Originally published in The Ottawa Citizen April 25, 2005
Original Title: Three More Members of the Club

Part One
Final of two parts

When discussing the potential side effects of drugs, risks must be viewed within a realistic context. Indeed, my last column on Ecstasy, or MDMA, and today’s on GHB (gamma-hydroxybutyrate), Rohypnol (flunitrazepam) and ketamine, contain information that is factually correct.

Each person reacts differently to the effects of a drug.

GHB, developed in 1960 by the French as an anesthetic, is a salty powder that is dissolved in water. It is manufactured from common industrial chemicals that can be purchased with home-production instruction manuals from websites.

It is structurally similar to a naturally occurring central nervous system transmitter, gamma-aminobutyric acid (GABA). GABA is believed to regulate sleep cycles, body temperature, memory and brain glucose levels. Its unpleasant salty or soapy taste can be masked by mixing it in flavoured or alcoholic drinks.

GHB’s effects are dose-dependent. The initial euphoria occurs about 15 to 30 minutes after ingestion, reaching a peak in 20 to 60 minutes. This effect can be tempered if taken with food. The use of alcohol or other central nervous system depressants can increase GHB’s potential toxic effects. The drug’s concentration within the powder is not known, increasing the risk of overdose.

The signs and symptoms of GHB intake that can precede overdose are dizziness, increased salivation, muscle relaxation and amnesia. There is evidence to suggest that as the level of consciousness wanes, the risk of a slower heart rate (bradycardia) and low body temperature (hypothermia) increases. Overdose might lead to abnormal and ineffective breathing patterns, seizures, coma and death. Recognition of the early signs and symptoms can help prevent this outcome.

Long-term regular users of GHB might develop drug dependence. The withdrawal syndrome can include insomnia, tremors and anxiety.

The drug Rohypnol, also known as the date-rape drug, is the same class of medication as Valium: It is a potent benzodiazepine. This prescription drug is available in many European and Latin American countries for use as a preoperative anesthetic, sedation, and as a treatment for insomnia. Being a prescription drug, there is quality control in its manufacturing process.

Rohypnol can induce sleep (hypnotic), reduce stress, inhibition and anxiety through sedation, and is a muscle relaxant at doses of one to two milligrams. The onset of action is about 30 minutes after ingestion, with a peak effect occurring after two hours. The drug’s effect can last up to 12 hours.

Exceeding the recommended dose can lead to loss of memory of events occurring from the time of ingestion onward (anterograde amnesia), lack of muscle control and loss of consciousness. Users who consume alcohol can increase the drug’s effect.

Depending on the dose and other concurrent drug use, some users can develop low blood pressure, confusion, dizziness, aggressive behaviour, urinary retention (inability to urinate) and visual disturbances.

Benzodiazepines are not usually recommended for long-term use because of the high risk of drug dependence. Some prescription benzodiazepines can cause dependence with two to three weeks of daily use. Withdrawal must be medically supervised in order to prevent seizures.

Ketamine is a derivative of phencyclidine (PCP). It prevents brain cells (neurons) to reclaim various neurotransmitter compounds that are released by one neuron to communicate with another. The neurotransmitter levels can build up and overstimulate certain brain areas. This effect can cause hallucinations and strange thoughts and ideations.

Ketamine is difficult to produce in a home lab because it requires a specialized manufacturing process. Most of the supply is taken from veterinary and human anesthesia products. Pharmaceutical grade ketamine comes as a liquid that can be swallowed or injected. Club users will allow the liquid to evaporate in order to collect the powder. The powder can be mixed with tobacco or cannabis and smoked or snorted.

Ketamine has a rapid onset of action that lasts 30 to 45 minutes. It can cause a dreamlike state or a feeling of floating outside the body. Increasing doses can lead to confusion, anterograde amnesia and delirium. Depending on the dose, other drug and alcohol ingestion and the person’s ability to metabolize the drug(s), some can develop hypertension, rapid heart rate (tachycardia), palpitations, a reduction in breathing effort (respiratory depression) with periods of apnea (no breathing).

Chronic users can become addicted. Withdrawal can be severe and require medical supervision to assist in the detoxification process.

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The purpose of this series was to provide information about what is known about these drugs and not to be interpreted as scaremongering.

Information should be provided within a frame of reference or context that provides the reader with a means to gauge true risk. To wit, some users will not experience the severe side effects of club drugs; others will.

More research is required to provide people with an accurate assessment of their chances of experiencing these harmful effects. Until then, the user is travelling through uncertain risk territory.

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© Dr. Barry Dworkin 2005