students answered the survey. The mean age of the participants was 22.8 (S.D. 3.5) years and their average level of education was 16.5 (S.D. 2.5) years. Among the respondents, 90 were male (41.9%) and 125 (58.1%) were female. There was no difference between men and women in terms of age or years of education. The participants described their sexual orientation as follows: 163 (75.8%) heterosexual, 32 (14.9%) homosexual, l0 (4.7%) bisexual; 10 students (4.7%) did not indicate their sexual orientation. Respondents were asked if they recognized the previously mentioned GHB-related compounds. The most commonly recognized compound was GHB (53%), followed by GHRE (46%). The most commonly used compounds were GHRE (28.8%) and GHB (19%). GHRE users reported consumption 23 times per month, while GHB users reported use 1-2 times per month.
The respondents reported frequent effects from using GHB-compounds, including euphoria (n = 41), increased energy (n = 51), weight loss (n = 59), and dizziness (n = 13). Other reported effects were irritability (n = 3), a decreased need for sleep (n = 3), and social problems associated with the use of GHB (n = 1).
Regarding the use of GHRE, there was a significant difference between males and females (chi square] = 49.0 df = 1 p<0.001). A total of 59 women reported using GHRE, compared to only 3 men. Fifty-seven of the GHRE users reported their sexual orientation as heterosexual, 3 as bisexual, and 2 as homosexual. 96 % of GHRE users (57/62) reported weight loss as an effect of GHB--and among the 59 women, 55 reported weight loss as a cause for using GHRE. Increased energy was reported by 23 out of the 59 women who used GHRE and the 3 men.