Forensic Science Update: Gamma-Hydroxybutyrate (GHB)

[ghostcorps]

Hang on. Qualifications are irrelevant, but everyone else's pisstaking of you, or anyone else for that matter, were (rightly) ignored? Odd. Thanks for answering anyways.

yes, they are irrelavant.. sure if someone wants to make their status known.. they rightly will earn the kudos for the good work they have done.... but it does not make them infallible... so i chose to remain anon and use my submissions as my only weight.

BTW. I have to go.. I look forward to catching up in the morning

 

[johnboy]

So long as you know that there are many cases where GHB was the sole cause of death.

and I would much rather OD on MDMA than GHB

OK this seems to be the opposite of what you were saying before but we'll ignore that. We've been over tha ground enough. What is important is the messages were are trying to get out to people, and as you have rightly said we need to stress those three things. Reiterating the myth that a GHB OD is "safe" isn't something we need to go over. Perhaps it is an interesting academic exercise but it doesn't help us with the harm reduction work.

 

[ghostcorps]

oh shit.. did i say that>?.. umm.. i mean the other way around.. thanks for picking me up on that.... ... sorry... I was in ahurry (It has ben edited to reflect what I meant to say).... at least OD'ing on GHB i know im not going to wake up braindamaged.

but as for many cases of GHB-onloy death.. i have a report of one.. sent to me by the chemist involved in the case. But I wouldnt say there are many like it.... with a blood level of 219 mg/L GHB.. its as close to suicide by intoxication as your likly to get without actually being.. suicide.

please.. Again... I dont ask provocativly.. i ask due to lack of documentation.. please provide me with examples of Death by GHB.. preferably with an actual coronial conclusion if possible.. Dr P.. perhaps you should be the one I should ask?

 

[johnboy]

it will take me a bit longer to find the recent cases that i am thinking of but literally 30 seconds on google found me this:

Of these 32 cases, GHB was found to be the sole cause of death in eight cases

http://www.usdoj.gov/dea/pubs/cngrtest/ct990311.htm

Being DEA testimony before congress you can take it with as many mountains of salt as you please. More later.

 

[ghostcorps]

from your text:

As previously mentioned, there have been 32 GHB-related deaths since 1995

funny how at one point they are saying GHB was the sole cause of death then later they say it was only GHB related... ...

since we are going to use DEA information

http://thedea.org/statistics.html

the same period -1995-1999 deaths related to MDMA total 68.

 

[johnboy]

No they say that 8 of the 32 are soley due to GHB. And comparing the two totals would only be relevant if we knew for sure that the amount of people usuing MDMA was equal to those using GHB, which I kind of doubt. And is that figure to do with soley MDMA or polydrug incidents?

Not that this matters of course because we aren't arguing the comparison of those two drugs anymore, you just wanted examples of deaths soley to do with GHB, right?

 

[johnboy]

Oh and of course they make the caveat that must be attached to any of these statistics:

Also, the basis of reporting a death as "associated with MDMA" is not that it was caused by MDMA; rather that it was caused by drug use, and one of the drugs present was MDMA. This is a slippery distinction. For instance, if a person takes MDMA and drinks at a party, then, hours later, drives drunk and is killed in an accident, the death would be reported as MDMA-related.

And this one:

The death rate for MDMA, assuming that there really were about 60 deaths directly caused by MDMA in 2000, would be roughly 2 in 100,000 users. The death rate from smoking, by contrast, is on the order of 400 per 100,000 users. Even alcohol, America's official "it's not really a drug" drug, nets about 50 deaths per 100,000 users each year:

What would be interesting would be to plug usage estimates for GHB into this and see where it is placed. My guess would be somewhere between MDMA and alcohol. Let's face it no illicit drug is ever going to be in the same league as the big two legal ones.

 

[ghostcorps]

No they say that 8 of the 32 are soley due to GHB.

Not that this matters of course because we aren't arguing the comparison of those two drugs anymore, you just wanted examples of deaths soley to do with GHB, right?

Right, I simply added the MDMA stats to continue to previous argument that MDMA is as lethal as GHB. but I have not contested that GHB can kill.. what I was asking for, specifically, is the amount of GHB ingested in such cases and evidence of brain damage cuased solely by GHB. Which I am finding quite hard to locate.. the only cases I have are where the victim has ingested inordinatly large amnounts and died... I want tox reports of cases of death by slight misjudgements.. or even large misjudgements.. not cases where a person has drunk enough to kill a horse.

not to say that I dont appreciate your info... but I was kind of expecting Dr Platypus could be able to provide such specifics...?

 

[johnboy]

He no doubt will when he has time.

 

[ghostcorps]

I'm sure he is a busy man.. so I dont expect much. But some evidence or at least solid theory of GHB causing briandamage comlete with facts regarding the blood levels of GHB known to induce hypoxia and ischemia as opposed to reducing the effects of them. And a brief collection of tox reports on GHB only deaths.

should give me something to think about.

 

[johnboy]

That's not expecting much? OK then. Well here's the case I was thinking of. I saw Dr Karl Jansen talk about this at the Club Health conference.

A healthy, 22-year-old male and his girlfriend both lost consciousness following ingestion of 15 ml of 1,4-B at a flat where others were present. He told his companions that he had taken too much, had a seizure and went to bed. He was found three hours later, not breathing, by friends. Neither he nor his girlfriend had ingested alcohol or any other drugs except 1,4-B. An ambulance was called and he was found to be in cardiac arrest. No initial bystander CPR had been administered. He was intubated, ventilated, resuscitated and defibrillated. Spontaneous circulation occurred after 30 minutes.

On arrival at the Emergency Department of Auckland Hospital, observations and biochemistry were typical of 1,4-B overdose (unpublished data, Auckland Hospital Emergency Department Overdose Database).1 The local analytical method used for biological samples measures only GHB. The blood level of GHB on admission was 220 mg/l. A chest X-ray indicated aspiration pneumonia. Brain death was confirmed the next day. The patient’s girlfriend recovered after six hours of ventilation.

1,4-B was detected in bottles, vomit and towels taken from the scene. Blood samples taken on admission were analysed for alcohol, most psychotropic medicines that affect the mind, and morphine, heroin, cocaine and amphetamines. Urine was analysed for alcohol and cannabis. There was no evidence for the use of any drugs except 1,4-B. Conclusions from the post-mortem examination were that death resulted from complications due to a 1,4-B overdose. Vomitus was inhaled resulting in pneumonia, shock, cardiac/respiratory arrest and brain damage.

Some promotional web sites and ‘user guides’ have stated that taking too much 1,4-B or GHB results in a deep sleep from which the person recovers in a few hours, and that there is no need to call emergency services unless the person has also used drugs such as alcohol. A pamphlet distributed in Auckland at the time of this death stated that ‘there have been instances where people have been inappropriately taken to an emergency room when their friends found them unconscious and unrousable, and assumed they were in danger. These individuals invariably woke up about three hours later, wondering where they were and why all these strange people were doing things to them. Unless other drugs or alcohol have been consumed with these substances, the only treatment necessary is to allow the sleeping person to wake up naturally.’ This case illustrates that such advice can be dangerous. The case is also relevant to statements such as: ‘a significant part of the Government’s strategy to demonise GHB has been to encourage reporters and coroners to allege GHB as a cause of death...Of those twelve deaths, none were caused by any toxicity of GHB. They were either caused by pre-existing medical conditions (cirrhosis), other drugs, or traffic accidents.’ The case reported here correctly attributes the death to taking 1,4-B.

http://www.nzma.org.nz/journal/116-1184/650/

 

[ghostcorps]

Vomitus was inhaled resulting in pneumonia, shock, cardiac/respiratory arrest and brain damage..

Ok so i will conceed that GHB caused his death by causing him to vomit and choke on it. But surely you must see this is not exactly respiratory failure caused by GHB...?

and no.. i dont belive i'm asking much.. its the least amount of evidence that would be required to prove his claim that GHB use can result in brain damage. sure If he takes the route of saying that complications such as choking on ones own vomit are directly attributable to GHB Overdose.. then theres no point continuing. But if he intends to take the discusison seriously.. then It would need the specific details I suggested.

As for deaths by GHB.. there is no argument that it can happen. I ask for this information simply on a personal interest note.. to get an idea of the minimum lethal dose of GHB only. There is still no LD50 for humans... so Ill take what ever numbers I can get.

 

[johnboy]

Why are you redirecting this towards repiratory failure? My first comment was that GHB has caused deaths by itself. I made no comment about how exactly death was caused, mainly because I am not, as I keep pointing out, a doctor. To me the guy is dead, that is tragedy enough.

You asked for evidence that this had occured, and I supplied it. I am not going to enter into whatever arguement you think you may be having with Dr Caldicott over the minutae of cause and effect.

I just want everyone here to read the last paragraph of that report and let it sink in. Being unconscious due to GHB is in no way "safe".

 

[ghostcorps]

I am not redirecting towards Respiratory failure, I am discussing it as Dr P (or C) has suggested that GHB causes brain damage through respiratory failure, And I would like to know at what point GHB causes such respiratory failure.. considering that the study I posted states quite clearly that GHB reduces the damage of respiratory failure (I am assuming that is to a point, And would liek info regarding the amount of GHB required to reach that point. And examples.)

. Deaths are not imposible on GHB.. why do you reply as though I have said as much? I did not ask for evidence that this has occured.. as I have a lot of it.. I asked for specifics If you dont have them.. thats Ok too..

It seems I am not having a discussion with the doc.. as he has not replied since I questioned him about hypoxia and ischemia. I can only hope he is busy.. because I am very eagre to hear what he has to say.

 

[drplatypus]

I think it would be a fair assumption that I am busy Ghostcorps. Does the fact that you 'can only hope' that I am busy suggest that you think I am otherwise overwhelmed by the calibre of your arguments? If that is the case, you are deluded.
So, in no particular order
Are you referring to Li's review article in
Annals of Emergency Medicine? If so, that is a review of some of
the potential clinical effects of GHB and the papers cited therein
are the ones you should read, not Li. To help you in your side of
the argument, (and ensure a level playing field, because you appear to be disadvantaged in at least your ability to search the medical literature) there has been
further work to show that GHB can stop the build up of lactate in
the brain, traditionally viewed as a marker of anaerobic or hypoxic
respiration (hint: try the Journal of Trauma, last month I think) So
the reason why I didn't argue with your point regarding Li is that
there is some truth to the facts you state. The conclusions you
draw from those are fundamentally flawed; to turn it around and
suggest that, through GHB use, you are safe from being unable to
breathe doesn't really merit comment (but I will anyway!). There is a world of difference
from a scientific observation in a pig or a rat to taking that to
medical applicability in a human. One can fully 'recover' from
carbon monoxide poisoning, and still have serious problems with
emotional lability and short term memory loss. Hypoxia is
ALWAYS dangerous not merely for survival, but also for how WELL
you survive. It is important to be able to correctly and
dispassionately interpret the results of science, rather than recruit
them to your agenda. The real question is "do you trust the animal
results well enough- the only ones in wich they could look at the
direct effects on the brain- to risk not being able to drve a car
again, or long term depression?". God knows I would LOVE it if it
did mean we didn't need oxygen- it would make life a hell of a lot
easier for us in resus
Your fixation about doses is irrelevent. The poisoning dose may be known in rats. You can't get ethical permission to experiment on killing people with GHB. What is known is that people have died from GHB use ALONE with blood levels as little as 77mg/ml postmortem blood- AND NOTHING ELSE. CAUSE OF DEATH: GHB OVERDOSE. NOTHING ELSE. Is the medical profession now part of the Industrial Military complex, and not to be trusted on their post-mortems?! And just because you can't find it in the medical literature doesn't mean you can attempt a half hearted attempt at trying to sell GHB as a safe drug. Much information in medicine is available only to doctors, for reasons of personal confidentiality. That applies to post-mortem data. The truth is that WE DON'T FIND IT INTERESTING ANYMORE!!! We KNOW that GHB causes deaths, and we don't need any more deaths to convince us. I am having trouble getting my data on Australian GHB deaths published because in the field of medicine and toxicology IT IS OLD NEWS. The only reason that I am trying to publish it is to stop the naive falling falling for the clap-trap put out by the regular GHB apologists/partial scientists/first-aid certificate holders who feel they have a special insight on the subject. Once again, I DON"T CARE if people use GHB /jump off a bridge/ whatever- their life. I do care about the science and the medicine being hijacked and misrepresented by EITHER side of the drugs debate, which is beginning to happen in this thread.
As for pulling rank or anything- I regard Bluelight as an equal rights
bulletin board, and I agree with whoever (Ghostcorps?) was
suggesting that the best argument wins
It is a myth and a false reassurance that GHB doesn't kill
people on its' own. As I have mentioned, we are finally publishing a series in which there are
several deaths from GHB alone, from Australia. Almost every issue of the American Journal of Emergency Medicines supplement for Poison Control CEntres lists of deaths over the last 5 years has GHB ONLY related deaths reported. There are several others in the
medical literature as well, as well as numerous in the grey
literature.
Just to kick off your reading...Try
Bosman IJ, Lusthof KJ.
Forensic cases involving the use of GHB in The Netherlands.
Forensic Sci Int. 2003 Apr 23;133(1-2):17-21.
And if you have any doubts about acute toxicity,
try
Robert S. Gable
Comparison of acute lethal toxicity of commonly abused psychoactive substances
Addiction
Volume 99 Issue 6 Page 686 - June 2004

We have just finished a comprehensive review of the world literature on GHB and its associated drugs; all publications, all languages; more than 1550 articles over the last 18 months. And OUR finding is that GHB is a dangerous drug. If your research is as comprehensive as that then I will continue this debate. My instinct is that you need to fill out your reading a bit.

I have used my sparse lunch break to write this, and a hungry DrPlatypus is an evil Drplatypus . I'm hoping we don't get a GHB OD this afternoon...

 

[ld50 vs ssri]

That was very informative Dr platypuss. cheers for that

Shit missin lunch YOU ARE DEDICATED!

 

[ghostcorps]

I hope your were busy.. because for you to be overwhelmed by me would be shameful ;p

The conclusions you
draw from those are fundamentally flawed; to turn it around and
suggest that, through GHB use, you are safe from being unable to
breathe doesn't really merit comment (but I will anyway!).

I am primarily reffering to this article.

.. I mentioned that the study showed GHB has demonstrated the ability to protect the body from effects of hypoxia and ischemia.. I did not say it protects you from not breathing. I also said I assumed that was to a point..

There is a world of difference
from a scientific observation in a pig or a rat to taking that to
medical applicability in a human

When did I point to any studies on pigs or rats? Other than the LD50, Which I was using to compare GHB's toxicity to MDMA not to suggest exactly how much GHB will kill 50% of humans...

I have never said that GHB does not kill, I highly doubt the common perception that it kills at even a slight miscalculation, and have endevoured to disprove this view. but never said that it cannot be lethal. I dont spose you have a determination of the minimum amount (mg/K) of GHB required to stop a persons breathing? 77mg/ml postmortem blood Is definatly very, very, low. Could you elaborate on the actual cause of death? This is definatly enough for me to take your side unconditinally (though im sure you could care less).. but I would appreciate a bit more info if you please.

I do care about the science and the medicine being hijacked and misrepresented by EITHER side of the drugs debate, which is beginning to happen in this thread.

So we agree on something, I am not trying to claim that the doctors are part of a conspiracy.. what I am claiming is that the information attributed to them is oftem edited or intentionally lacking to make a drug or statsitic seem far worse than it is.. hence my comments about drug 'related' deaths as opposed to deaths by a particular drug. whether this is the doctors omission or the medias is a moot point. But I feel it necessary to counter the misrepresentation as best I can.


you are correct I am hindered in my ability to search alot of the litterature published. But what I have found has led me to vbelive what I have stated in the thread above. Feel free to direct me to an endless source anytime.

particularly in refferance to this:

there has been
further work to show that GHB can stop the build up of lactate in
the brain, traditionally viewed as a marker of anaerobic or hypoxic
respiration (hint: try the Journal of Trauma, last month I think)

Thanks.

 

[drplatypus]

I seriously admire your motives Ghostcorps, and if I've come over a bit sharp, I apologise. Your willingness to question commonly held beliefs is good science

 

[drplatypus]

I think these articles might support your argument better than Li's rather outdated review

Guney O, Bengi Celik J, Arazi M, Erkan Ustun M.
Effects of gamma-hydroxybutyrate on cerebrospinal fluid lactate and glucose
levels after spinal cord trauma.
J Clin Neurosci. 2004 Jun;11(5):517-20.


Wei ZZ, Xia SS.
gamma-hydroxybutyrate protects the liver from warm ischemia-reperfusion injury
in rat.
Hepatobiliary Pancreat Dis Int. 2004 May;3(2):245-9.


Yosunkaya A, Ak A, Bariskaner H, Ustun ME, Tuncer S, Gurbilek M.
Effect of gamma-hydroxybutyric acid on lipid peroxidation and tissue lactate
level in experimental head trauma.
J Trauma. 2004 Mar;56(3):585-90.

 

[drplatypus]

Oh and cause of death is usually given as
1) immediate cause
2)any contributing factors

In the case I mentioned, cause of death was
1) respiratory arrest
2) Secondary to GHB ingestion

This was in a fit young patient with no other risk factors. But you are correct that in the majority of cases, death is usually associated with a 3 figure number, mostly in the mid 2 or 3 hundredss. The problem is that it is enzymatically metabolised, which means that metabolic rates can vary from person to person- I am alway reluctant to suggest the effect of any drug, even therapeutic, will be identical in all persons. eg suxamethonium in patients with pseudocholinesterases, variabilities in CY2 DP6, idiosyncratic reactions to metaclopramide etc. Legal drugs have a reporting system for side effects, which illicits don't, so I reckon the medical profession misses loads of these. Hence my lurking on the Bluelight site!!!