GHB and date rape: risks and prevention

GHB and Date Rape

The increased use of gamma-hydroxybutric acid (GHB) to facilitate assault is a growing concern across America. Colloquially known as the 'date-rape' drug, GHB is not only inexpensive, it is also easily accessible and easy to use by those wishing to conduct sexual assault (Hensley, 2002; Sanguinetti, Angelo & Frank, 1997).

For this reason, there is a need for women to be better informed about the uses of GHB, its effects, and how it is used in sexual assault. In addition GHB's legal status will be discussed as well as the regulations that are in place from the FDA and DEA.

GHB Overview:

GHB is a colorless and odorless central nervous system depressant (Blumenstyk, 2004). Chemically, "GHB is a short-chained fatty acid found endogenously in the mammalian brain. GHB putatively serves as a neurotransmitter with unknown functions; however, GHB can also be administered exogenously and readily passes the blood-brain barrier to enter the central nervous system" (Drasbek, Christensen, & Jensen, 2006).

There are several street terms for GHB including: Fantasy, liquid X, liquid ecstasy, Grievous Bodily Harm, scoop, soap, cherry meth, salty water, organic quaalude, Growth Hormone Booster, G., Somatomax, PM, Gamma OH, and Georgia Home Boy.

It is available in both liquid and powder form (Maxwell, 2005).

This powerful liquid has a slightly salty taste that is easily masked when dissolved in any type of flavored beverage.

One teaspoon of the liquid is all that is needed for intoxication to take effect.

In 10 to 15 minutes, the drug takes effect. GHB causes the victim's muscles to relax and produces a lasting antero-grade amnesia. This amnesia is so complete, the victim remembers nothing of the events that occurred while under the drug's effects (Maxwell, 2005; Hensley, 2002; Schwartz, Milteer, & LeBeau, 2000).

In low doses, GHB can produce relaxation and euphoria. However, in high doses, it can cause nausea, seizures, slowed breathing, unconsciousness, coma, and even death (Devine, 2003). GHB occurs naturally in the body and it disappears rapidly from the bloodstream. For this reason, it is difficult to detect the ingestion of GHB (Blumenstyk, 2004; Strahler, 2004).

As stated by Jansen and Theron (2006), GHB is a very powerful sedative that can easily induce coma and, in fact, has been used in medicine as an anesthetic (Maxwell, 2005). The victim, under the influence of GHB, becomes rapidly intoxicated and falls unconscious. When in a GHB-induced coma, the victim shows no external evidence of mental activity. Motor activity is non-existent, other than breathing. and, there is no response, by the victim, even to strong stimuli. This causes them to be defenseless to the rape.

Most victims recover spontaneously within 5 hours, recovering fully from the GHB-induced coma (Van Sassenbroeck et al., 2007; Strahler, 2004; Chin, Sporer, Cullison, Dyer, & Wu, 1998).

Once fully conscious, the victim may realize they were raped; however, they will have no memory of the actual rape itself or the perpetrator (Hensley, 2002). The popularity of the use of GHB as a Mickey Finn began in the 1990s (Strahler, 2004).

However, GHB and its predecessors have been around much longer than that.

GHB was first synthesized in 1960 (Maxwell, 2005), as a means of generating active analogs of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the brain, and serves as both a precursor and a degradation product of GABA. While GABA can be formed from glutamate by glutamic acid decarboxylase, GABA is degraded to succinic semialdehyde by GABA transaminase.

At this point, GHB may be formed depending on the activity of the enzyme succinic semialdehyde reductase.

It has been suggested that GHB itself serves as an endogenous neuromodulator, besides taking part in GABA metabolism. In accordance with this idea, GHB is synthesized in neurons, can be released in Ca2+ -dependent manner, and GHB uptake mechanisms have been demonstrated. There are still, however, controversies regarding the receptor target for GHB in the brain (Drasbek, Christensen, & Jensen, 2006).

Since the 1980s, GHB has become a widespread drug of abuse in the United States. Recreational use of the drug has also reached Europe. In these recreational uses, GHB is taken with the intention of inducing euphoria and relaxation (Galloway, Frederick, Staggers, Gonzales, Stalcup, & Smith, 1997).

It's commonly found at music festivals and rave parties. However, it is also found in health clubs for anabolic purposes. There are two challenges to the recreational use of GHB. The first challenge is the very steep dose-response curve of the drug, which means it is very easy for an individual to overdose.

Drasbek, Christensen and Jensen (2006) and Galloway, Frederick, Staggers, Gonzales, Stalcup, and Smith (1997) note that this is especially dangerous given the inaccurate GHB concentrations in samples that were obtained on the street. Overdosing can lead to deep sedation, coma or even death. The second challenge comes with prolonged use of GHB.

Prolonged use can lead to induced dependency syndrome, which can be associated with a severe withdrawal phenomenon.

Withdrawal is likely caused by the constant stimulation of various brain receptors, by GHB. This leads to plastic changes in the brain tissue. The co-ingestion of ethanol, cocaine, amphetamine, or other substances can increase the toxicity of GHB (Drasbek, Christensen, & Jensen, 2006). Withdrawal symptoms from GHB abuse can include: anxiety, insomnia, and tremor. These symptoms can last up to 12 days (Galloway, Frederick, Staggers, Gonzales, Stalcup, & Smith, 1997).

Although sometimes used for anesthesia, it's popularity for this has dwindled due to adverse effects. However, now GHB is used clinically treat narcolepsy (Drasbek, Christensen, & Jensen, 2006). GHB is also used to treat petit mal seizures, alcohol dependence and opiate dependence (Nava et al., 2007; Galloway, Frederick, Staggers, Gonzales, Stalcup, & Smith, 1997). Regretfully, it is also used to facilitate date rape as well.

GHB and Date Rape:

Drug-facilitated sexual assault is typically defined as the surreptitious slipping of a drug into a person's food or beverage. Once the drug is ingested, the victim becomes severely incapacitated and/or unconscious. As Jansen and Theron (2006) note, this drugging may "involve the voluntary consumption of alcohol and the voluntary and/or involuntary consumption of other drugs." Specifically with GHB, it is relatively easy for a perpetrator wishing to conduct sexual assault to pour a small amount of GHB into a victim's drink, without their knowledge (Hensley, 2002).

Once the drug is ingested, the victim is so incapacitated that they are unable to give consent to sexual acts and/or physically able to defend themselves against such an attack. Because of this distinction, drug-facilitated sexual assault cases are differentiated from victims who have been drinking or taking drugs that are sexually assaulted against their will (Jansen & Theron, 2006). Although these victims also deny giving consent, these victims willingly became intoxicated.

Traditional cases of date rape involve substances that will likely physically disable their victims, sedating them into a state of unconscious anesthesia, which deprives them of cognition. This includes the ability to be oriented, the ability to remember what happened during the event, and the ability to maintain consciousness. The ideal drug, according to Jansen and Theron (2006) will create profound memory loss and will last at least a few hours, while impairing the ability to move. The ideal date rape drug is colorless and odorless, and can be dissolved easily in alcoholic or other beverages.

GHB meets all of these requirements for the perfect date rape drug.

Once awakened from their drugged coma, victims report a significant period of memory loss, where they typically have been moved to a new location. Often, the last memory a victim recalls is drinking a strongly flavored beverage that has been given to them by the perpetrator.

When they awaken several hours later, they often find that some of the clothes are missing, or that they've been dressed incorrectly. There may be other evidence of sexual assault as well; however, the victim will have no memory of the event (Jansen & Theron, 2006).

In Montreal, Canada, as many as 35% of reported sexual assaults now involve the administration of drugs or alcohol. GHB is a preferred choice due to its fast-acting effects and that it is relatively undetectable, when slipped into a victim's drink. Yet, despite this disturbing trend in drug-facilitated sexual assault building a legal case against a perpetrator when GHB is used is challenging, because it so quickly leaves the bloodstream. Yet, many social workers don't request blood tests on victims unless they specifically note that they did not consent to use any drugs or alcohol (Devine, 2003).

This is significantly damaging to those trying to legally prove a sexual assault case. In these instances, the legal case relies on proving consent or non-consent. Devine (2003) notes that blood tests are needed as soon as possible to give this evidence. Rape and drugging must be proven for the case to be successfully proven that no consent was given. This is especially true when combined with the effect of loss of memory of the actual event or the perpetrator.

Legal Status of GHB:

GHB is currently a controlled substance. In the United States, it is classified as an illicit club drug, by the National Institute on Drug Abuse. The primary concern is GHB's use as a date rape substance, due to its colorless and odorless appearance, and the ease of use on victims who are sedated prior to sexual assault (Drasbek, Christensen, & Jensen, 2006).

GHB was introduced in the United States' over-the-counter market in the spring of 1990.

It was introduced as a dietary supplement, as well as a sedative and for body-building effect (Maxwell, 2005).

This introduction was rapidly followed by reports of severe adverse effects at doses ranging from approximately 1 teaspoon to 4 tablespoons. Right away, there were widespread reports of poisonings.

In November 1990, this led to a U.S. Food and Drug Administration ban on the distribution of GHB for human use, outside approved clinical trials.

Adverse effects reported included: vomiting, nausea, dizziness, weaknesses, seizure-like activity, tonic-clonic, loss of peripheral vision, agitation, confusion, hallucinations, bradycardia, decreased respiratory effort, unconsciousness, and coma. These adverse effects were reported in as little as 15 minutes from oral ingestion. Acute symptoms appeared to remit after 7 hours. However, some patients reported lingering dizziness for up to 2 weeks. "Respiratory arrest occurred in one healthy 24-year-old male who reportedly ingested 'several' beers and a 'small' amount of GHB; he was intubated, mechanically ventilated and recovered without sequelae" (Galloway, Frederick, Staggers, Gonzales, Stalcup, & Smith, 1997).

Maxwell (2005) notes that the National Institute on Drug Abuse categorized GHB as a 'club drug', along with several others, including ecstasy (MDMA) ketamine, Rohypnol, methamphetamine, and lysergic acid diethylamide (LSD).

These drugs were described as being used primarily in all-night dance parties, such as raves. However, in 2003, the National Institute on Drug Abuse's Community Epidemiology Work Group doubted the appropriateness of the term 'club drugs' since the use of drugs, such as GHB, had dispersed beyond the club culture. Although GHB is commonly used in clubs (McGinn, 2005), it was argued that each of these drugs had very different pharmacologic properties, as well as different physiological and psychological effects and potential consequences. In addition, these drugs, like GHB, are being used outside the club venues, by a greater variety of people.