GHB Rohipinol

  1. Work in ER. Recently had a 21 yr old female brought in by ambulance. GCS 3. No deep tendon reflex could not arouse, pink warm and dry VS stable BP slightly decreased pulse 88. History was in a bar found passed out in stall by staff. They thought she was drunk, friends had not seen her for an hour or so. Staff took her outside going to send her home in taxi but she began to vomit and not very responsive so amb was called. Parents came in, seemed very caring and concerned. WE did all knids of tests. After two hours with no response we did CT head..normal and she began to wake up. within 15-30 mins she was fully away. states she remembers becoming very nauseated and vision very blurry, dizzy remembers going to BR but that is it. doesn't remember ambulance etc next remembers her dad taking to her but being unable to move and the Dr. looking into her eyes but not being able to focus or control eye her eye movement. ETOH 35 (over 17 here is high) but I have seem people with 80 and I can always arouse them if only for a few seconds. Dr did not feel this was drug related but I'm not too sure. Ther was no sign of sexual assault though we did not do a gyne exam she was fully dressed when she came in.
    My NET search was surprising as it seemed she had all the symptoms of GHB I haven't had any experience with these drugs so would appreciate your input. How have these patients presented to your ER? Anything that alerts you to overdose? Or that this is what you are dealing with?
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  2. 8 Comments

  3. by   CEN35
    i wish i could help you on this one? we really haven't seen much of it at all? i have never really researched it either. to tell you the truth? i'm not even totaly sure what it is? guess now i have something to check into eh?
  4. by   ERnursie
    was there a drug screen done? we haven't had alot of GHB in our ER but we do get alot of drug use. It may be possible that is was GHB. With all the drugs available on the internet it can be anything.sorry i can't help more.
  5. by   Cathy RN
    These are known as the date rape drugs. And from what I understand from our sexual assault team nurses,the drugs are sometimes just dropped into an individuals drink I think everyone gets the rest of the story. Some are laced with Ketamine. There is a test that can be done but it is metabolized rapidly in the body.Drug screen was not done our Doctor did not feel it was necessary as it did not change his standard of care and there was little legal benifit. Scary isn't it?
  6. by   kaycee
    I have not seen this yet either. We see mostly Heroin ODs and mixes of prescriptions drugs and alcohol. Can't believe your doc didn't want a drug screen regardless of standard of care. Oh well it's different everywhere.
    We did have a young girl in another facility OD on Esctasy and not survive. It's scarey when they are so young. I have teenagers I worry all the time. Hopefully they'll make the right choices.
  7. by   teeituptom
    Wow cant believe yall dont see much of thet. Here in texas we see a lot of GHB usage. On morning we had 6 patients all come in with GHB and alcohol use. 3 had to be intubated to maintain airways untill it wore off, usually just a few hours.GHB now that is off the legal market was available at all health food stores and health clubs. You can still order it over the internet to obtain it, frightening huh. there are also precursors to GHB that are on the market waiting to be taken off hopefully.
    Yes what you describe sounds like an GHB overdose. but it does not show up on toxicology screens, there are only a few labs in the country that will do GHB analysis at present time,so tox screens are a waste except to rule out other causes.
    GHB when mixed with alcohol produces a profound coma, but short acting. airway maintenance is your key to treatment.If they do not respond to narcan or romazicon, then GHB is a good possibilty.
    Yes ghb is also used as a date rape drug,so that should always be of concern. In the er when they come in with low GCS we tend to focus on airway management and stability and quite often we insert foley catheters, so if the possibility of sexual assault is of concern, you have to be aware that foley insertion could quite possibly affect any evidence collection re sexual assault. And yes we have seen it used for that purpose,but quite often we have already contaminated any eveidence collection in just stabilizing the patient. The ER doctors are now doing doing a quick visualization with UV light and visual exam prior to foley inertion.Also remember to bag their clothes and belongings for evidenciary collection, the police may want them anyway.
    Hopefully ypu continue to not see much of it. However here it is continuing to occur all to frequently. we also see rohypnol use also. partcularly as they can drive down to mexico and buy it over the counter there, and just bring it back. We have a significant number of date rapes assaults using these drugs. and others also.
    All we can rely on is public education and awareness to improve this situation.
    teeituptom
  8. by   MollyJ
    from www.nida.nih.gov

    Some Facts About Club Drugs

    Methylenedioxymethamphetamine (MDMA)

    Slang or Street Names: Ecstasy, XTC, X, Adam, Clarity, Lover's Speed

    MDMA was developed and patented in the early 1900's as a chemical precursor in the synthesis of pharmaceuticals. Chemically, MDMA is similar to the stimulant amphetamine and the hallucinogen mescaline. MDMA can produce both stimulant and psychedelic effects.

    Methylenedioxyamphetamine (MDA) and methylenedioxyethylamphetamine (MDEA) are drugs chemically similar to MDMA.


    MDMA is taken orally, usually in a tablet or a capsule. MDMA's effects last approximately 3 to 6 hours, though confusion, depression, sleep problems, anxiety, and paranoia have been reported to occur even weeks after the drug is taken.


    MDMA can produce a significant increase in heart rate and blood pressure and a sense of alertness like that associated with amphetamine use.


    The stimulant effects of MDMA, which enable users to dance for extended periods, may also lead to dehydration, hypertension, and heart or kidney failure.
    MDMA can be extremely dangerous in high doses. It can cause a marked increase in body temperature (malignant hyperthermia) leading to the muscle breakdown and kidney and cardiovascular system failure reported in some fatal cases at raves. MDMA use may also lead to heart attacks, strokes, and seizures in some users.

    MDMA is neurotoxic. Chronic use of MDMA was found, first in laboratory animals and more recently in humans, to produce long-lasting, perhaps permanent, damage to the neurons that release serotonin, and consequent memory impairment.

    *MDMA use has been reported across the country, including many of the 21 cities that comprise NIDA's Community Epidemiology Work Group (CEWG), a network of researchers that provide ongoing community-level surveillance of drug abuse. CEWG cities in which MDMA use has been reported inlcude: Chicago, Denver, Miami, Atlanta, New Orleans, San Francisco, Austin, Seattle, Boston, Detroit, New York, St. Louis, Dallas, and Washington, D.C.


    Gamma-hydroxybutyrate (GHB)

    Slang or Street Names: Grievous Bodily Harm, G, Liquid Ecstasy, Georgia Home Boy

    GHB can be produced in clear liquid, white powder, tablet, and capsule forms, and it is often used in combination with alcohol, making it even more dangerous. GHB has been increasingly involved in poisonings, overdoses, "date rapes," and fatalities. The drug is used predominantly by adolescents and young adults, often when they attend nightclubs and raves. GHB is often manufactured in homes with recipes and ingredients found and purchased on the Internet.

    GHB is usually abused either for its intoxicating/sedative/euphoriant properties or for its growth hormone-releasing effects, which can build muscles.


    Some individuals are synthesizing GHB in home laboratories. Ingredients in GHB, gamma-butyrolactone (GBL) and 1,4-butanediol, can also be converted by the body into GHB. These ingredients are found in a number of dietary supplements available in health food stores and gymnasiums to induce sleep, build muscles, and enhance sexual performance.


    GHB is a central nervous system depressant that can relax or sedate the body. At higher doses it can slow breathing and heart rate to dangerous levels.


    GHB's intoxicating effects begin 10 to 20 minutes after the drug is taken. The effects typically last up to 4 hours, depending on the dosage. At lower doses, GHB can relieve anxiety and produce relaxation; however, as the dose increases, the sedative effects may result in sleep and eventual coma or death.


    Overdose of GHB can occur rather quickly, and the signs are similar to those of other sedatives: drowsiness, nausea, vomiting, headache, loss of consciousness, loss of reflexes, impaired breathing, and ultimately death.


    GHB is cleared from the body relatively quickly, so it is sometimes difficult to detect in emergency rooms and other treatment facilities.
    *CEWG cities in which GHB use has been reported include: Detroit, Phoenix, Honolulu, Miami, New York , Atlanta, Minneapolis/St. Paul, Dallas, Seattle, San Francisco, San Diego, New Orleans, Newark, Los Angeles, Baltimore, Boston, and Denver.


    Ketamine

    Slang or Street Names: Special K, K, Vitamin K, Cat Valiums

    Ketamine is an injectable anesthetic that has been approved for both human and animal use in medical settings since 1970. About 90 percent of the ketamine legally sold today is intended for veterinary use.

    Ketamine gained popularity for abuse in the 1980s, when it was realized that large doses cause reactions similar to those associated with use of phencyclidine (PCP), such as dream-like states and hallucinations.


    Ketamine is produced in liquid form or as a white powder that is often snorted or smoked with marijuana or tobacco products. In some cities (Boston, New Orleans, and Minneapolis/St. Paul, for example), ketamine is reportedly being injected intramuscularly.


    At higher doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems.


    Low-dose intoxication from ketamine results in impaired attention, learning ability, and memory.
    *CEWG cities in which Ketamine use has been reported include: Seattle, Miami, New York, Chicago, Minneapolis/St. Paul, Newark, Boston, Detroit, New Orleans, and San Diego.


    Rohypnol

    Slang or Street Names: Roofies, Rophies, Roche, Forget-me Pill

    Rohypnol (flunitrazepam) belongs to the class of drugs known as benzodiazepines (such as Valium, Halcion, Xanax, and Versed). It is not approved for prescription use in the United States, although it is approved in Europe and is used in more than 60 countries as a treatment for insomnia, as a sedative, and as a presurgery anesthetic.

    Rohypnol is tasteless and odorless, and it dissolves easily in carbonated beverages. The sedative and toxic effects of Rohypnol are aggravated by concurrent use of alcohol. Even without alcohol, a dose of Rohypnol as small as 1 mg can impair a victim for 8 to 12 hours.


    Rohypnol is usually taken orally, although there are reports that it can be ground up and snorted.


    The drug can cause profound "anterograde amnesia"; that is, individuals may not remember events they experienced while under the effects of the drug. This may be why one of the street names for


    Rohypnol is "the forget-me pill" and it has been reportedly used in sexual assaults.


    Other adverse effects associated with Rohypnol include decreased blood pressure, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal disturbances, and urinary retention.
    *CEWG cities in which Rohypnol use has been reported include: Miami, Houston, and along the Texas-Mexico border.


    Methamphetamine

    Slang or Street Names: Speed, Ice, Chalk, Meth, Crystal, Crank, Fire, Glass

    Methamphetamine is a toxic, addictive stimulant that affects many areas of the central nervous system. The drug is often made in clandestine laboratories from relatively inexpensive over-the-counter ingredients. It is being used by diverse groups, including young adults who attend raves, in many regions of the country.

    Available in many forms, methamphetamine can be smoked, snorted, injected, or orally ingested.

    Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in beverages.


    Methamphetamine is not sold in the same way as many other illicit drugs; it is typically sold through networks, not on the street.


    Methamphetamine use is associated with serious health consequences, including memory loss, aggression, violence, psychotic behavior, and potential cardiac and neurological damage.


    Methamphetamine abusers typically display signs of agitation, excited speech, decreased appetite, and increased physical activity levels.


    Methamphetamine is neurotoxic. Methamphetamine abusers may have significant reductions in dopamine transporters.


    Methamphetamine use can contribute to higher rates of transmission of infectious diseases, especially hepatitis and HIV/AIDS.
    *CEWG cities in which Methamphetamine use has been reported include: San Diego, San Francisco, Phoenix, Atlanta, St. Louis, Denver, Honolulu, Los Angeles, Minneapolis/St. Paul, Philadelphia, Seattle, Dallas, and many rural regions of the country.


    Lysergic Acid Diethylamide (LSD)

    Slang or Street Names: Acid, Boomers, Yellow Sunshines

    LSD is a hallucinogen. It induces abnormalities in sensory perceptions. The effects of LSD are unpredictable depending on the amount taken, on the surroundings in which the drug is used, and on the user's personality, mood, and expectations.

    LSD is typically taken by mouth. It is sold in tablet, capsule, and liquid forms as well as in pieces of blotter paper that have absorbed the drug.


    Typically an LSD user feels the effects of the drug 30 to 90 minutes after taking it. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors.


    LSD users report numbness, weakness, or trembling, and nausea is common.


    There are two long-term disorders associated with LSD, persistent psychosis and hallucinogen persisting perception disorder (which used to be called "flashbacks").
    *CEWG cities in which LSD use has been reported include: Boston, Detroit, Seattle, Chicago, Denver, New Orleans, San Francisco, Atlanta, and Phoenix.


    --------------------------------------------------------------------------------
  9. by   Jen S
    I work in an ER that sees 75,000 patients per year. We have had several cases of GHB. But most of our patients have ended up intubated. While we waited for the drug to wear off.
  10. by   LilgirlRN
    What you've described sounds to me like a GHB OD. Patients are so completely out that many end up tubed. When they awaken, its always almost instantaneous...like they are asleep one minute and fully awake the next, no gradual wake up. We see a lot of it where I work. I work in an inner city ER in Birmingham, Alabama, we are close to all the "happening" places ..ie bars and dance clubs. We see equal amounts of men and women that have been "slipped" something, however, some of the kids play with GHB, the call it swirling. You can get high on it as long as you don't take too much, its the too much that makes you unconscious with N&V, then we have to protect the airway etc.

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GHB Rohipinol