History

GHB was first synthesized in the mid-1970s by Dr. H. Laborit, a French researcher interested in exploring the effects of gamma-aminobutyric acid (GABA) in the brain. Laborit was attempting to manufacture a GABA-like agent that would cross the blood-brain barrier (Vickers, 1969). During the 1980s, GHB was widely available in health food stores. It came to the attention of authorities in the late 1980s as a drug of abuse, and the Food and Drug Administration (FDA) banned it in 1990, after reports of several poisonings with the drug (Chin, Kreutzer, & Dyer, 1992). In the past decade, it has become more widely known as a drug of abuse associated with nightclubs and raves.

GHB is known as "liquid Ecstasy," and in Great Britain as GBH, or "grievous bodily harm." It can be found, occurring naturally, in many mammalian cells. In the brain, the highest amounts are found in the hypothalamus and basal ganglia (Gallimberti et al., 1989). It is likely that it is itself a neurotransmitter (Galloway et al., 1997). GHB is closely linked to GABA and is both a precursor and a metabolite of GABA (Chin et al., 1992).

In the 1970s, GHB was available commercially as a sleep aid. It has some demonstrated therapeutic efficacy, particularly in the treatment of narcolepsy (Lammers et al., 1993; Mamelak, Scharf, & Woods, 1986; Scrima, Hartman, Johnson, Thomas, & Hiller, 1990). In 1990, after reports indicated that GHB might have contributed to the hospitalization of several California youth, the FDA banned it. GHB has an extremely small therapeutic index, and as little as double the euphorigenic dose may cause serious central nervous system (CNS) depression. In recent years, it has been associated with numerous incidents of respiratory depression and coma. Increasing numbers of deaths have been linked to GHB (Li, Stokes, & Woeckner, 1998).

The legal status of GHB is complicated. Recently, GHB, under the brand name Xyrem, was classified as a Schedule III controlled substance, but with special regulations. The company that makes and markets the medication has developed a rigorous system that makes Xyrem available to patients from a single specialty pharmacy. Both physicians and patients must receive an education program from the manufacturer, Orphan Medical, before obtaining Xyrem. Orphan Medical has worked closely with the FDA, the Drug Enforcement Administration (DEA), and law enforcement agencies to develop strict distribution and risk-management controls designed to restrict access to Xyrem to the intended patient population (Tunnicliff & Raess, 2002). Illicit use of Xyrem is subject to penalties reserved for Schedule I drugs.

Most of the GHB sold in the United States is of the bootleg variety, manufactured by nonprofessionals. In fact, it is relatively easy to manufacture, and Internet sites devoted to explaining the process can be found readily, although they are sometimes cleverly concealed.

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