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GHB The Facts

Coroners & ME's Don't Detect GHB

In the U.S.A. the National Forensic Laboratory Information System data indicated that GHB rarely is identified in drug items analyzed by state and local forensic laboratories.

Dr. Deborah L. Zvosec, Ph.D., Research Associate, Department of Emergency Medicine Hennepin County Medical Center, Minneapolis, MN did research to identify 226 deaths from GHB & analogs that occurred from 1995-2005.

The 226 deaths that she identified included 155 men and 71 women, including 209 in the U.S. (36 states), 4 in Canada (Quebec), and 13 in the UK. Ages ranged from 15-53 years (average: 28 years). Of the 226, 207 deaths were classified as GHB-caused, in which toxic effects of GHB caused or contributed to death. GHB is lethal with and without other drugs or alcohol. GHB/analogs are not “sleep-it-off” drugs.

She notes that:

1. routine toxicology tests used by hospitals and ME’s do not detect GHB/analogs;

2. many coroners and ME’s are unfamiliar with GHB/analogs and do not know to request specific tests to detect them;

3. limited funds are available for death investigations, so toxicology testing often stops when other drugs are detected;

4. there are no centralized databases to indicate when and where GHB-associated deaths are detected;

5. death records are often un-searchable, due to limited technology and/or funds; and

6. access to death records is, in some states, limited by privacy concerns.

GHB Early Warning Signs

GHB Overdose

  1. Zvosec D, Dyer J, Porrata T, Smith S, Strobl A. Preventable deaths associated with Gamma
    hydroxybutyrate (GHB) ingestion: 226 fatalities (Abstract 49). European Journal of Emergency
    Medicine 2008;15:304.

  2. Zvosec D, Smith S, Porrata T, Strobl A, Dyer J. Fatal motor vehicle collisions while Gamma hydroxybutyrate (GHB)-intoxicated. Proceedings of the Joint Annual Meeting of the International Council on Alcohol, Drugs, and Traffic Safety (ICADTS) and the International Association of Forensic Toxicologists (TIAFT), Seattle, WA, August 29, 2007.

  3. Zvosec DL, Smith SW, Porrata T, Strobl AQ, Dyer J. Preventable deaths from Gamma hydroxybutyrate ingestion. Abstract 247. Annals of Emergency Medicine 2006;48(4):S75.

  4. Zvosec DL, Smith SW, Porrata T, Quinn AQ, Dyer JE. 226 Gamma hydroxybutyrate (GHB)-associated fatalities: Overlap of postmortem GHB levels with endogenous, therapeutic, and non-fatal GHB toxicity cases and factors supporting exogenous origin. Oral presentation at the Annual Meeting of the National Association of Medical Examiners, Savannah GA, October 13, 2007.

GHB Traffic Stop

Refences

Pascal Kintz, Marion Villain, Vincent Cirimele, Bertrand Ludes GHB in postmortem toxicology: Discrimination between endogenous production from exposure using multiple specimens Forensic Science International, Volume 143, Issues 2–3, 16 July 2004, Pages 177-181

Aino Kankaanpää, Raija Liukkonen, Kari Ariniemi Determination of γ-hydroxybutyrate (GHB) and its precursors in blood and urine samples: A salting-out approach Forensic Science International, Volume 170, Issues 2–3, 6 August 2007, Pages 133-138

Francesco Mari, Lucia Politi, Claudia Trignano, Maria Grazia Di Milia, Marianna Di Padua, Elisabetta Bertol What constitutes a normal ante-mortem urine GHB concentration? Journal of Forensic and Legal Medicine, Volume 16, Issue 3, April 2009, Pages 148-151

Riccardo Rossi, Massimo Lancia, Cristiana Gambelunghe, Antonio Oliva, Nadia Fucci Identification of GHB and morphine in hair in a case of drug-facilitated sexual assault Forensic Science International, Volume 186, Issues 1–3, 15 April 2009, Pages e9-e11

Albert A. Elian GC–MS determination of gamma-hydroxybutyric acid (GHB) in blood Forensic Science International, Volume 122, Issue 1, 15 October 2001, Pages 43-47 C.

Jones Suspicious death related to gamma-hydroxybutyrate (GHB) toxicity Journal of Clinical Forensic Medicine, Volume 8, Issue 2, June 2001, Pages 74-76

Simon L. Hill, Simon H.L. Thomas What's new in… Toxicity of drugs of abuse Medicine, Volume 37, Issue 11, November 2009, Pages 621-626

Marianne Ingels, Cyrus Rangan, Joseph Bellezzo, Richard F Clark Coma and respiratory depression following the ingestion of GHB and its precursors: Three cases The Journal of Emergency Medicine, Volume 19, Issue 1, July 2000, Pages 47-50

Albert A Elian A novel method for GHB detection in urine and its application in drug-facilitated sexual assaults Forensic Science International, Volume 109, Issue 3, 10 April 2000, Pages 183-187

Casey T. Lesar, John Decatur, Elaan Lukasiewicz, Elise Champeil Report on the analysis of common beverages spiked with gamma-hydroxybutyric acid (GHB) and gamma-butyrolactone (GBL) using NMR and the PURGE solvent-suppression technique Forensic Science International, Volume 212, Issues 1–3, 10 October 2011, Pages e40-e45

Marion Villain, Vincent Cirimele, Bertrand Ludes, Pascal Kintz Ultra-rapid procedure to test for γ-hydroxybutyric acid in blood and urine by gas chromatography–mass spectrometry Journal of Chromatography B, Volume 792, Issue 1, 15 July 2003, Pages 83-87

Simon P Elliott Gamma hydroxybutyric acid (GHB) concentrations in humans and factors affecting endogenous production Forensic Science International, Volume 133, Issues 1–2, 23 April 2003, Pages 9-16

Pasarapa Towiwat, Siripan Phattanarudee, Timothy J. Maher Comparative study of equimolar doses of gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4-BD) and gamma-butyrolactone (GBL) on catalepsy after acute and chronic administration Food and Chemical Toxicology, Volume 51, January 2013, Pages 337-342

Sandra Rinne Dahl, Kirsten Midtbøen Olsen, Dag Helge Strand Determination of gamma-hydroxybutyrate (GHB), beta-hydroxybutyrate (BHB), pregabalin, 1,4-butane-diol (1,4BD) and gamma-butyrolactone (GBL) in whole blood and urine samples by UPLC–MSMS Journal of Chromatography B, Volumes 885–886, 15 February 2012, Pages 37-42

Niklas Timby, Anders Eriksson, Kerstin Boström Gamma-hydroxybutyrate-associated deaths The American Journal of Medicine, Volume 108, Issue 6, 15 April 2000, Pages 518-519

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