GHB

Long Term effects
• More prolonged
“burn out” or
“crash periods” up
to a week later
• Dental Damage
• Depression for
weeks
• Renal failure
MDMA Focused Tx
• Benzodiazepines
- Ativan 0.5-2 mg
- Valium 2.5-10 mg
• beta blockers have fallen out of favor (like
Brevibloc), Consider an adrenergic
blocker w/ alpha blocker properties as
well.
Take Home Information
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Core Temp if unresponsive
Fluid Resuscitation
Sedation PRN
Watch for DIC, SZ
P.U.H.A. IF GROSSLY
SYMPTOMATIC.
Rohypnol
• Sedative
• Potent Benzodiazepine
- 10x more potent than valium
- Used during sexual assaults, date rape and
robberies
• Rohypnol is not approved for prescription
use in the United States
• Used in many countries for insomnia, as a
sedative, and as a pre-surgery anesthetic.
Rohypnol- Street Names
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Roofies
Rophies
Roche
Rope
R-2
Forget-Me pill
Mexican Valium
Rohypnol
• Action- sedative
• Route
- Oral
• Tasteless and odorless
• Dissolves easily in carbonated beverages
- Snorted
• Effects
- Onset in 15-20 minutes
- Lasts 4-6 hours, but can last 8-12
- Alcohol intensifies effects
Rohypnol- Signs and Symptoms
• profound anterograde amnesia- unable to
remember events while under drug’s influence
• Loss of motor control
• Lack of coordination
• Slurred speech
• Hypotension
• Drowsiness
• Visual disturbances
• Dizziness
• Confusion
• Gastrointestinal disturbances
• Urinary retention.
Rohypnol- Management
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ABC’s
Support and manage
Oxygenation (15L NRB or BVM)
IV access
Monitor
GHB
GHB
• Gamma-hydroxybutyrate
• CNS depressant
• Widely available over-the-counter in health
food stores during the 1980s until 1992
• Body builders used to aid in fat reduction
and muscle building
• Available in tablets, capsules, powders or
clear liquid
GHB Analogs- Introduction
• Gammahydroxybutyrate
(GHB) may be made
in homes by using
recipes with common
ingredients.
• "Liquid Ecstasy,"
"Georgia Home Boy,"
"Grievous Bodily
Harm,
• “Liquid ecstasy," do
not confuse w/ MDMA
• GBL, GBH, One 4 B
GHB- Street Names
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Liquid X
G
Grievous Bodily Harm
Georgia Home Boy
Blue Nitro
Easy Lay
Soap
Vita-G
So Many Names….
• Tranquili G, Midnight Blue, Verve, Rejoov,
Somax, SomatoPro, Flower Power,
Puritech, Alcover, G-riffick, Eclipse,
GHGold, Soap, Vita G, Dormir, Enliven, FX,
Serenity, Inner G, Zen, White Magic
Cleaner, Weight Belt Cleaner, Ink Jet
Cartridge Cleaner, Plant Food, Fingernail
Polish Remover, Paint Stripper.
There are more than 80 known names for
GHB and its equally deadly analogs.
GHB analogs –
How are they used?
• GHB can be produced in clear liquid, or a
white powder, tablet, and capsule forms,
and it is often used in combination with
alcohol, making it even more dangerous
• It is often carried in an eye dropper, or in
water/Gatorade bottles and passed
around.
• Typically measured out in capfuls.
• Occasionally blue food coloring is used to
identify it at some raves.
• Historically used as a body building aid
Recognizing GHB
AKA: GHB, G, Jib, Scoop,
Liquid E, Liquid X, Woman’s
Viagra, Grievous Bodily Harm,
Easy Lay, Gamma 10, Salty
Water, GH Buddy, Aminos,
Blue Nitro, Blue Thunder,
Thunder Nectar, Renewtrient,
Revivarant, Remforce,
Firewater, Invigorate, Xyrem
(research product), sodium
oxybate, Fantasy & One4B
(NZ)
Other GHB Products
Efforts to Avoid Detection
• GHB & its analogs are
NOT protected by the
Dietary Supplement &
Heath Education Act of
1994.
• Unapproved for human
use.
• “Misbranded” drugs.
• May be listed as
“weight belt cleaner”
or other solvent use or
plant growth formula—
trying to avoid
GHB- No longer Just for
Rapists
• Recreational Use
• Muscle Gain
• Those under
mandatory drug
testing
• Elderly
What To Expect
Typical Drinks To Hide GHB
Any Substance can be used to
hide a GHB Analog!
Typical GHB Containers
Typical bottles for hiding GHB-film canisters, hair spray,
liquid candy bottles, food
coloring, breathe mint
containers (may be liquid LSD
or G), vanilla bottles,
Gatorade, pump hand lotion
bottles.
Recognizing
Containers
ANY container
that will hold
a liquid.
GHB addicts have hidden it in engine
compartments, attics, etc.
Billy Idol: Famous GHB’er
Billy almost died in 1993 from (then
legal) GHB in front of a L.A. Night
club
Nick Nolte
GHB
• Action- CNS Depressant
- Involved in poisonings, overdoses, date rapes, and
deaths.
• Route
- Oral
- Comes in tablets, capsules, powder or clear liquid
• Effects
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Begin in 10 to 20 minutes
Last up to 4 hours
Higher doses may result in sleep, coma, or death.
Clears quickly from body, making it virtually
undetectable
GHB- Signs and Symptoms
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Drowsiness
Dizziness
Nausea
Seizures
Unconsciousness
Respiratory Depression
Coma
- Victims report knowing what is going on, but
unable to move
GHB analogs - What does it
do
• At lower doses, GHB has sedative
effects, but, as the dose increases,
GHB effects may result in sleep
,eventual coma, respiratory arrest, or
death.
• It is these effects that make it both a
prime drug at Raves, and for Date
Rape
GHB analogs toxicity- mild
• Lethargy, easily aroused with
repeated stimulation
• Drowsiness, somnolence, dizziness,
euphoria
• Confusion (dazed and confused)
• Amnesia, Susceptible to suggestion
GHB analogs ToxicitySevere
• 66% with GCS <9, ½ of these may have
GCS at 3!
• Frequent Vomiting,
• Bradycardia,
• Respiratory depression or arrest
• Seizures
• Sudden onset of coma . Patients often
demonstrate extreme SUDDEN combativeness
and agitation despite such profound CNS and
respiratory depression
• Death (usually secondary to respiratory failure
or aspiration)
GHB
• ALCOHOL IS THE
MOST COMMON
DRUG CO
CONSUMED IN
GHB RELATED
DEATHS
GHB- Management
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ABC’s
Support and manage
Oxygenate (15L NRB or BVM)
Seizure precautions
GHB analogs-Treatment
• Primary Supportive
• Beware of positional Asphyxia, but
soft restraints are a good idea
• Due to the risk of sudden airway
failure, aspiration, and respiratory
collapse, these patients need
aggressive airway monitoring by ALS
providers
GHB analogs-Treatment
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Protect your self
VOMIT
Be cautious using respiratory depressants
Making the decision to tube/not tube is
tough, these patients do frequently vomit.
• ETT placement is uncommon, but post
ETT sedation/paralysis and restraint
should be mandatory in the field
Difficulty in Prosecution
• Sort Duration
• Amnesia clouds
recall
• Often pro-sexual
appearing
behavior
• Lack of :
- Credible witness
- Evidence
GHB analogs- What does this
mean to me?
• GHB analogs are unpredictable in
clinical course, other than duration.
• GHB analogs cause a rapid change in
mental and respiratory status that
makes it difficult to plan treatment
and care
• GHB’s presentation often mimics
ETOH abuse and is often co-imbibed.
Harm Reduction
• Web sites
- www.dancesafe.org
- www.erowid.org
WWW.EROWID.ORG
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www.dancesafe.org
Non Profit
Drug testing kits
Drug warnings
Drug testing and postings
HARM REDUCTION
What To Expect
Anatomy of a Rave-Common
Medical concerns
• Severe
Dehydration and
Hyperthermia
• Poly-Pharm
involvement
• Date Rape
• Multiple Patients
(approach with a
plan)
• Volatile Crowds
Interacting with Ravers
• Remember there is a
cultural distrust
• Don’t be afraid to ask
for interpretation of
slang
• Generally not overtly
violent singularly, but
beware of crowds
• Our attitude and
interaction may have
a positive or negative
impact on the crowd.
• Check for a “Trip
Safety
• Hazards:
Uncontrolled Scenes
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Patients
Environment
Bystanders
Weapons
CLAN LABS
• Tactics learned from
law enforcement
community
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Staging
Isolation and Control
Scoop and swoop
Travel in Packs
SAFETY for the PT.
• Pt safety
poses an
extreme
challenge for
EMS
- Drug
Interactions
- Rapid
Changes
- Restraint
Summary
• “..Due to the poly-pharmacy drugs
that are being sold to ravers, all of
these patients deserve ALS
evaluation…”
• Knowing your onsets and durations
will help you a lot .
Don’t let this pt….
…turn out like this:
And don’t miss this!
Samantha Reid, Age 15
GHB induced death at a party
No alcohol was involved
The 4 guys who gave the GHB to her are
serving 5 ½ -15 years in prison
Melanie Sidone, 15 at the time, was in
a coma for 17 hours