What is GHB?
Gammahydroxybutyrate, also known as 4-hydroxybutanoic acid, is a naturally occurring substance found in the human central nervous system. As a recreational drug it is also known as G, GBH, Grievous bodily harm, Fantasy, Liquid Ecstasy, Liquid X, Georgia Home Boy, Sleep-500, Liquid E,G, Scoop, Juice, Mils, cherry meth, soap, organic Quaalude and blue nitro liquid. It acts, in small doses, as an aphrodisiac and gives users an alcohol-like high. GHB slows down nervous system activity and messages between the brain and body. It has at least two distinct binding sites in the central nervous system. It is an agonist at the GHB receptor, which is excitatory, and it is a weak agonist at the GABAB receptor, which is inhibitory. Thus GHB affects the release of dopamine in the brain in a biphasic manner. Low concentrations stimulate dopamine release via the GHB receptor. Higher concentrations inhibit dopamine release via GABA(B) receptors. After an initial phase of inhibition at the GABA(B) receptors, dopamine release is then increased via the GHB receptor as the concentration falls. This explains the paradoxical mix of sedative and stimulatory properties of GHB, as well as the so-called "rebound" effect, experienced by individuals using GHB as a sleeping agent, wherein they awake suddenly after several hours of GHB-induced deep sleep. It is also used by body-builders to help stimulate muscle growth by elevating the levels of human growth hormone. GHB is also produced as a result of fermentation, and so is found in small quantities in some beers and wines wine, beef, small citrus fruits, and almost all animals in small amounts. Note GHB is a prohibited substance in many jurisdictions. However, GBL (gamma butyrolactone) is often taken as a substitute for GHB as it is not illegal, and is converted by the body into GHB and thus poses the same dangers.
What does GHB look like and how is it consumed?
GHB is usually a colorless liquid with a faint chemical smell and a salty taste. It is very easy toad to drinks that can mask the saltiness and is often referred to as a “date rape” drug. It can also be produced as different salts, some of which may not have a taste as distinctive as the sodium salt. It is usually sold in brown plastic bottles, and people often use the cap to ‘measure’ a dose. GHB is also sold as a powder. While GHB is usually swallowed a smaller percentage of users have injected and inserted the drug into the anus.
Are there any medical uses for GHB?
The synthesis of GHB was first reported in 1874 but the first major research into its use in humans was conducted in the early 1960s to use in studying the neurotransmitter GABA. It quickly found a wide range of uses due to its minimal side-effects and short duration of action, the only difficulties being the narrow therapeutic dosage range and the dangers presented by its combination with alcohol and other nervous system depressants.
GHB was widely used in France, Italy, and other European countries for several decades as a sleeping agent and an anesthetic in childbirth but problems with its abuse potential and development of newer drugs have led to a decrease in legitimate medical use of GHB in recent times. It is considered a narcotic. The active ingredient in the prescription medication sodium oxybate (Xyrem) which is approved by the U.S. Food and Drug Administration (FDA) for the treatment of cataplexy associated with narcolepsy and Excessive Daytime Sleepiness (EDS) also associated with narcolepsy. It is currently regulated in Australia and New Zealand, Canada, most of Europe and in the US. Sodium oxybate is also used therapeutically in Italy under the brand name Alcover for treatment of alcohol withdrawal and dependence.
What are the effects/risks of GHB on everyone irrespective of their HIV status?
The desired effects of GHB are the Euphoria, increased sex drive and sensuality, fewer inhibitions, hallucinations, increased energy levels, great feelings of happiness and the need to socialize and talk.
The undesirable effects associated with overdose are Dizziness, vomiting, tremors, loss of coordination, loss of muscle tone, loss of gag reflex, confusion, irritation, agitation, tunnel vision, stopped breathing, blackouts, memory lapses, seizures and coma.
These effects are dose dependent. The drug normally starts to have an effect after about half an hour. The effects normally last an hour or two but can last up to 24 hours. In general, the doses used recreationally are between 500 mg and 3,000 mg but it is difficult to say what a safe dose of GHB is, as concentrations of the liquid vary. Therefore, it is easy to overdose on GHB. Often this is because people take a larger dose than they think they are taking, or they take a repeat dose because they do not think the first dose has worked. Many people have been hospitalized after taking GHB and some people have died, often because they developed breathing problems or choked on their own vomit.
People with asthma, breathing problems, epilepsy or low blood pressure are particularly likely to experience a bad reaction if they take the drug.
GHB has been found in numerous studies to be neurotoxic. The resultant impairment of spatial and working learning and memory are due to oxidative stress occurring mostly in the hippocampus and the prefrontal and cerebral cortex.
What are the additional effects/risks of GHB on an HIV+ person?
GHB can interact with some anti-HIV drugs. Levels of GHB can be increased to life-threatening extent if taken with protease inhibitors such as Aluvia (Kaletra), Ritonavir (Norvir) and saquinavir (Fortovase, Invirase).
Like many recreational drugs, GHB can impair your judgment and thus affect the kind of sex you have. Unsafe sex not only exposes others to the risk of HIV infection, it also exposes the HIV+ person to the risk of infection with other STIs. These can have potentially life threatening consequences in an HIV+ person.
Taking GHB may mean that you are physically or psychologically unable to take your ARVs and other medications on time and in the prescribed manner. This can lead to the evolution of resistant strain s of HIV and other pathogenic microbes you are being treated for.
How does it interact with alcohol and other recreational drugs?
GHB inhibits the elimination rate of alcohol and thus should NEVER be taken at the same time or within a few hours of alcohol as it can increase the chance of becoming unconscious or falling into a coma. GHB can also make the effects of other recreational drugs, such as ecstasy and ketamine unpredictable. Most deaths attributed or related to GHB are due respiratory depression caused by interaction with alcohol or other drugs.
Ketamine and HIV
What is Ketamine?
Ketamine, often known as 'K', 'Special-K', or ‘Ravers Smack’ is an anesthetic drug (used by vets in animals such as horses and by doctors in humans) and a muscle relaxant which, when used as a recreationally makes people feel detached from their immediate situation and surroundings. Many people who use ketamine say that it makes them experience their bodies very differently. The drug is used by clubbers, often with ecstasy or LSD (acid), and is also used during sex. Because of its anesthetic and muscle relaxant properties, it is often used for anal sex, particularly fisting. It normally starts to work within 20 minutes, often gradually. It is very short-acting, with its hallucinogenic effects lasting about 60 minutes when snorted or injected and up to two hours when taken orally although some users have reported the effects of the drug lasting from three to six hours. It usually takes a day or two to feel completely normal again for somebody who has taken ketamine. Ketamine is frequently used during sex and relaxant, it is often used for anal sex, particularly fisting.
What does Ketamine look like and how is it consumed?
Ketamine comes as a liquid, white powder or a pill and can be swallowed, snorted or injected intramuscularly or intravenously.
Are there any medical uses for Ketamine?
Surprisingly to some Ketamine is a core medicine in the WHOs Essential Medicines List. This is a list of minimum medical needs for a basic healthcare system. Ketamines most frequent medical use is to induce, and maintain general anesthesia usually in combination with a sedative in both animals and humans including pediatric anesthesia. It may also be used for sedation in intensive care, anesthesia for emergency surgery, analgesia, including the treatment of cancer pain and post operatively, to treat bronchospasm and induce bronchodilation in asthmatics or patients with chronic obstructive airway disease. It’s also used for treating depression in patients with bipolar disorder who have not responded to antidepressants. In patients with clinical depression, it produces a rapid antidepressant effect, acting within two hours as opposed to the several weeks taken by typical antidepressants to work. Medically, ketamine is usually injected intravenously or intramuscularly. Since it suppresses breathing much less than most other available anesthetics, ketamine is still used for this purpose. Due to the hallucinations it often causes, it is usually not the primary anesthetic. It is however, the anesthetic of choice when reliable ventilation equipment is unavailable. Ketamine can be used in podiatry and other minor surgery, and occasionally for the treatment of migraine. It sometimes forms part of a topical cream, gel or liquid for the treatment of nerve pain. Further research is currently being done into the drug's usefulness in pain therapy, depression, as well as for the treatment of alcoholism and heroin addiction.
So why is Ketamine illegal?
It is easy to over dose on it. When not used under medical supervision, a state of extreme dissociation accompanied by visual and auditory hallucinations (K-hole) can occur and it may cause heart or lung failure.
What are the effects/risks of Ketamine on everyone irrespective of their HIV status?
Like all uncontrolled street drugs adulterants have frequently been found in Ketamine. It is often 'cut' with other substances, which might be poisonous, or with other drugs, often amphetamines, LSD, and sometimes heroin. Doses found in street drugs are not controlled. The amount of ketamine you are taking could be much higher than you think.
Initially the body feels like it is heating up. Generally, individuals report feeling detached from their immediate environment, and often have an altered sense of their body. Hallucinations and an altered sense of color and sound are also frequently reported.
It is also known that ketamine can cause difficulties in communication and moving. Sometimes the drug causes a person to freeze completely. This is often referred to as a 'K-hole', as the user goes into an anaesthetized state. When in this condition, users are often totally unable to take care of themselves or to communicate. Difficulties swallowing, along with choking, vomiting and overheating have been recorded amongst ketamine users. Several deaths have also been reported among users in the UK.
In both the short and longer term, ketamine use can cause problems with memory and emotional and psychological disturbances including depression, mania, psychotic episodes and flashbacks in long term users. Tolerance of ketamine can develop, meaning that you have to take more of the drug to have the same experiences. Both physical and psychological dependence on ketamine are possible.
Because of its anesthetic effects, ketamine can stop people feeling pain.. There have been reports of people suffering severe internal injuries after being fisted whilst taking ketamine. Sexual inhibitions might also be lowered by taking ketamine and thus it may act as a trigger for unprotected sex for some people thus exposing them to the risk of infection with HIV and other STIs.
What are the additional effects/risks of Ketamine on an HIV+ person?
The protease inhibitors ritonavir (Norvir), lopinavir/ritonavir (Kaletra/Aluvia) and nelfinavir (Viracept) all increase the potency of Ketamine including its potential dangerous effects. It may also increase the level of efavirenz (Sustiva) in the blood. Ketamine is often taken with other drugs, such as ecstasy, which also interfere with the way the body processes ARVs.
Like many recreational drugs, Ketamine can impair your judgment and thus affect the kind of sex you have. Unsafe sex not only exposes others to the risk of HIV infection, it also exposes the HIV+ person to the risk of infection with other STIs. These can have potentially life threatening consequences in an HIV+ person.
Taking ketamine may mean that you are physically or psychologically unable to take your ARVs and other medications on time and in the prescribed manner. This can lead to the evolution of resistant strain s of HIV and other pathogenic microbes you are being treated for.
I hope readers have found this post useful.
Get tested, stay healthy and, if you’re HIV+, compliant with your ARV regimen,
Malcolm Brown.
International Contributor
"WE ARE ALL IN THIS TOGETHER.
NO PLHIV is alone with his or her struggle with HIV!"
-Pozziepinoy-
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