In the Grip of GHB

Despite reports linking it to dozens of deaths and thousands of overdoses, the illegal supplement GHB just won’t disappear.

First banned in this country more than a decade ago by federal regulators, the substance--best known as a party drug used on the rave scene--remains popular with fitness buffs, insomniacs and the depressed, who buy it on the Internet and from underground sources.

Now medical experts report another troubling problem: GHB is highly addictive and can be more difficult to kick than heroin. But unlike opiate addiction, most doctors are unaware of the stranglehold that GHB has on users. Consequently, medical treatment is often ineffective.

GHB, which severely depresses the nervous system, has sent more people to emergency rooms than a more highly publicized club drug, Ecstasy--about 12,900 at last count--and has been blamed for 71 GHB-related deaths since 1990, according to federal statistics.

“This is the most addictive drug I’ve ever seen,” says Dr. Stephen W. Smith, an emergency room doctor at Hennepin County Medical Center in Minneapolis who has treated about 50 patients for GHB addiction problems since 1998. “People are desperate to get off of it because it’s destroying their lives,” he says, yet only about one in 10 of his patients has successfully kicked the habit.

No one knows exactly how many Americans are addicted to GHB, or gamma hydroxy butyrate, because the federal government did not begin monitoring GHB abuse until after the drug was declared illegal in March 2000. No statistics have yet been released. GHB use is also difficult to track because the chemical is excreted from the body within 12 hours, and most emergency rooms don’t test for the presence of the drug. Consequently, GHB use often goes undetected.

Trinka Porrata, a retired Los Angeles Police Department narcotics detective who has investigated GHB for more than five years, believes that the statistics on emergency room visits and deaths linked to GHB understate the problem. “These figures are just the tip of the iceberg and the actual numbers are probably much higher,” says Porrata, who advises law enforcement officials on GHB’s dangers.

Most GHB abusers are not street junkies looking for a new high, however. Typically, they are people who have turned to the drug, which is promoted as a natural, nutritional supplement, to build buff bodies, lose weight or to fight insomnia, premenstrual pain and depression. Some professional athletes have used the substance--usually sold as a salty-tasting liquid--to improve performance. Phoenix Suns basketball player Tom Gugliotta, for instance, nearly died in 1999 after ingesting a GHB supplement to help him sleep.

Some users know the drug is illegal and buy bootleg brews over the Internet or from the back rooms of health food emporiums. Others stumble across ads on the Internet and purchase what they believe is a natural remedy to beat the blues or get in shape. While there’s no evidence that it helps increase muscle mass, “GHB seems to help users sleep better,” says Smith, an assistant professor of clinical emergency medicine at the University of Minnesota School of Medicine. “If they suffer from depression, they tell me that GHB makes them feel normal for the first time in their lives.”

Medical experts don’t have a clear idea of how GHB affects the body because no definitive research has been done. Based on physicians’ observations of how it affects people, however, they speculate that it alters levels of brain chemicals like dopamine and serotonin, which regulate mood and impulse control. In small doses, GHB is a mild stimulant that produces a feeling of intoxication or euphoria and releases inhibitions, which is why it’s a popular party drug.

In higher doses, however, anecdotal reports indicate it seriously depresses the central nervous system. Even a small increase in the dosage can push the sedative effects to a lethal level, causing unconsciousness, slowed heart rate, respiratory depression and coma, doctors say.

And habitual use, even for just a few weeks, can cause people to become physically and psychologically addicted, according to doctors who’ve treated GHB addicts.

“These are often not people with an addiction history,” says Dr. Karen Miotto, a psychiatrist at UCLA School of Medicine. “They stumble on GHB and have the hardest time staying off. I’ve had people cry, ‘I’ve never abused drugs. I’m a monster. What happened to me?”’

Tony Young, 39, of Seattle, saw an ad in a bodybuilding magazine for a product touted as an all-natural supplement that would help boost muscle mass. He ordered a two-month supply for $75. The supplement, whose active ingredient is a form of GHB, made him feel more relaxed and improved his sleep. But if he missed a dose, “I’d get cranky and severely depressed.”

He knew he was hooked. His addiction escalated to a $4,000-a-month habit. He sipped capfuls of GHB virtually around the clock. He tried drug rehabilitation twice but relapsed both times because he felt swallowed up in a depression when he stopped taking GHB.

Young struggled to maintain his normal routine, but he’d sometimes black out while driving. He was arrested several times for driving under the influence, and he crashed two cars, including one belonging to his employer, which cost him his job as an elevator mechanic supervisor.

About a year ago, Young, a husband and a father of two young boys, was sent to jail after a DUI conviction. “GHB ruined my life,” he said in a telephone interview from the King County Jail in Kent, Wash. “I’ve let everyone down.”

Despite the federal ban, GHB and its various chemical cousins, including GBL (gamma butyrolactone) and BD (1,4 butenediol), remain popular at gyms frequented by serious bodybuilders. It is passed around weight rooms, sold out of cars in parking lots and dispensed from behind juice-bar counters, according to those familiar with its sale and use. For bodybuilders, GHB’s allure comes from the scientifically unproven claim that its use will help people build bigger, leaner physiques. Promoters of the drug contend that it helps to release growth hormones, boosting muscle mass and trimming fat.

GHB was first developed in the 1960s as an anesthetic, but research was discontinued when high doses in animals caused grand mal seizures, says Dr. Wallace D. Winters, a former UCLA pharmacology professor who has studied GHB. In the 1980s, GHB was sold in health food stores as a sleep aid and nonsteroidal performance enhancer for bodybuilders. In 1990, however, the Food and Drug Administration yanked GHB from the market after the agency received dozens of reports of adverse affects, ranging from nausea and vomiting to seizures, comas and death.

Supplement manufacturers circumvented the federal ban by developing chemically similar products. When people consumed these products, which had legal uses as industrial solvents or cleaners, the body metabolized them and converted them into GHB. Thus, the products had the same effects as those of GHB. These products were marketed under such brand names as Blue Nitro, Enliven, Thunder Nectar and Serenity. In March 2000, federal regulators stepped in again to close a legal loophole and extended the ban to include chemical analogues of GHB.

But that action still hasn’t halted trade in GHB products. The Internet is rife with thinly disguised products containing GHB and similar compounds that sell for $50 to $75 a bottle. And while the manufacture and sale of GHB and similar compounds is against the law, the drug easily can be made with two legal ingredients: gamma butyl lactone, an industrial solvent used for degreasing engines and as a floor stripper, and sodium hydroxide, or lye.

Recipes for making bootleg GHB are available over the Internet, and the street version is potentially hazardous because of uncertain quality control in underground labs, according to the National Institute on Drug Abuse. In fact, there have been several cases in which users burned their mouths, throats and esophagi with what is essentially lye because the GHB wasn’t formulated correctly, according to Porrata.

GHB seems to “constantly keep reinventing itself” and attracting new groups of users, says Dr. Alex Stalcup, an addiction specialist in Concord, Calif., who first noticed in the late 1980s that habitual GHB users suffered withdrawal symptoms. He was medical director of San Francisco’s Haight-Ashbury Free Clinic at the time. He said he is now treating GHB addicts who have worked in Silicon Valley’s technology companies and who have used the drug “to come off of amphetamines.”

To be sure, GHB isn’t addictive for everyone. “The people who get addicted are not the partyers who take it occasionally,” says Smith, of the University of Minnesota. “The GHB addicts are the ones who use it regularly for health reasons--bodybuilders or people who suffer from depression.”

Several recovering GHB addicts said in interviews that they initially felt great when they started taking the drug. They said they would take a capful at night and wake up feeling refreshed and energized after four or five hours of sleep. But these people, who asked not to be identified, said that their GHB use eventually became more frequent and that they needed more of the drug to produce the same feeling.

Addiction experts said that withdrawal from GHB is worse than kicking cocaine. Typical symptoms include insomnia, nausea, vomiting, tremors and seizures. Some sweat profusely and ooze a waxy, oily liquid from their hands or soles of their feet. Blood pressure and heart rates soar to dangerous levels, and many have mini-seizures in which their heads snap forward suddenly--a syndrome habitual users call “carpeting out” or “throwing down,” says Smith. “It’s similar to severe alcohol withdrawal where there’s an outpouring of adrenaline and epinephrine--two hormones that spike the heart rate and blood pressure.”

Compounding the problem is that most doctors don’t know how to treat GHB addiction--or even recognize that GHB is the problem when addicts are undergoing withdrawal symptoms. “Unless the person tells them they’re on GHB, doctors don’t know what they’re dealing with,” says Stalcup.

Unlike drugs or alcohol, which can be detoxified from the body within a few days, the acute phase of GHB withdrawal lasts up to two weeks, addiction specialists say. Delirium, disorientation and hallucinations can sometimes last for days. Some patients are in such a state of agitation that they are sedated with drugs or must be placed in restraints. Patients often are released after three days, even though they are still experiencing withdrawal symptoms, because most addiction centers don’t realize they need to stay longer.

“Many people have protracted symptoms where they are anxious and depressed for months,” says Miotto. “They self-medicate with alcohol and all kinds of drugs when they get off GHB--and end up dependent on opiates like Vicodin in an effort to make themselves feel right. Some don’t get back to normal for a year, and a few never do. That’s why so many relapse; the withdrawal is so debilitating that they get stuck in a vicious cycle where they can’t get off.”

Patti Trovato-Ragano says her son, Matthew Coda, might still be alive if he had received adequate medical care after he became addicted to GHB in the early 1990s. Coda became addicted to GHB in 1998 after years of taking what he initially believed to be natural, herbal supplements to help him get fit. At the height of his addiction, he was rushed to the emergency room in a coma 18 times in two years.

“He’d fall asleep standing up,” recalls Trovato-Ragano, an oncology nurse in Naples, Fla. “If he didn’t have his bottle of GHB, he couldn’t sleep. He’d have terrible stomach pains and vomiting; he was severely depressed; his heart rate would jump to 120, and his blood pressure was off the charts.”

In August 1999, Coda, then 26, entered a detoxification program. But a week later, he was back on the street, even though he was still suffering from serious withdrawal symptoms. Apparently, in his quest for relief, Coda accidentally overdosed on other drugs. On Sept. 1, he was found dead in his bed. “He was begging for help for months,” says his mother. “But the doctors didn’t have a clue about GHB.”