In September 2013, The Telegraph featured an article highlighting the proliferation of legal highs in Britain.

It refers to a report from the Centre for Social Justice (CSJ) which states that Britain is now

the “addicted man of Europe” with some of the highest rates of substance abuse.

Legal highs popular

The report also tells us that one in 12 youngsters in the UK have experimented with legal highs, easily available on the Internet. Britain is also the ‘global hub’ for legal high websites.

Legal highs are not necessarily safe. The CSJ report says that between 2011 and 2012, deaths from legal highs increased from 29 to 52.

Young people from all classes are attracted to legal highs. Their friends tell them these are inexpensive, non-addictive, fun and present no problems with the law.

Furthermore, there is always a new one to try. More than 70 new legal highs went on the market in 2012.

However, the future of the legal high user is not always bright (emphases mine):

In England, 6,486 people were treated in 2011-12 for abusing legal highs, an increase of 39 per cent compared with five years previously. So many new legal highs are now available, it is impossible for researchers to keep up. They range from GBL – an industrial solvent used to clean metals that is technically banned, but easy to buy and has been linked to numerous deaths, – to nitrous oxide, better known as laughing gas.

Data compiled by the Home Office on laughing gas showed that it was inhaled by at least 350,000 16-24-year-olds last year.

It is now the second-most popular drug among young people after cannabis and is freely available to buy – including on some of the best-known shopping websites. Doctors warn it can lead to strokes, seizures, even death. Last August, Joe Benett, a 17-year-old public schoolboy, suffered a heart attack and brain damage after taking what he thought was laughing gas at a party with friends. It turned out to be a cocktail of toxic gases, including butane and pentane, used to make polystyrene.

Legal highs have been around forever: glue, petrol and other substances. They are nothing new, however, they always attract new, mostly young, users. This is why the head of the UK’s strategic drugs disruption unit said:

If I told you to go and swallow bleach you wouldn’t do it, but if I told you I had this great new drink …

Kids, as we know, can be tempted to try anything. That is what I keep at the back of my mind when I ask myself why I’m doing this. If a white powder comes online tomorrow advertised as the new whizz bang pop, and no one knows exactly what it is, who knows if that isn’t going to be the next drug that kills our children?

The legal high scene revolves around clubs, parties and music festivals. That isn’t exactly news, either, although those venues are associated with a new phenomenon of mixing legal highs with unknown and unexpected results. Accident & Emergency or the crematorium might end up being the next destination.

GBL / GHB addictive and dangerous

Whilst researching for my posts on ketamine, I ran across this article on the UK edition of Vice. It is an interview with Dr Owen Bowden-Jones, founder of the Club Drug Clinic. It is located at London’s Chelsea and Westminster Hospital.

The clinic opened in 2011. Bowden-Jones and his colleagues have been so inundated with patients that they have opened up a second, more centrally-located branch in Tottenham Court Road. He thinks the Clinic’s future could well include educating general practitioners (family doctors) on what to look for in patients with legal high problems and how to treat them.

He explains the club drug phenomenon as follows:

What we’ve seen are relatively major reductions in heroin and crack use, and an increase in a new group of drugs called “club drugs” – things like ketamine, MDMA, mephedrone.

… we’re finding that quite a few of these people are beginning to inject their drugs, especially mephedrone and ketamine. So all of the very real dangers that we used to see with heroin injecting, we’re now beginning to see with these newer club drugs.

He also mentions a legal high — GBL or GHB. Before reading about the Club Drug Clinic’s experiences with patients who have taken it, what follows is an explanation of what these two substances are:

GHB, scientifically known as gamma-hydroxybutyric acid, is a depressant drug, commonly coming in the form of a colourless, odorless, salt-like whitish powder which may also be dissolved in liquid.

GHB has an intoxicating effect when used and can be naturally found in small quantities in meat, wine and some citrus fruits.

People selling GHB often claim that it has weight loss effects and promotes body building, but there is no clinical data to back these claims. It has often been used at parties but it is an addictive drug and people can develop a dependence on this.

Scientifically labeled as gamma-butyrolactone, GBL is a type of organic solvent used for various industrial purposes such as cleaning metal and stripping paint.

Usually found in liquid form, GBL is a very different narcotic substance than others because of its shape-shifting abilities it has, as once it is in the body, the liver can change it into the GHB drug.

Of GBL, Bowden-Jones says it is often used before sex and warns that it can lead to a coma:

It gives people a sense of slight euphoria but generally it’s also a sedative. It’s what we called pro-sexual … and it’s usually pipetted, one or two mils, into a drink. There are some real dangers here. The first is that the difference between the recreational dose and the toxic overdose amount is very small. Also, because people measure it in mils, the difference between one or two mils means the difference between getting the effects you want and actually going into a coma. So it’s a very dangerous drug in terms of what we call a “narrow therapeutic range”.

He adds that a user may be up every few hours to take another dose:

The other thing about it is that it’s highly addictive, so we see people setting their alarm clocks at night to wake up and dose themselves, so they dose right through a 24-hour cyclesometimes every hour. And they walk around with little bottles – pipettes in their pockets – to make sure they’re not caught without the G. The reason for that is that, once someone’s dependent, the withdrawal symptoms are really horrendous. They come on very rapidly, they’re very distressing.

And people think this is safer than a glass or two of wine?

He describes the detox process which has to be managed particularly carefully with GBL. He begins by explaining the withdrawal symptoms:

Intense anxiety, agitation, rapidly going into a delirium. One of the things we’ve been doing here is detoxifications for people who get dependent on G, and it’s a really tricky medical detox to do because if it goes wrong people get sick very quickly. It has to be managed very carefully.

He strongly advises not to try detoxing outside of a clinical environment which actually has experience of doing GBL detoxes:

a number of people who’ve been detoxed off G have ended up in intensive care if they’ve not been managed properly, so it’s really important if any services out there are thinking of doing GBL detoxes – or if anyone’s wanting to go and get a GBL detox – that they go and get it from somewhere that does it regularly. It would be a bad idea to go somewhere that’s never done it before.

Not surprisingly, GBL/GHB users are fond of their drug. However, they have occasional questions. One drugs forum, Bluelight, has a thread about what to do if a user overdoses (language alert).

It mentions that certain US states — Illinois, for one — may charge a dead user’s friends with manslaughter. I would like to see a law like that in the UK.

An Australian doctor writing under the pseudonym of drplatypus had the best advice. He works in A&E and sees a fair number of drug-related cases. I’ve sanitised part of his commentary:

Intriguing interpretation of clinical medicine, particularly the assumption that CPR is some form of benign first aid. If you are getting CPR under the age of 75, you are in deep [trouble]

I particularly like the idea about discharge against medical advice. It’s true, as doctors we have nothing better to do with our time than to persuade ungrateful patients to stay against their wishes. You toddle off home, because as consequence of your medical education (oh sorry, that’s right, you don’t have one) you know when it’s best for you to leave hospital… Of course you do… I mean, you’re the one who thinks GHB and it’s precursors are safe…young people continue to die under the influence of GHB and its precursors, contrary to whatever is assumed to be the case by the G using community

Then, there is an entry on Drugs Forum concerning self-detoxing from GBL/GHB. This was also depressing and rather frightening to read. People tinkered with their doses, took other drugs, got the DTs and so on. A long-term user even insists he isn’t addicted to the stuff.

In that thread, a German man posting as Synthacious actually gave the sensible and practical answer, similar to Dr Bowden-Jones’s:

A friend of mine was on GBL, he took about 2ml an hour over a period of 2-3 months. He had previous experience with GBL and withdrawal, but this time he overdid it.

When he wasn’t dosing his GBL for 2 hours, he started shaking, sweating and wasn’t even able to hold a pencil straight and write. Taking less with every dose or leaving more and more time between the doses didn’t work; he tried this several times.

So to finally quit, he went to an hospital, told the doctors everything about his habits and they decided to put him in a detox program. He got Clomethiazol (192mg capsules), 4 times a day with decreasing dose. He was in the clinic for 5 days, the doses went down very fast. He didn’t have any withdrawal symptoms at all, only a bit of sweating in the first night. As i visited him, he was quite happy and had neither psychic nor physical problems. No craving at all. Since then, he is clean of GBL and has no intention to do it again. He is doing an ambulant therapy, where he talks to a doctor every week.

So if you have the possibility and the need of detoxing from GBL in a hospital, I can only tell you to do it this way. He told his boss he had some minor illness and only missed 3 days of work without anyone there knowing what was up (even though he went to work on GBL for several months). He didn’t have to do anything in the hospital, he was just lieing around in bed the whole day.

(FYI: The same detox is used on heavy alcoholics. Clomethiazol is used to keep your body save in this time.)

Legal highs — the devil’s playground and a living hell.

Parents, schools and church groups for teens should make sure children understand the effects of these drugs. Whilst some users can get by with no problems, for others, it might mean a life of misery — or even death.

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