Pubdate: Mon, 26 Nov 2001
Source: Los Angeles Times (CA)
Copyright: 2001 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: Linda Marsa, Times Health Writer

IN THE GRIP OF GHB

The Illegal Supplement Is Popular With Fitness Buffs, Insomniacs And 
Partyers--And Is Highly Addictive. Many Doctors Are Grappling With How To 
Treat People Who Are Hooked.

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."
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