常见滥用药物危害特性

常見濫用藥物危害特性

及案例介紹劉清輝醫師高雄市立凱旋醫院成癮防治科1成癮物質的分類鴉片類(Opioids):海洛英(Heroin)、速賜康(Pentazocine)、配西汀(Demerol)安非他命及其相關化合物(Amphetamine):甲基安非他命(Methamphetamine)、快樂丸(MDMA)古柯鹼(Cocaine)大麻(Cannabis)幻覺劑(Hallucinogens):LSD(Lysergicacid)PCP(Phencyclidine):天使塵2成癮物質的分類鎮靜、安眠或抗焦慮劑(Sedatives、Hypnotics、orAnxiolytics)吸入劑(Inhalants):強力膠(Glue)有機溶劑酒精(Alcohol)尼古丁(Nicotine):香菸咖啡因(Caffeine):咖啡、茶其他:Ketamine、GHB3「危害防制條例」之分級第一級:海洛英(Heroin)、嗎啡(Morphine)、鴉片(Opium)、

古柯鹼(Cocaine)及其相類製品。第二級:罌粟(OpiumPoppy)、古柯(Coca)、大麻(Cannabis)、MDMA、安非他命(Amphetamine)、配西汀(Demerol)、

潘他挫新(Pentazocine)及其相類製品。第三級:西可巴比妥(Secobarbital)、異戊巴比妥(Amobarbital)、Ketamine、GHB、酣樂欣(Triazolam)、FM2(flunitrazepam)、可待因(Codeine)及其相類製品。第四級:Allobarbital、Alprazolam4DiagnosesAssociatedwithClassofSubstancesDependenceAbuseIntoxicationWithdrawalIntoxicationDeliriumWithdrawalDeliriumDementiaAmnesticDisordersPsychoticDisordersMoodDisordersAnxietyDisordersSexualDysfunctionsSleepDisorders5藥物成癮的四個階段:第一階段:初嚐快感

常用藥物:酒、菸、大麻、強力膠一類。第二階段:感受快感的盪漾

常用藥物:加上大麻、大麻油,和安非他命、安眠藥之類。第三階段:迷上快感

常用藥物:加上古柯鹼、迷幻藥、鴉片。第四階段:服用藥物才感覺正常

常用藥物:加上海洛英。6酒精(一)歷史:幾萬年前,人類已知發酵水果、穀類以製酒。西元800年,阿拉伯發明蒸餾製酒,’alcohol’乃源自阿拉伯字”alkuhl”,意為精髓(essence)。1849年之瑞典首先提出「酒癮」(alcoholism),之後被廣泛使用。在美國,醫院自1840年代開始治療酒癮患者,而19世紀後半,酒癮相關問題成為醫學研究之主要課題。台灣近年來酒癮有逐年昇高的趨勢。(二)藥理作用:中樞神經抑制作用,及影響多種生理、代謝作用。7酒精(三)中毒過量:判斷力損害、言詞模糊、運動協調障礙、步態不穩、眼球震顫、注意力或記憶力損害、木僵或昏迷。血中酒精濃度0.5%以上:影響呼吸和心跳,可能致命。(四)戒斷症狀:失眠、焦慮、手抖、噁心或嘔吐、自主神經系統活躍、激動、幻覺或錯覺、大發作癲癇。震顫性譫妄(DeliriumTremens):通常在戒斷後24-72小時發生,表現為意識不清、波動性變化、激躁不安、自主神經系統過度亢奮、高燒、幻覺(主要為視幻覺)。假设不治療死亡率高達20%,死因常為併發高燒、感染、內外科疾病和自主神經系統亢奮過久,造成心臟循環衰竭而死亡。8酒精(五)酒癮相關疾病:精神科:酒精中毒、戒斷、病態性中毒、精神病、憂鬱症、失憶、痴呆等。神經科:魏尼基氏腦症(Wernicke’ssyndrome),柯沙科夫精神病(Korsakaff’ssyndrome),周邊神經病變、肌肉病變等。胃腸系統:胃炎、酒精性肝炎、脂肪肝、肝硬化、急慢性胰臟炎、膽結石。血液系統:貧血、血小板功能失常等。其他:如代謝問題、意外傷害等。9鎮靜安眠劑(一)歷史:1962年Bayer發明bartituricacid,1903年barbital問世,1903年至1960年代末期,巴比妥鹽類(barbituates)是最普遍的鎮靜安眠藥,1960年代Benzodiazepine崛起,因其具有較佳的平安性,迅速取代巴比妥鹽類的角色。在台灣,民國68年之後,因速賜康被管制,此類藥物便逐漸流行氾濫。(二)使用途徑:口服、靜脈注射。(三)藥理作用:作用於GABAtypeA接受器。中樞神經抑制作用。具鎮靜、安眠、抗焦慮、肌肉放鬆、抗痙攣等效果。10鎮靜安眠劑(四)中毒過量:判斷力損害、言詞模糊、運動協調障礙、步態不穩、眼球震顫、注意力或記憶力損害、木僵或昏迷。(五)戒斷症狀:失眠、焦慮、手抖、噁心或嘔吐、自主神經系統活躍、激動、幻覺或錯覺、大發作癲癇。(六)併發症:中毒或戒斷的併發症可能導致死亡。精神神經科:感覺、運動、認知、情感、自我控制等方面的改變。其他內外科併發症或意外傷害。11Rohypnol(FM2)Rohypnol,atradenameforflunitrazepam,hasbeenofparticularconcernforthelastfewyearsbecauseofitsabuseindaterape.Itbelongstoaclassofdrugsknowsasbenzodiazepines.Whenmixedwithalcohol,Rohypnolcanincapacitatevictimsandpreventthemfromresistingsexualassault.Itcanproduce"anterogradeamnesia,"whichmeansindividualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrugs.Also,Rohypnolmaybelethalwhenmixedwithalcoholand/orotherdepressants.12RohypnolRohypnolisnotapprovedforuseintheUnitedStates,anditsimportationisbanned.IllicituseofRohypnolstartedappearingintheUnitedStatesintheearly1990s,whereitbecameknownas"rophies,""roofies,""roach,"and"rope."AbuseoftwoothersimilardrugsappearstobereplacingRohypnolabuseinMiami,Texas,andBoston.Theseareclonazepam,marketedintheU.S.asKlonopinandinMexicoasRivotril,andalprazolam(marketedasXanax).Rohypnol,however,continuestobeaproblemamongtreatmentadmissionsinTexas,particularlyamongyoungHispanicmalesalongtheMexicanborder.13Rohypnol

SlangorStreetNames:Roofies,Rophies,Roche,Forget-mePillRohypnol®(flunitrazepam)belongstotheclassofdrugsknownasbenzodiazepines(suchasValium®,Halcion®,Xanax®,andVersed®).ItisnotapprovedforprescriptionuseintheUnitedStates,althoughitisapprovedinEuropeandisusedinmorethan60countriesasatreatmentforinsomnia,asasedative,andasapresurgeryanesthetic.14RohypnolRohypnolistastelessandodorless,anditdissolveseasilyincarbonatedbeverages.ThesedativeandtoxiceffectsofRohypnolareaggravatedbyconcurrentuseofalcohol.Evenwithoutalcohol,adoseofRohypnolassmallas1mgcanimpairavictimfor8to12hours.Rohypnolisusuallytakenorally,althoughtherearereportsthatitcanbegroundupandsnorted.15RohypnolThedrugcancauseprofound"anterogradeamnesia";thatis,individualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrug.ThismaybewhyoneofthestreetnamesforRohypnolis"theforget-mepill"andithasbeenreportedlyusedinsexualassaults.OtheradverseeffectsassociatedwithRohypnolincludedecreasedbloodpressure,drowsiness,visualdisturbances,dizziness,confusion,gastrointestinaldisturbances,andurinaryretention.16鴉片類藥物(一)歷史：鴉片乃由罌粟植物未成熟之蒴果，以刀割痕取其流出之汁液而得，六千年前的蘇美人即記載罌粟為’快樂的植物’。滿清政府於1664年頒發吸菸處死的律令,故”菸民”將鴉片(煙)摻入香菸裡,以做為脫罪之用。後來變成以吸食鴉片為主,1840年”鴉片戰爭”戰敗後,對鴉片沒有任何管制。嗎啡是由德國人於1806年在鴉片內提煉出主要的有效成份,以希臘神話裡夢幻之神Morphius命名為Morphine。嗎啡在臨床上具有鎮痛、止咳、止瀉及催眠作用。海洛英乃由嗎啡加上雙乙醯合成,在1874年在德國首先合成,而由拜爾藥廠生產製造,其商品名乃由德語Heronisch而來,意為”少量而有強效之奇妙藥品”。它的止痛效力為嗎啡的4-8倍,但毒性則為嗎啡的10倍。17鴉片類藥物(二)使用途徑：吸入、鼻吸、口服或注射。(三)藥理作用：鴉片、嗎啡、海洛英或合成的類似作用於中樞神經的鴉片受器的化合物通稱為鴉片劑(Opiate)。具強烈的成癮性。(四)中毒過量：其特徵為意識障礙,針狀瞳孔、呼吸、心跳變慢、體溫及血壓下降(假设嚴重缺氧則可能瞳孔放大,反射消失,發紺)。死亡最常見原因是呼吸抑制。18鴉片類藥物(五)戒斷症狀：愈短效的藥物,其戒斷症狀及顶峰期越快出現。一般海洛英(heroin)約在戒斷後6小時開始出現症狀,48至72小時為顶峰期,7至10天後消失。戒斷6小時後：焦慮、失眠、哈欠、流汗、流鼻水、流淚,進一步出現瞳孔放大,起雞皮疙瘩、發冷、噁心、肌肉疼痛。18-24小時後:加上呼吸、脈搏、血壓、體溫均上升、嘔吐。24-36小時後:加上腹瀉、脫水。19鴉片類藥物(六)併發症：生理方面：因使用不潔或共用針頭而傳染到愛滋病、肝炎、肌肉血管病變或敗血症等。心理社會方面：因成癮者以追逐藥物使用為生活的重心,無法過一般正常的生活,造持人格敗壞,家庭、人際關係的破壞,甚至為了籌措金錢而導致種種不法行為。

20安非他命(一)歷史：1887年合成，1931年上市(噴鼻劑，主治鼻塞)，1935年出現錠劑(主治嗜睡)，1935至1946年認為安非他命有39種合法醫療用途，1960年末濫用大盛,1970年後因管制而減少。民國78年嚴格取締後台灣開始氾濫，79年10月列為麻醉藥品管制。(二)使用途徑：蒸發吸入、與煙草混合抽吸、口服、鼻吸或注射。(三)作用機轉：增加多巴安、新腎上腺素釋放,並抑制回收。21安非他命(四)藥理作用：自覺疲勞消失,注意力、知覺變得敏銳,興奮、欣快感，心跳加速、瞳孔放大、食慾及睡眠下降、血壓上升。(五)中毒過量：多疑敏感、焦慮易怒、躁動不安、妄想、幻覺、血壓上升、心跳加快、瞳孔放大、高燒、心律不整、出血性中風、癲癇、心臟循環衰竭死亡。(六)戒斷症狀：心情低落易怒、疲倦、焦慮、睡眠障礙(嗜睡)、食慾增加、激躁或遲緩。最嚴重的症狀是憂鬱(甚至有自殺意念或行為)。(七)安非他命精神病：表現似妄想型精神分裂症。

22MethamphetamineMethamphetamineisanaddictivestimulantdrugthatstronglyactivatescertainsystemsinthebrain.Methamphetamineiscloselyrelatedchemicallytoamphetamine,butthecentralnervoussystemeffectsofmethamphetaminearegreater.Bothdrugshavesomemedicaluses,primarilyinthetreatmentofobesity,buttheirtherapeuticuseislimited.23MethamphetamineMethamphetamineismadeinillegallaboratoriesandhasahighpotentialforabuseanddependence.Streetmethamphetamineisreferredtobymanynames,suchas"speed,""meth,"and"chalk."Methamphetaminehydrochloride,clearchunkycrystalsresemblingice,whichcanbeinhaledbysmoking,isreferredtoas"ice,""crystal,"and"glass."24HealthHazardsMethamphetaminereleaseshighlevelsoftheneurotransmitterdopamine,whichstimulatesbraincells,enhancingmoodandbodymovement.Italsoappearstohaveaneurotoxiceffect,damagingbraincellsthatcontaindopamineandserotonin,anotherneurotransmitter.Overtime,methamphetamineappearstocausereducedlevelsofdopamine,whichcanresultinsymptomslikethoseofParkinson'sdisease,aseveremovementdisorder.25HealthHazardsMethamphetamineistakenorallyorintranasally(snortingthepowder),byintravenousinjection,andbysmoking.Immediatelyaftersmokingorintravenousinjection,themethamphetamineuserexperiencesanintensesensation,calleda"rush"or"flash,"thatlastsonlyafewminutesandisdescribedasextremelypleasurable.Oralorintranasaluseproduceseuphoria-ahigh,butnotarush.Usersmaybecomeaddictedquickly,anduseitwithincreasingfrequencyandinincreasingdoses.26methamphetamineAnimalresearchgoingbackmorethan20yearsshowsthathighdosesofmethamphetaminedamageneuroncell-endings.Dopamine-andserotonin-containingneuronsdonotdieaftermethamphetamineuse,buttheirnerveendings("terminals")arecutbackandre-growthappearstobelimited.Thecentralnervoussystem(CNS)actionsthatresultfromtakingevensmallamountsofmethamphetamineincludeincreasedwakefulness,increasedphysicalactivity,decreasedappetite,increasedrespiration,hyperthermia,andeuphoria.OtherCNSeffectsincludeirritability,insomnia,confusion,tremors,convulsions,anxiety,paranoia,andaggressiveness.Hyperthermiaandconvulsionscanresultindeath.27MethamphetamineMethamphetaminecausesincreasedheartrateandbloodpressureandcancauseirreversibledamagetobloodvesselsinthebrain,producingstrokes.Othereffectsofmethamphetamineincluderespiratoryproblems,irregularheartbeat,andextremeanorexia.Itsusecanresultincardiovascularcollapseanddeath.AstudyinSeattleconfirmedthatmethamphetamineusewaswidespreadamongthecity'shomosexualandbisexualpopulations.Ofthesegroups,membersusingmethamphetaminereportedtheypracticesexualandneedle-usebehaviorsthatplacethematriskofcontractingandtransmittingHIVandAIDS.28Methamphetamine

SlangorStreetNames:Speed,Ice,Chalk,Meth,Crystal,Crank,Fire,GlassMethamphetamineisatoxic,addictivestimulantthataffectsmanyareasofthecentralnervoussystem.Thedrugisoftenmadeinclandestinelaboratoriesfromrelativelyinexpensiveover-the-counteringredients.Itisbeingusedbydiversegroups,includingyoungadultswhoattendraves,inmanyregionsofthecountry.Availableinmanyforms,methamphetaminecanbesmoked,snorted,injected,ororallyingested.29MethamphetamineMethamphetamineisawhite,odorless,bitter-tastingcrystallinepowderthateasilydissolvesinbeverages.Methamphetamineisnotsoldinthesamewayasmanyotherillicitdrugs;itistypicallysoldthroughnetworks,notonthestreet.Methamphetamineuseisassociatedwithserioushealthconsequences,includingmemoryloss,aggression,violence,psychoticbehavior,andpotentialcardiacandneurologicaldamage.30MethamphetamineMethamphetamineabuserstypicallydisplaysignsofagitation,excitedspeech,decreasedappetite,andincreasedphysicalactivitylevels.Methamphetamineisneurotoxic.Methamphetamineabusersmayhavesignificantreductionsindopaminetransporters.Methamphetamineusecancontributetohigherratesoftransmissionofinfectiousdiseases,especiallyhepatitisandHIV/AIDS.31古柯鹼(一)歷史：第六世紀時,南美印地安人以咀嚼古柯葉提神。十五世紀傳入歐洲,但未流行。1860年Niemann純化出古柯因(Cocaine)並廣被當做局部麻醉劑使用。十九世紀末時,被注意到有成癮性,1930年代因安非他命合法、廉价、容易取得且效用相似而銷聲匿跡。在美國,1970年代安非他命被禁止後,再度流行,1980年代中期古柯鹼(Cocainefreebase)大量生產,價錢廉价而氾濫成災。在台灣也有人引入國內。32古柯鹼(二)使用途徑：蒸發吸入、鼻吸或靜脈注射。(三)作用機轉：抑制多巴安、新腎上腺素回收。(四)藥理作用、中毒症狀、戒斷症狀：似安非他命,但更嚴重,更容易上癮。33CrackandCocaineCocaineisapowerfullyaddictivedrugofabuse.Oncehavingtriedcocaine,anindividualcannotpredictorcontroltheextenttowhichheorshewillcontinuetousethedrug.Themajorroutesofadministrationofcocainearesniffingorsnorting,injecting,andsmoking(includingfree-baseandcrackcocaine).Snortingistheprocessofinhalingcocainepowderthroughthenosewhereitisabsorbedintothebloodstreamthroughthenasaltissues.Injectingistheactofusinganeedletoreleasethedrugdirectlyintothebloodstream.Smokinginvolvesinhalingcocainevapororsmokeintothelungswhereabsorptionintothebloodstreamisasrapidasbyinjection.34Crack"Crack"isthestreetnamegiventococainethathasbeenprocessedfromcocainehydrochloridetoafreebaseforsmoking.Ratherthanrequiringthemorevolatilemethodofprocessingcocaineusingether,crackcocaineisprocessedwithammoniaorsodiumbicarbonate(bakingsoda)andwaterandheatedtoremovethehydrochloride,thusproducingaformofcocainethatcanbesmoked.Theterm"crack"referstothecracklingsoundheardwhenthemixtureissmoked(heated),presumablyfromthesodiumbicarbonate.35cocaineThereisgreatriskwhethercocaineisingestedbyinhalation(snorting),injection,orsmoking.Itappearsthatcompulsivecocaineusemaydevelopevenmorerapidlyifthesubstanceissmokedratherthansnorted.Smokingallowsextremelyhighdosesofcocainetoreachthebrainveryquicklyandbringsanintenseandimmediatehigh.TheinjectingdruguserisatriskfortransmittingoracquiringHIVinfection/AIDSifneedlesorotherinjectionequipmentareshared.36HealthHazardsCocaineisastrongcentralnervoussystemstimulantthatinterfereswiththereabsorptionprocessofdopamine,achemicalmessengerassociatedwithpleasureandmovement.Dopamineisreleasedaspartofthebrain'srewardsystemandisinvolvedinthehighthatcharacterizescocaineconsumption.37HealthHazardsPhysicaleffectsofcocaineuseincludeconstrictedperipheralbloodvessels,dilatedpupils,andincreasedtemperature,heartrate,andbloodpressure.Thedurationofcocaine'simmediateeuphoriceffects,whichincludehyper-stimulation,reducedfatigue,andmentalclarity,dependsontherouteofadministration.Thefastertheabsorption,themoreintensethehigh.Ontheotherhand,thefastertheabsorption,theshorterthedurationofaction.Thehighfromsnortingmaylast15to30minutes,whilethatfromsmokingmaylast5to10minutes.Increasedusecanreducetheperiodofstimulation.38cocaineSomeusersofcocainereportfeelingsofrestlessness,irritability,andanxiety.Anappreciabletolerancetothehighmaybedeveloped,andmanyaddictsreportthattheyseekbutfailtoachieveasmuchpleasureastheydidfromtheirfirstexposure.Scientificevidencesuggeststhatthepowerfulneuropsychologicreinforcingpropertyofcocaineisresponsibleforanindividual'scontinueduse,despiteharmfulphysicalandsocialconsequences.Inrareinstances,suddendeathcanoccuronthefirstuseofcocaineorunexpectedlythereafter.However,thereisnowaytodeterminewhoispronetosuddendeath.39cocaineHighdosesofcocaineand/orprolongedusecantriggerparanoia.Smokingcrackcocainecanproduceaparticularlyaggressiveparanoidbehaviorinusers.Whenaddictedindividualsstopusingcocaine,theyoftenbecomedepressed.Thisalsomayleadtofurthercocaineusetoalleviatedepression.Prolongedcocainesnortingcanresultinulcerationofthemucousmembraneofthenoseandcandamagethenasalseptumenoughtocauseittocollapse.Cocaine-relateddeathsareoftenaresultofcardiacarrestorseizuresfollowedbyrespiratoryarrest.40AddedDanger:CocaethyleneWhenpeoplemixcocaineandalcoholconsumption,theyarecompoundingthedangereachdrugposesandunknowinglyformingacomplexchemicalexperimentwithintheirbodies.NIDA-fundedresearchershavefoundthatthehumanlivercombinescocaineandalcoholandmanufacturesathirdsubstance,cocaethylene,thatintensifiescocaine'seuphoriceffects,whilepossiblyincreasingtheriskofsuddendeath.41強力膠(一)歷史：1960年代流行於美國,1965年傳入,1972傳入台灣,在青少年中流行起來。(二)使用途徑：裝入塑膠袋搓揉使其揮發而吸食。(三)藥理作用：主要成份為甲苯(44%)。生理反應與酒精類似,具中樞神經抑制作用。先有去抑制化現象,欣快感、飄浮感,繼而進入幻旅(trip),出現錯覺、幻覺,然後進入抑制期,略微嗜睡、口齒不清。42強力膠(四)中毒過量：頭暈、視覺障礙(模糊或複視)、眼球震顫、運動協調障礙、言辭模糊、步態不穩、震顫、欣快感。更高劑量會導致昏睡、精神運動性遲滯、廣泛肌肉無力、反射降低、木僵或昏迷。(五)戒斷症狀：輕微,可能會失眠、胃口不佳、顫抖、噁心嘔吐。(六)併發症：感覺異常、運動障礙、聽力喪失、周邊神經病變、心肌病變、肝腎傷害、缺氧、窒息、意外死亡。43新興藥物濫用形態新的藥物濫用形態“”v.s.“非法藥品”v.s.“合法物質”“成癮”v.s.“控制使用”44俱樂部用藥ClubdrugPub,Rave,夜總會,地下舞廳,KTV網咖私人聚會45俱樂部用藥Recreationaluse,助興,流行Perceivedharm下降Availability增加使用容易公開及半公開使用46新聞媒體報導的clubdrugs快樂丸搖頭丸搖腳丸,一粒沙(elisa)

安非他命(甲基安非他命)FM2大麻K安笑氣Others...47ClubDrugsAnumberofourNation'sbestmonitoringmechanismsaredetectingalarmingincreasesinthepopularityofsomeverydangeroussubstancesknowncollectivelyas"clubdrugs."Thistermreferstodrugsbeingusedbyyoungadultsatall-nightdancepartiessuchas"raves"or"trances,"danceclubs,andbars.MDMA(Ecstasy),GHB,Rohypnol,ketamine,methamphetamine,andLSDaresomeofthecluborpartydrugsgainingpopularity.NIDA-supportedresearchhasshownthatuseofclubdrugscancauseserioushealthproblemsand,insomecases,evendeath.Usedincombinationwithalcohol,thesedrugscanbeevenmoredangerous.48"Clubdrug"isavaguetermthatreferstoawidevarietyofdrugs.Uncertaintiesaboutthedrugsources,pharmacologicalagents,chemicalsusedtomanufacturethem,andpossiblecontaminantsmakeitdifficulttodeterminetoxicity,consequences,andsymptomsthatmightbeexpectedinaparticularcommunity.Noclubdrugisbenign.ChronicabuseofMDMA,forexample,appearstoproducelong-termdamagetoserotonin-containingneuronsinthebrain.Giventheimportantrolethattheneurotransmitterserotoninplaysinregulatingemotion,memory,sleep,pain,andhigherordercognitiveprocesses,itislikelythatMDMAusecancauseavarietyofbehavioralandcognitiveconsequencesaswellasimpairingmemory.49ClubdrugsBecausesomeclubdrugsarecolorless,tasteless,andodorless,theycanbeaddedunobtrusivelytobeveragesbyindividualswhowanttointoxicateorsedateothers.Inrecentyears,therehasbeenanincreaseinreportsofclubdrugsusedtocommitsexualassaults-yetanotherreasonwhyNIDAisalertingyoutotheseescalatingtrends.50GHB1.Gammahydroxybutyrate(GHB)isanillicitchemicalthathasbecomeamajorcauseofdrug-relatedcomasintheUSandothercountries.Infact,thenumberofGHBoverdosesintheUnitedStateshasnowout-pacedoverdosesfromMDMA(Ecstasy).2.GHBwasrejectedbytheAmericanmedicalcommunityinthe1960s,buthasbecomepopularamongmanypeopleforitsabilitytocrosstheblood-brainbarrierfreelyanddepressconsciousness,resultingineuphoriaandintoxication.51GHB3.ItisalsotoutedontheInternetasasleepaid,ananti-depressantandweightlossproduct,althoughtheseusesarenotsubstantiatedbyrealityandmaycarryapotentiallydeadlytwist.4.Startingfirstasanalternativetosteroidsinthelate1980s,whensteroidswerebeingcontrolled,GHBhasgrownintoamulti-headedmedicalnightmare,drainingemergencyroomservices,shatteringthelivesofthosewhohavelostlovedonestoit,andterrifyingfamilies/friendsofthoseaddictedtoit.Yetitisstillamysterytomostlawenforcementofficers,medical/coronerpersonnel,andparents.52GHBhasalsobeenasociatedwiththesocalled"daterape"drugs.GHBcanbeproducedinclearliquid,whitepowder,tablet,andcapsuleforms,anditisoftenusedincombinationwithalcohol,makingitevenmoredangerous.GHBisusuallyabusedeitherforitsintoxicating/sedative/euphoriapropertiesorforitsgrowthhormone-releasingeffects,whichcanbuildmuscles.53GHBGHBisacentralnervoussystemdepressantthatcanrelaxorsedatethebody.Athigherdosesitcanslowbreathingandheartratetodangerouslevels.GHBintoxicatingeffectsbegin10to20minutesafterthedrugistaken.Theeffectstypicallylastupto4hours,dependingonthedosage.OverdoseofGHBcanoccurratherquickly,andthesignsaresimilartothoseofothersedatives.54GHBGHBisclearedfromthebodyrelativelyquickly,soitissometimesdifficulttodetectinemergencyroomsandothertreatmentfacilities.55GHBGHBwasfirstsynthesizedinFrancemorethan40yearsagoasapossibleanesthetic,butbecauseofitsundesirablesideeffectswasrejectedbytheAmericanmedicalcommunity.Itslegaluseanywhereisdwindlingascountriesarebeginningtorecognizetheproblems.GHBresurfacedin1987asanorphandrugbeingresearchedtotreatthecombinationofsleepdisordersknownasnarcolepsy/cataplexy.56GHBAtaboutthesametime,steroidusersweretoldthatitmightenhancethebody’sproductionofgrowthhormone(indeepsleepstate).However,duetogrowingnumbersofoverdoses,itwasorderedofftheshelvesofstoresinNovember1990.Unfortunately,ithasgainedstatusasarecreationaldrugandasarapedrug,andhasbecomedangerouslycommon.AsaresultofincreasedrestrictionsonGHBitself,its“analogs,”orchemicalcousinsthatturnintoGHBinthebody,havebecomeincreasinglyprevalent.57USERSOFGHB

*Attendeesatdanceclubsor“rave”partiesareperhapsthemostprominentusersofGHBtoaltermood.*SexualpredatorsofallagesareattractedbythedisinhibitingandeuphoriceffectsofGHB,fortheyknowausermaybeeasilytakenadvantageofinanassault.Someexoticdancersandstrippersself-dosewithGHB,seekinga“sexier”performance.*Bodybuildersandotherathletes,includingprofessionalathletes,aretheleastrecognizedusers.Infact,thisgroup,oftenusingitonadailybasis,aretheonesmostlikelytobecomeaddicted.*BusinessprofessionalswhotravelfrequentlyandthinkGHBisasafesleepaid(comparabletomelatonin,forexample)areanotherunrecognizedgroup,alsosubjecttoaddictionandwithdrawal.58USERSOFGHB*Theelderlyarealsopotentialvictims,beingtoldthatGHBisananti-agingcompound.*GayandlesbianpopulationsalsouseGHBasarecreationaldrug.Insomecases,itisalsousedinthiscommunityforrapeorrobberypurposes..*PeoplesubjecttodrugtestingprogramsuseGHBasanalcoholsubstituteandtobypassdrugtesting.NOTE:IdentificationofGHBiscomplicatedbytheshortdurationoftimethatitpersistsinbodyfluidsandbytheabsenceofGHBtestingfromthenormaltestingproceduresofmostagencies.Thiswillchange,asrisksofGHBaremorewidelyrecognized.59ANALOGSOFGHB

Overthepastseveralyears,avarietyofstates,haveaddedGHBtotheirlistsofcontrolledsubstances,thusmakingitpossibleforcriminalpenaltiestobeadministeredforuseofthedrug.Thisforcedgammabutyrolactone(GBL)and1,4-butanediol(BD),tostepintothespotlight.GBLisbothaprecursor(aprimaryingredientinmakingGHB)andanactiveanalog(asubstancethatconvertstoGHBinthehumanbody,withthesamephysicaleffectasGHB).BDisanactiveanalog,alsoconvertingrapidlytoGHBinthebody.Anotheranalogthathassurfaced,gammahydroxyvalerate(GHV),isonitswaytobecomingasuniversalasGBLandBD.BothGBLandBDachievethisconversioninsideofthebody,andGBLcantransformintoGHBbothinsideandoutsideofthebody.60ANALOGSOFGHB

GHBremainsaccessibletoabusersthroughthissimpleconversion,thoughallareillegalforhumanconsumptionsinceMarch2000,whenGHBwasfederallyscheduled.Whatisunsettling,though,ishoweasyitistogetaholdoftheseprecursors.GBLandBDandvalericacidsubstancesareavailableatgyms,chemicalsupplystores,theInternet,andthroughmailorder.Theyaresoldaspowders,capsules,gelsorliquidsandcanbefoundinavarietyofconcentrations,colors,andflavors.Therearemorethan80streetandtradenamesforGHBanditsanalogs61EFFECTSOFGHB

GHB’sdepressanteffectsonthebraininlowdosesproduceahighoreuphoricfeelingasinhibitionsaredepressed.Whenthedoseisincreased,profoundcomaresults.Theheartratemayalsobedepressedorslowed.Effectsonthenervoussystemmayresultinaspasmofmusclecontractionscalledmyoclonus,producingseizure-likemovements.62EFFECTSOFGHB

Othereffectssuchasconfusion,amnesia,vomitingandirregularbreathingaredangerouswhencombinedwiththemajordepressanteffectsofGHB.OtherdrugsincombinationwithGHB,especiallyotherdepressantssuchasalcohol,mayworsenthedepressiveeffectsandincreasethepossibilityofafataloutcome.63EFFECTSOFGHB

The“desired”effectsforGHBinlowdosesmaysoundinviting,buttheconsequenceofthewrongdosemaybedeath.ThedosageresponseofGHBisquitesteep,meaningthatatinyincreaseindosemaycauseadramaticincreaseinsymptomsand,thus,inrisk.Variableeffectsmeanthatateaspoonmightbeperfectonetime,butmaybecomeanoverdosethenexttime!ItisalsoimportanttobeawareoftheconsequencesthatoccurwhenGHBismixedwithotherchemicals.Forinstance,mixingGHBwithalcoholorotherdepressantsisevenmorelikelytoresultindeath.Theeffectslastaboutfourhoursandcanresolvequitesuddenly.64GHBOVERDOSE

ThemostdistinctiveandterrifyingfeatureofGHBisitsoverdosetimecourse.Within15minutesaperson’sstateofmindbecomesalteredandthereisahighpossibilityofalossofconsciousnessoranactualcoma.Breathingcanslowtoonlyfourtosixbreathesperminute!Mostpeopledo“sleepoff”aGHBoverdose;thosewhodon’tarecalled“dead.”AGHBoverdoseISa911emergency.65THEFUTUREOFGHB

WhetherGHBcontinuestobeawidelyuseddrugdependsonthestepsthataretakentoeducatethepublic.Insteadofbeingperceivedasadietarysupplement,peopleneedtorecognizeGHBforwhatitis:anillictanddangerousdrug.EventhoughGHB(alsoknownassodiumoxybate,tradenameXyrem)hasbeenapprovedformedicalpurposes,itsdeadlyrisksforrecreationaloranyunsupervisedandunmonitoreduseremainthesame.ThereisnoevidencethatprofessionallymadeGHBisanylessdangerousintheabusearena.HealthcareprovidersandlawenforcementofficersneedtobecomefullyawareoftheeffectsanddangersofGHBsothattheycanplayanimportantroleininformingthepublic.66GHBGHBisusuallyliquid&maybehiddeninanytypeofcontainer.Water/drinkbottles,eye&nasalspray&mouthwashcontainersarecommon.Becauseofitsusuallysaltyorchemicaltaste,itisoftendisguisedinsweetorfruitydrinkswhengiventounknowingvictimsforrapeorrobbery.67GHBDescription:Aclearliquid.Looksjustlikewater.Canbemistakenforwaterbecauseitisusuallyfoundinasmall(30ml)clearplasticbottle,awaterbottle,orevenGatoradebottles,whichcontainsseveraldoses.Onequicktaste,andyou'llknowit'snotwater.Notascommon,butalsofoundasawhitepowder.Infactpowderuseisontherise!68GHBEffects:Intoxication,increasedenergy,happiness,talking,desiretosocialize,feelingaffectionateandplayful,milddisinhibition,sensuality,enhancedsexualexperience,musclerelaxation,lossofcoordinationduetolossofmuscletone,possiblenausea,difficultyconcentrating,lossofgagreflex.69GHBManypeoplehavebadreactions.Thesecaninclude

nausea,headaches,drowsiness,dizziness,amnesia,vomiting,lossofmusclecontrol,respiratoryproblems,lossofconsciousness,beingconsciousbutunabletomove,anddeath-Especiallywhencombinedwithalcoholorotherdrugs.70GHBEffectsoflargedoses:Disinhibition,sedation,desiretosleep,ramblingincoherentspeech,giddiness,silliness,difficultythinking,slurredspeech,passingout,anddeath.Effectsofoverdose:Sleepordeepsedationfromw