Citation: Erowid. "GHB Overdoses & Poisonings: An Experience with GHB (exp1926)". Erowid.org. Jun 19, 2000. erowid.org/exp/1926
In the last few years we have had the unfortunate luck to personally witness 10 or so GHB-overdoses of various severities and have read or been told about dozens more.
First, I want to make it clear that we are not anti-GHB. But it has become clear to us that when compared to almost any other substance used by the entheogen community, the immediate dangers of GHB use (as it currently exists) are significant. It also seems quite true that these dangers could be substantially reduced with a few precautions on the part of the entire community. As the use of GHB increases it seems clear that these situations will continue to arise until and unless we do something about it. It is certainly possible to use GHB and never encounter a problem with overdoses...but the risk is there even for those who are careful and conscientious about their use.
There has been some discussion around what terminology is appropriate when talking about GHB, and for the time being we've decided on the following.
- GHB Overdose
- A situation in which an individual intentionally takes GHB and falls unconscious or vomits without intending to.
- GHB Poisoning
- A situation in which an individual accidentally takes far too much GHB. Generally identified by unconsciousness, vomiting, abnormal breathing, and possibly convulsions.
- GHB Coma
- An unrousable sleep caused by the ingestion of GHB.
Following are synopses of the GHB 'overdoses' that we've personally seen. Interestingly, it seems that people feel embarassed when they experience a GHB poisoning and are reluctant to tell people about it. We've sanitized these stories so the individuals and situations are unidentifiable. I would describe all of these cases as accidents surrounding GHB use, not abuse.
The first was at Burningman '96. A friend staying in our camp was offered GHB for the first time. He chose a dose of 2.5 grams (he weighed 135 lbs)and enjoyed it quite a bit. At about T+1.5 hrs he decided to boost his dose and unfortunately picked a different bottle of GHB which was of a significantly different concentration. Remembering the dosage from the first bottle at 4 capfulls, he decided to take a half dose of 2 capfulls. A single dose from the new bottle turned out to be 1/2 cap. He accidently ingested a 4x dose on top of a several hour old full dose. We estimate that he took an additional 8 grams rather than the intended 2 grams.
Pretty quickly he started to feel sick, threw up, became incoherent and passed out. Soon after passing out, he started to convulse, his arms and stomach and legs spasming. He continued to vomit and his breathing was disturbing. Luckily we had a doctor and some equipment available so we hooked him up to a bloodgas monitor (pulse-oximeter with alarm set points), turned him on his side and cleared his airway, which was difficult because his mouth would clench and unclench. His breathing was 'wet' meaning he had respirated some of the vomit, but it didn't seem too dangerous. He was monitored for a couple hours and then stabilized. At about T+4, he became semi-conscious and at T+7 he awoke and was able to drag himself back to his tent.
He had a terrible hangover the next day and claimed that he felt negative after-effects for more than two weeks after the event, particularly during the first week, he felt foggy, had difficulty concentrating, and somewhat 'anhedonous' meaning he didn't enjoy anything.
Note : This overdose was a direct result of varying concentrations of GHB. If GHB sales was legal to produce and sell with sales and quality regulated, it is considerably more likely that the GHB bottle would have been labelled correctly with dosage information.
Then a couple of years later at a large weekend festival, one individual who was quite experienced with GHB was seen staggering into camp where she collapsed. There had already been several experiences throughout the weekend of individuals who had taken GHB found unrousable in their tents, but in seemingly good health. Anyway, as people checked on the collapsed individual they found she had a large bleeding gash on her leg...down to the bone. After laying unconscious for a few minutes, she started to convulse, her arms flailing and hitting herself in the face. As others tended to her wound it was interesting to note that she didn't respond at all to cleaning and bandaging of the deep gash. The individual was not well known to those caring for her. Her breathing became labored and went into irregular cheynes-stokes type breathing (which is reported in many GHB overdose cases)...heavy, short, shallow, shallow, heavy etc. It was not known what substance she had taken, but everyone! guessed GHB was involved. At this point the question becomes one of - Are you willing to take responsibility for this person's life. How can you be sure your estimation of the situation is correct? What if other substances were involved...what if GHB had been mixed with alcohol? What if things go wrong? Those caring for the person chose to call the paramedics to care for her. She was sent to a hospital over an hour away. She awoke 2 hours later in the hospital and was quite upset that the paramedics had been called.
She later described that she had been on GHB by itself and had just taken a large dose for the purpose of putting herself to sleep.
During a large multi-group camping trip the same summer, after being gone all day, one member of our camp returned late one evening to report that he had taken a small amount of 1,4B only to awaken in the hospital. He had apparently been found totally unconscious by people in another camp. He didn't remember anything after taking the 1,4B until he awoke strapped down with hospital staff forcing a breathing tube down his throat. With a breathing tube in you can't even moan because any movement of the throat causes intense gagging. His throat was damaged by the rough intubation to the point where he couldn't really talk for a couple of days after the incident.
When he received the bill from the hospital he discovered that he had been *helicoptered* to the hospital, a fact he had no memory of, resulting in a bill for over $7,000. The speculation is that because of general fatigue the relatively small amount of 1,4B affected him more strongly than usual, but there's no way to really know the cause.
More recently, a close friend decided to take some GHB one evening when we were hanging out. Through a very unfortunate series of mistakes, the individual found themselves with a severe case of GHB poisoning. While in the process of measuring out a small dose (1 gram), an open jar of GHB was mistaken for water which was used to wash down the intended dosage. A large gulp of GHB was ingested, probably somewhere in the range of 10-20 grams. Because the taste of GHB was already in his mouth from the 1 gram...his thought as he swallowed the large gulp was 'This GHB is stronger tasting than usual...even a gulp of water didn't wash away the taste.' It wasn't until after swallowing that he realized what had happened.
He immediately went to the bathroom and tried to induce vomiting and spent the next 20 minutes drinking water and forcing himself to vomit 10+ times. At about T+20 minutes he started to become uncoordinated and stopped responding to any input. It was unclear how much of the GHB remained in his stomach, but as he were quite a ways from a hospital it seemed like a good idea to those with him to get him in the car and drive closer to the hospital in case emergency care was required.
On the way to the emergency room, he vomited profusely and started having convulsions. His arms, stomach and legs jumped and his head bobbed up and down. His breathing became extremely shallow and was difficult to detect. Despite being turned on his side, he started to aspirate (breath in) the vomit and his friend had to stop the car to take a minute to clear his airway and check his breathing. His breathing sounded _awful_. He had clearly sucked a lot of material into his lungs and it sounded like he was trying to breath through mud.
When they got to the hospital, his friend layed him on his side and tried to decide whether the trauma of the emergency room was necessary. It became very clear that there was no way they were going to risk this person's life or long-term lung health by 'wating to see' if further problems developed or if he stopped breathing or seemed like he was going to die. His breathing was shallow and wet. His pulse was weak but regular. The convulsions were disturbing but not life threatening.
His friend decided that for the several thousand dollars he knew the hospital would cost, it was worth it to avoid the possibility of long term health problems and or (unlikely) death.
The person was intubated immediately, their lungs cleared of most of the inhaled vomit and strapped down to keep them from pulling the IV and tubes out. He continued to convulse for about an hour. His blood-oxygen levels never fell below 98% (except for instrument errors, which are apparently common). His pulse settled out at 40 for a half hour or so and then went to 50 for another hour.
The doctors and emergency room people had never seen a case of GHB poisoning before. They had absolutely no knowledge about the situation and were entirely unwilling to listen to the information or suggestions the friend had. They said he would be in a coma for '1-2 days' and wouldn't even begin to listen when told that a GHB coma lasts 3-6 hours. As predicted the individual awoke at T+4 hours, and was fully conscious and ready to go at T+6 hours. It took a very intense and determined fight with the hospital to get them to release the individual.
This hospital visit cost 8300$. The whole experience was pretty unwanted and unpleasant, but when put in the position of making decisions like that, I can't imagine deciding to let someone who is in a coma, convulsing, vomiting, and aspirating their vomit to just lie there.
One interesting case was a friend who had been taking GHB on weekends in combination with ecstasy or speed. They found their tolerance for GHB rose quite quickly until they were taking 10-15 grams at a time for the desired effects. One day they decided to do GHB alone and ingested about 10 grams. This led to waking up in the hospital, tied down, with tubes and catheters and a $2500 bill. Obviously the tolerance they had built up to GHB was only when done in combination with a strong stimulant.
There are also many situations where a mild GHB overdose (defined as a situation where someone takes GHB and falls unconscious but experiences no vomiting, convulsions, or other negative effects) can be a pleasant experience.
A small group of people each drank a small recreational dose of GHB while hanging out together. Most of the group felt a mild effect which made them a bit more social, much like the effects of a small amount of alcohol. One gentleman became sleepy within 30 minutes and fell asleep. He was asleep and unrouseable for 2 hours, but appeared to be sleeping peacefully. Those around him knew that he had consumed GHB so, though they watched him carefully, they didn't panic. When he awoke as expected, about 2 hours later, he felt rested and well and had no noticeable negative effects.
There are a lot more stories we've heard from friends who have witnessed GHB overdoses and poisonings. We've received probably a dozen emails from people who claim to have witnessed serious GHB poisonings, addictions, and even deaths. We have been unable to verify or refute any of these GHB alone deaths, primarily due to lack of specific information about the cases.
We do not argue that it is the only right thing to do to bring someone to the hospital in cases like these, but our opinion of it has radically changed after dealing with a few cases and having to make decisions for someone else's life. Be careful out there.
- It is very clear to us that GHB alone :
- can interact very dangerously with alcohol
- can cause unconsciousness
- can cause vomiting
- can suppress the gag reflex
- can cause convulsions
- may dangerously suppress breathing in some people
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