Introduction

The Horizontal Working Party on Drugs, at its meeting of 22 September
1999, requested the EMCDDA and Europol to provide preliminary information
on the substance GHB under Article 3 of the joint action. Europol
national units and Reitox national focal points were subsequently requested
to provide information on GHB. The EMCDDA and Europol also conducted
enquiries. No reporting took place using the �Europol–EMCDDA reporting
form on new synthetic drugs’.

Six Member States have decided to put GHB under permanent control:
Belgium (Royal Decree 22.1.1998); Denmark (Euphorians Act, 16.12.1999);
France (Decree 28.4.1999); Ireland (Misuse of Drugs Act, May 1999); Italy
(Decree 266, 11.11.1999); and Sweden (Narcotics Act, 13.1.2000).

In Austria, Finland and Germany, GHB is controlled by the Medicines Act.
In Greece, it is subject to monitoring. In the United Kingdom, the Advisory
Council of the Misuse of Drugs recommended monitoring of GHB misuse;
its manufacture and supply fall within the scope of the Medicines Act 1968.
In the Netherlands, GHB has been controlled by the Medicines Act since
1996. In October 1999, the Dutch Coordination Centre for Assessment and
Monitoring of New Drugs of Misuse (CAM) concluded its risk assessment on
GHB and recommended continued monitoring and a further risk assessment
in case of new evidence.

Available information on GHB

Chemical and physical description, including the name under which GHB
is known

The full chemical name for GHB is gamma-hydroxybutyrate.

GHB is known by a variety of street names: �liquid ecstasy’, �gamma-OH’,
�oxybate’, �somatomax’, �GBH’, �happiness drops’, �liquid loving’ and others.
It is usually available as a clear, odourless, colourless and sometimes tasteless
liquid. The substance is most frequently sold in plastic bottles or in capsules.
It is also available in the form of white powder tablets.

GHB was originally developed as an anaesthetic drug and is used as a
licensed medicine in some Member States. It acts as a central nervous system
depressant and hypnotic and is chemically related to the brain neurotransmitter
gamma-aminobutyric acid (GABA). In some Member States, GHB is
offered for retail sale through shops, the Internet and magazine advertisements.
The typical dose is around 10 ml equivalent to about 1g of GHB.

GHB is absorbed within 10–15 minutes and in adverse circumstances neither
flumazenil nor naloxone appear to be effective. GHB cannot be detected
in blood or urine by means of routine toxicological analysis, nor does it
react with the reagents in commonly used field-test kits. Suitable methods of
identifying GHB in the laboratory are NMR and infrared spectroscopy.

Information on the frequency, circumstances and/or quantities in which
GHB is encountered

In Austria, although there have been no reported seizures or hospital treatment
episodes attributed to GHB, there is some anecdotal evidence of use
among very small, closed groups.

In Belgium there are regular seizures, particularly during the summertime, of
small quantities of GHB in liquid form and, incidentally, in capsules. In

September 1999, there was a report of two cases of hospitalisation near the
French border. GHB was suspected but results from blood sample analysis
have not been made available yet.

In Finland, 757 millilitres of GHB were seized in seven incidents in 1998. In
1999, the Finnish forensic laboratories analysed samples of GHB relating to
total seizures of over 3 800 grams. Also, over 5 litres of the precursor GBL
were seized.

In France, there have been few seizures reported and no reported fatal or
non-fatal intoxications. A survey, which compared 900 young people who
regularly attended techno party events with a control group matched for age
and sex of people who do not attend such events, found that 4 % of techno
party attenders said they had taken GHB. Among the control group, consumption
of GHB was non-existent indicating that the use is not widespread.

According to the French Centre d’Evaluation et d’Informations sur les
Pharmacodependances, abuse of 1,4-butanediol as a substitute for GHB has
increased since the classification of the latter under French legislation, in
April 1999. The substance 1,4-butanediol is being sold as �ecstasy’.

In Denmark, there have been five seizures of GHB since June 1999 and in
the same period 12 patients with non-fatal intoxications associated with
GHB have been treated in hospital.

Germany reports some incidents of seizures of small, insignificant quantities
of GHB.

In Ireland, one seizure of GHB in liquid (25 millilitres) and one in powder
form were reported.

In the Netherlands, there were a number of small seizures from discotheques.
At least eight hospitalised, non-fatal intoxications associated with GHB
have been recorded. Producers of GHB are thought to be involved in the
production of controlled drugs, with dealers possibly having links to ecstasy
producers. They are individuals with a criminal background or members of
small groups, rather than criminal networks.

In Spain, the first seizure took place in Madrid in January 1996. From 1996
to November 1999, a total of 16 small seizures were reported. Since 1995,
one non-fatal intoxication was registered. On the basis of current evidence,
GHB use in Spain is thought to be very limited (Cabrera et al., 1998).

In Sweden, seizures have found GHB in connection with other seizures of
narcotic drugs and anabolic steroids. In 1997, one seizure of 50 kg was

reported, and in 1998 one seizure of 13.5 and 20 litres as well as some small
seizures.

In the United Kingdom, London, the North-West, the Midlands and South
Wales have been identified as the main areas of production and supply. GHB
is mainly distributed through retail outlets and over the Internet. Proactive
enforcement against sale and supply of GHB via retail outlets has curtailed
the overt advertising and supply of GHB, particularly in London’s sex shops.
The disruption of overt supply has led to distribution patterns similar to those
of illicit drug networks. In addition, the Medicines Control Agency (MCA)
has taken action against a number of unlicensed operators. There is little evidence
of widespread use or that illicit use is increasing. GHB is supplied to
bodybuilders via mail order and in gyms. Seizures are rarely submitted for
laboratory examination. The Forensic Science Service handles less than 10
cases each year. There is no current intelligence regarding international trafficking
of GHB into or from the United Kingdom. There is intelligence that
the precursor, GBL, is being sourced from other Member States, for example
Belgium, to be used in GHB production. The high profit margins and the
comparatively limited penalties encourage the involvement of organised
criminal groups. There is evidence of criminals involved in controlled drugs
also being involved in the production and supply of GHB.

A first indication of the possible risks associated with GHB

In small doses (10 mg/kg body weight) GHB diminishes tension but in marginally
larger doses (50–70 mg/kg body weight) it can cause nausea, vomiting,
confusion, convulsion, anaesthesia, apoplexy, respiratory depression and
coma.

It has been stated that adverse effects occurred both when GHB was used
alone or in combination with other drugs and alcohol (Williams et al., 1998).
The risks of GHB consumption are more severe when taken with alcohol and
drugs such as benzodiazepines, barbiturates, opiates, anti-convulsants, and
antihistamines.

GHB use could lead to the development of physical dependence (Galloway
et al., 1997).

The earliest recorded indications of illicit use of GHB were in Sweden and
in the United States during the early 1990s. At that time in Sweden, the small
number of GHB overdoses was associated with bodybuilders.

Since 1995, eight deaths linked to GHB use have been reported within the
European Union (6). In September 1995, March 1996, November 1997 and
January 1999, four deaths were reported from the United Kingdom. In
February 1996 and in March 1997, two deaths were reported from Sweden.
Alcohol was implicated in each of the deaths in Sweden and the United
Kingdom. In 1998 and in 1999, two deaths were reported from Finland.

A substantial number of hospital admissions and comas associated with a
combination of GHB and alcohol were reported from the United Kingdom,
Sweden and the Netherlands. In the Netherlands, the conclusion of the risk
assessment on GHB for continued monitoring was based mainly on the danger
the drug presented for individual health, due to the fact that the desired
effect and the dosage to cause unconsciousness or reversible coma are
closely linked to each other.

Information on chemical precursors

The precursor to GHB is gamma-butyrolactone (GBL), a solvent widely used
in industry and commercially available. GHB is easily manufactured by
adding aqueous sodium hydroxide to gamma-butyrolactone (GBL). No special
equipment is required for this process. A major technical difficulty facing
control of GHB is that the chemical reaction above is reversible. The precursor
can simply be recovered from a GHB solution by adding acid to neutralise
the sodium hydroxide. Because of the wide use of these chemicals,
the monitoring of sales in Europe does not offer a feasible method of identifying
illicit production.

Information on the mode and scope of established or expected use of
GHB as a psychotropic substance

Effects of GHB are more similar to those produced by alcohol, marijuana
and diazepam, than they are to MDMA and other stimulant drugs. Although
GHB may be distributed through the same market as ecstasy, it is not likely
to be purchased as or mistaken for ecstasy because of its distinguishing physical
appearance and effects. GHB dissolves easily and is colourless, odourless
and sometimes tasteless. Therefore, it can be taken easily and unobtrusively
in social settings where alcoholic drinks are served. The comparatively low
price of GHB may provide a cheap alternative to alcohol for young people
on low incomes.

The reasons given by the techno party attenders in the French survey for
taking GHB included the effects induced by taking it. Additional reasons
were that in association with other substances it enhanced the overall effects
or facilitated the �come down’ from taking stimulant drugs.

There is little evidence that GHB is abused on a wide scale in any Member
State. In parts of the United Kingdom, GHB use is reported as being established
on the �gay scene’ and it is thought to have made some inroads into
the �heterosexual scene’. Anecdotal and media reports have suggested that
GHB has widespread potential for being surreptitiously added to drinks for
sexual purposes, including rape.

Books about GHB are available and information about recipes, taste, effects
and where to purchase supplies is commonly exchanged via the Internet.

Information on other use of GHB and the extent of such use

There are claims that GHB has anabolic properties and bodybuilders therefore
use it. Internet discussion groups and other media provide evidence that
GHB is used outside of the �dance scene’ for a number of reasons such as:
to induce sleep, as a substitute for alcohol, and for sexual purposes and
relaxation.

Drafted by Europol and EMCDDA
17 March 2000

(6) In 1993, one death, which occurred in association with heroin use, was recorded in Italy.