GBL: Physiological effects
Last modified: Sunday, 31. May 2009 - 3:43 pm
When swallowed, GBL is converted in the body to GHB, causing psychological symptoms and brain depression as indicated above, as well as other symptoms that include low blood pressure or heart rate, low body temperature, and nausea and vomiting. As GBL and related drugs shut down vital brain functions, breathing slows down and may even stop. If emergency treatment is not available, respiratory depression or dangerous slowing of heart rate can cause death.
Physical effects begin within 15-30 minutes of taking the drug and last three to six hours. The sometimes deadly effects of GBL and related drugs appear to be dose-related, so that the larger the dose, the more frequent and severe the ill effects. At GHB doses of 0.5-1.5 grams, the user may feel relaxed or drunk; doses of 1.0-2.5 grams increase muscle relaxation and impair coordination; and doses over 2.5 grams can cause nausea, vomiting, drowsiness, breathing difficulty, slow heart rate, coma, and death.
Harmful side effects
Overall, the DEA has reported more than 72 deaths and 5,500 emergency room overdoses associated with GHB, and serious ill effects related to GBL and related drugs, GHB and BD, in at least five children under 18 years of age. All five children had vomiting and became unconscious, and most had respiratory depression and dangerous slowing of heart rate. As GBL crosses the placenta, a pregnant woman exposes her unborn baby to its dangerous effects.
Slow, shallow breathing, and irregular or slow heart rhythms related to use of these drugs can deprive the brain of oxygen and blood flow, causing unconsciousness, coma, epileptic fits or seizures, loss of muscle tone, and permanent brain damage. Lack of oxygen and blood flow to other vital organs can cause other serious complications such as kidney failure, requiring dialysis; or pulmonary edema associated with fluid collection in the lungs; shortness of breath; coughing up blood; and heart failure. The combination of unconsciousness, difficulty breathing, and vomiting can cause aspiration, or choking to death on vomit.
From October 1998 through January 1999, poison control centers in New Mexico identified 14 patients seen in emergency rooms for symptoms related to use of products containing GBL. Five of these patients had also consumed alcohol and/or other drugs. The most common symptoms and signs were nausea and vomiting in 10 (71%), decreased level of consciousness in nine (64%), slow heart rate in seven (50%), prolonged unconsciousness in six (43%), fainting in six (43%), seizures in four (29%), confusion in four (29%), combative behavior in four (29%), respiratory depression in three (21%), memory loss in two (14%), and inappropriately elevated mood in two (14%). Three were hospitalized, one with cardiac arrest, one with respiratory arrest, and one after a car crash associated with the effects resulting from use of GBL.
During the same timeframe, there were 20 emergency room visits for complications of GBL use reported in Texas. These patients ranged in age from 11 to 41 years, and 10 had also consumed alcohol and/or other drugs. Ten had to be hospitalized, including one with respiratory arrest. The most common symptoms and signs were decreased level of consciousness in 13 (65%), prolonged unconsciousness in nine (45%), respiratory depression in nine (45%), anxiety and nervousness in seven (35%), nausea and vomiting in six (30%), confusion in six (30%), tremors and twitching in four (20%), rapid heart rate in three (15%), and combative behavior in three (15%).
In a series of nine toxic reactions to BD reported in the New England Journal of Medicine in early 2001, the effects of BD were similar to those of GBL and GHB, and included addiction, withdrawal, and death. The eight patients seen at Hennepin County Medical Center, Minneapolis, Minnesota, had used BD recreationally, to enhance bodybuilding, or to treat depression or sleep problems. One patient was seen twice with toxic effects and had withdrawal symptoms after her second episode, including hallucinations, sleeplessness, fear, agitation, and uncontrollable body movements. Reactions in most patients included vomiting, loss of bowel and bladder control, agitation, striking out at others, fading in and out of consciousness, respiratory depression, and death. Six patients, including two who died, had not used alcohol or any other drugs with BD. Those who died had taken 5.4-20 g of BD, and the others took doses ranging from 1 to 14 g.
Long-term health effects
GBL and related drugs can cause physical and psychological dependence and addiction with sustained use. Withdrawal symptoms in users of high doses, especially when used for longer than four months, can include sleeplessness, muscle cramps, tremor, anxiety, hallucinations, and delusions lasting from 48 hours to 12 days after last use.
In a series reported in 2001 of five patients seen for abrupt withdrawal from GBL, symptoms included rapid heart rate, high blood pressure, delusions of being persecuted or harmed, hallucinations, and fluctuating states of consciousness. Most of the patients were body builders, and ranged in age from 23 to 33 years. Patients had been taking GBL for two to nine months, and developed withdrawal symptoms one to six hours after their last dose, with symptoms lasting up to 14 days.
In testimony before the FDA, drug researcher Deborah Zvorsec reported that GHB users need increasing amounts of the substance to feel good. By the time they realize they have become tolerant or even addicted, they develop severe anxiety, sleeplessness, panic attacks, and hallucinations when they try to stop. Detoxification, even with medical supervision, resembles the terrifying state of hallucinations and extreme anxiety called “DTs,” or delirium tremens, that accompany alcohol withdrawal. After detoxification most patients suffer from severe depression and anxiety lasting weeks to months, and some also have muscle twitching and tremors, or uncontrolled shaking. Very few are able to refrain from using GHB again. “GHB is perhaps the most addictive drug ever abused,” Zvorsec testified.
While some users may recover completely and rapidly from intoxication with GBL or related drugs, previous exposure does not predict future response. These users may be lulled into a false sense of security, thinking they are immune to any toxic reactions, only to suffer serious reaction or even death the next time.
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