1
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Zhang Q, Wei H, Lee A, Felmlee MA. Sex and Cross-Sex Testosterone Treatment Alters Gamma-Hydroxybutyrate Acid Toxicokinetics and Toxicodynamics in Rats. Pharmaceutics 2024; 16:143. [PMID: 38276513 PMCID: PMC10821532 DOI: 10.3390/pharmaceutics16010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Γ-hydroxybutyric acid (GHB) is widely abused due to its sedative/hypnotic and euphoric effects. In recent years, GHB use has witnessed a notable rise within the LGBTQ+ community. GHB is a substrate of monocarboxylate transporters (MCTs) and exhibits nonlinear toxicokinetics, characterized by saturable metabolism, absorption, and renal reabsorption. This study investigates the impact of exogenous testosterone administration on GHB toxicokinetics and toxicodynamics, exploring the potential of MCT1 inhibition as a strategy to counteract toxicity. Ovariectomized (OVX) females and castrated (CST) male Sprague Dawley rats were treated with testosterone or placebo for 21 days. GHB was administered at two doses (1000 mg/kg or 1500 mg/kg i.v.), and the MCT1 inhibitor AR-C 155858 (1 mg/kg i.v.) was administered 5 min after GHB (1500 mg/kg i.v.) administration. Plasma and urine were collected up to 8 h post-dose, and GHB concentrations were quantified via a validated LC/MS/MS assay. Sleep time (sedative/hypnotic effect) was utilized as the toxicodynamic endpoint. Testosterone treatment significantly affected GHB toxicokinetics and toxicodynamics. Testosterone-treated CST rats exhibited significantly lower renal clearance, higher AUC, and increased sedative effect, while testosterone-treated OVX rats demonstrated higher metabolic clearance. AR-C 155858 treatment led to an increase in GHB renal and total clearance together with an improvement in sedative/hypnotic effect. In conclusion, exogenous testosterone treatment induces significant alterations in GHB toxicokinetics and toxicodynamics, and MCT inhibition can serve as a potential therapeutic strategy for GHB overdose in both cisgender and transgender male populations.
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Affiliation(s)
- Qing Zhang
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
| | - Hao Wei
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
- QPS LLC, Newark, DE 19711, USA
| | - Annie Lee
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
| | - Melanie A. Felmlee
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
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2
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Palamar JJ. Prevalence and Correlates of GHB Use among Adults in the United States. J Psychoactive Drugs 2023; 55:268-273. [PMID: 35616605 PMCID: PMC9699895 DOI: 10.1080/02791072.2022.2081948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Gamma-hydroxybutyrate (GHB) was a somewhat prevalent club drug two decades ago, but research has been lacking regarding the current epidemiology of use. In this study, prevalence and correlates of past-year GHB use were estimated based on noninstitutionalized US adults participating in the 2015-2020 National Survey of Drug Use and Health (N= 241,675). An estimated 0.05% (95% CI: 0.04-0.07) of adults in the US have used GHB in the past year. Compared to those age 18-25, those age 35-49 were at increased odds for use (aOR = 2.28, 95% CI: 1.02-5.10), and compared to heterosexual men, gay men in particular were at high odds for use (aOR = 27.82, 95% CI: 11.09-69.80). Those identifying as bisexual men (aOR = 3.39, 95% CI: 1.17-9.82) and lesbian/bisexual women (aOR = 3.37, 95% CI: 1.44-7.90) were also at high odds for use. Despite all drugs examined being significant correlates of use in bivariable models (ps < .001), only past-year use of methamphetamine (aOR = 15.68, 95% CI: 7.40-33.25), ketamine (aOR = 8.52, 95% CI: 2.67-27.20), and ecstasy (aOR = 4.41, 95% CI: 1.80-10.75) was associated with increased odds of use in the multivariable model. Results suggest that GHB use is currently rare, but gay men and people who use other party drugs are at particularly high risk for use.
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Affiliation(s)
- Joseph J Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY USA
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3
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Drevin G, Briet M, Ferec S, Demiselle J, Beloncle F, Abbara C. Acute Sodium Oxybate Intoxication: A Case Report and Review of the Literature. Ther Drug Monit 2023; 45:277-281. [PMID: 35914751 DOI: 10.1097/ftd.0000000000001011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite a better safety profile than illicit γ-hydroxybutyric acid (GHB) and other GHB analogs, sodium oxybate continues to raise serious concerns regarding clinical safety. In this study, the authors report the case of near-fatal intoxication involving sodium oxybate-alcohol combination in a 40-year-old woman. In addition, a review of the literature on published cases of intoxication involving this pharmaceutical form of GHB was conducted. A 40-year-old woman was admitted to the intensive care unit in a coma after voluntary ingestion of 18 g of sodium oxybate and alcohol. METHODS The GHB plasma concentration was quantified to be 146 mg/L using liquid chromatography coupled with tandem mass spectrometry. An English literature search was performed using PubMed without any limiting period to identify all available scientific publications involving cases of sodium oxybate intoxication. RESULTS Six cases were identified. Five involved fatal intoxication cases, with GHB postmortem blood concentrations ranging from 11.5 to 3500 mg/L. One involved a nonfatal intoxication case with a GHB serum concentration of 569 mg/L 7 hours postingestion. CONCLUSIONS In the present case, the estimated elimination half-life was 154 minutes. The risk of acute poisoning seems to be high considering the pharmacokinetic properties of sodium oxybate. Physicians and toxicologists must take such properties into account.
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Affiliation(s)
- Guillaume Drevin
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
- Université d'Angers, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
- Université d'Angers, Angers, France
- Laboratoire MitoVasc, UMR INSERM 1083 CNRS 6015, Angers, France; and
| | - Severine Ferec
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
| | - Julien Demiselle
- Service de Médecine intensive-réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - François Beloncle
- Service de Médecine intensive-réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - Chadi Abbara
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
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4
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Wang T, Nielsen KL, Frisch K, Lassen JK, Nielsen CB, Andersen CU, Villesen P, Andreasen MF, Hasselstrøm JB, Johannsen M. A Retrospective Metabolomics Analysis of Gamma-Hydroxybutyrate in Humans: New Potential Markers and Changes in Metabolism Related to GHB Consumption. Front Pharmacol 2022; 13:816376. [PMID: 35308203 PMCID: PMC8927817 DOI: 10.3389/fphar.2022.816376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
GHB is an endogenous short-chain organic acid presumably also widely applied as a rape and knock out drug in cases of drug-facilitated crimes or sexual assaults (DFSA). Due to the endogenous nature of GHB and its fast metabolism in vivo, the detection window of exogenous GHB is however narrow, making it challenging to prove use of GHB in DFSA cases. Alternative markers of GHB intake have recently appeared though none has hitherto been validated for forensic use. UHPLC-HRMS based screening of blood samples for drugs of abuse is routinely performed in several forensic laboratories which leaves an enormous amount of unexploited data. Recently we devised a novel metabolomics approach to use archived data from such routine screenings for elucidating both direct metabolites from exogenous compounds, but potentially also regulation of endogenous metabolism and metabolites. In this paper we used UHPLC-HRMS data acquired over a 6-year period from whole blood analysis of 51 drivers driving under the influence of GHB as well as a matched control group. The data were analyzed using a metabolomics approach applying a range of advanced analytical methods such as OPLS-DA, LASSO, random forest, and Pearson correlation to examine the data in depth and demonstrate the feasibility and potential power of the approach. This was done by initially detecting a range of potential biomarkers of GHB consumption, some that previously have been found in controlled GHB studies, as well as several new potential markers not hitherto known. Furthermore, we investigate the impact of GHB intake on human metabolism. In aggregate, we demonstrate the feasibility to extract meaningful information from archived data here exemplified using GHB cases. Hereby we hope to pave the way for more general use of the principle to elucidate human metabolites of e.g. new legal or illegal drugs as well as for applications in more global and large scale metabolomics studies in the future.
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Affiliation(s)
- Tingting Wang
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
- *Correspondence: Tingting Wang, ; Mogens Johannsen,
| | - Kirstine L. Nielsen
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Kim Frisch
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Johan K. Lassen
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Camilla B. Nielsen
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Charlotte U. Andersen
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Palle Villesen
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Mette F. Andreasen
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Jørgen B. Hasselstrøm
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
| | - Mogens Johannsen
- Department of Forensic Medicine, Section for Forensic Chemistry, Aarhus University, Aarhus, Denmark
- *Correspondence: Tingting Wang, ; Mogens Johannsen,
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5
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Ricci G, Busardò F, Gibelli F, Sirignano A, Brunetti P. Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs. Expert Opin Drug Metab Toxicol 2022; 17:1445-1454. [DOI: 10.1080/17425255.2021.2029404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Francesco Busardò
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
| | - Filippo Gibelli
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
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6
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Giorgetti A, Busardò FP, Giorgetti R. Toxicological Characterization of GHB as a Performance-Enhancing Drug. Front Psychiatry 2022; 13:846983. [PMID: 35509886 PMCID: PMC9058118 DOI: 10.3389/fpsyt.2022.846983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Performance-enhancing drugs (PEDs) are represented by several compounds used to ameliorate the image, the appearance, or an athletic or non-athletic performance. Gamma-hydroxybutyrate (GHB) is an endogenous molecule first used as anesthetic and then marketed as a nutritional supplement with a wide diffusion in the bodybuilding community. The aim of the present work is to provide a toxicological characterization of the use of GHB as a PED, including the scientific basis for its use, the patterns of use/abuse, and the health risks arising from its consumption in this peculiar recreative setting. A literature search was performed on multiple databases including experimental studies on humans and animals as well as epidemiological reports and forensic case reports/series. Experimental studies demonstrated that the use of GHB as a PED is motivated by the release of growth hormone and the induction of sleep. However, the panel of desired performance-related effects was much wider in real cases and epidemiological studies. Even though the use of GHB among bodybuilders has decreased, its use to enhance some kind of performance, particularly sexual ones or social-communicative ones, as well as means to increase mood and perceived energy, is still common.
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Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
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7
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Gallart-Mateu D, de la Guardia M, Garrigues S. Date-rape evidence through fast determination of γ-butyrolactone in adulterated beverages. Talanta 2021; 232:122387. [PMID: 34074389 DOI: 10.1016/j.talanta.2021.122387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
An infrared spectroscopy (IR) based methodology has been developed to determine γ-butyrolactone (GBL) in adulterated beverages. The proposed method permits the direct screening of GBL in beverages and involves a minimum sample treatment requiring less than 2 min for quantitative determination of GBL. Sensitivity of IR method was improved by using liquid-liquid extraction (LLE) providing detection limits of 0.023 mg g-1. Accuracy of the proposed methodology was evaluated through the analysis of soft beverages and alcoholic cocktails spiked with GBL at concentration levels ranging from 0.075 to 10 mg g-1 providing recovery values from 91 to 100%. GBL was determined in twelve blind-spiked beverages, including from mineral water to wine and cocktails. Results obtained were statistically comparable to those provided by a liquid chromatography (LC) reference methodology and consistent with the spiked values. Therefore, the use of LLE-FTIR allowed a simple, sensitive and quantitative determination of GBL in soft beverages and alcoholic cocktails, thus evidencing its use for sex submission intention.
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Affiliation(s)
- D Gallart-Mateu
- Department of Analytical Chemistry, University of Valencia, Jeroni Munoz Building, 50th Dr. Moliner St., 46100, Burjassot, Valencia, Spain.
| | - M de la Guardia
- Department of Analytical Chemistry, University of Valencia, Jeroni Munoz Building, 50th Dr. Moliner St., 46100, Burjassot, Valencia, Spain.
| | - S Garrigues
- Department of Analytical Chemistry, University of Valencia, Jeroni Munoz Building, 50th Dr. Moliner St., 46100, Burjassot, Valencia, Spain.
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8
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Severe Metabolic Failures After Recreational Ingestion of γ-Butyrolactone. J Clin Psychopharmacol 2021; 40:624-626. [PMID: 33009224 DOI: 10.1097/jcp.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Holt AK, Poklis JL, Cobb CO, Peace MR. The Identification of Gamma-Butyrolactone in JUUL Liquids. J Anal Toxicol 2021; 45:892-900. [PMID: 34100536 DOI: 10.1093/jat/bkab067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Gamma-Butyrolactone (GBL), a commonly used industrial solvent, is used recreationally as a central nervous system (CNS) depressant and, therefore, a United States Drug Enforcement Agency (DEA) List 1 chemical of the Controlled Substances Act. GBL was identified presumptively in the liquid from JUUL Virginia Tobacco flavored pods during routine untargeted screening analysis of e-cigarette products by gas chromatography-mass spectrometry (GC-MS). Methods for the confirmation and quantitation of GBL were developed for GC-MS and liquid chromatography-tandem mass spectrometry (LC-MS-MS) in the liquids and the aerosol generated from the liquid. Three flavors of JUUL pods available at the time of analysis were obtained by direct purchase from the manufacturer, purchase from a local vape shop, and via submission from a 3rd party. The only liquid flavor to contain GBL was Virginia Tobacco, with an average of 0.37 mg/mL of GBL, and it was detected in the aerosol. Studies evaluating the pharmacological effects of inhaling GBL do not exist, however a case report of chronic oral GBL ingestion indicates acute lung injury. The identification of GBL in an e-cigarette product purportedly compliant with federal regulation continues to demonstrate public health and public safety concerns.
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Affiliation(s)
- Alaina K Holt
- Department of Forensic Science.,Integrative Life Sciences Doctoral Program
| | | | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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10
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Jarsiah P, Roehrich J, Kueting T, Martz W, Hess C. GHB related acids are useful in routine casework of suspected GHB intoxication cases. Forensic Sci Int 2021; 324:110833. [PMID: 34020075 DOI: 10.1016/j.forsciint.2021.110833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
GHB related acids (3,4-dihydroxy butyric acid, 2,4-dihydroxy butyric acid and glycolic acid) are produced through oxidative GHB metabolism. These analytes could be potential biomarkers to ensure the diagnosis of a GHB intoxication and even prolong the detection window. Within this study, forensic routine cases were measured to consider the potential of additional gas chromatographic mass spectrometric analysis on these acids. 17 GHB positive real cases (10 serum samples and 7 urine samples) and 40 cases with suspicion of drugging in DFC cases and negative GHB results (21 serum samples and 19 urine samples) were evaluated. Increased GHB related acid concentrations were detected in all serum and most urine samples positive on GHB. In some GHB negative cases, especially in serum samples, concentrations of GHB related acids gave hints that GHB actually was taken. We recommend to use the following cut-offs for a more reliable interpretation of potential GHB intoxication cases: 3,4-OH-BA:>3 mg/L in serum and>50 mg/L in urine; 2,4-OH-BA:>2 mg/L in serum and>25 mg/L in urine; GA:>5 mg/L in serum and>400 mg/L in urine.
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Affiliation(s)
- Pouria Jarsiah
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany; Special Laboratory, Medical Care Centers Dr. Eberhard & Partner, Dortmund, Germany
| | - Joerg Roehrich
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Theresa Kueting
- Institute of Forensic Medicine, Forensic Toxicology, University of Bonn, Germany
| | - Walter Martz
- Institute of Forensic Medicine, Forensic Toxicology, University of Gießen, Gießen, Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, Forensic Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany.
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11
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Küting T, Schneider B, Heidbreder A, Krämer M, Jarsiah P, Madea B, Hess C. Detection of γ-hydroxybutyric acid-related acids in blood plasma and urine: Extending the detection window of an exogenous γ-hydroxybutyric acid intake? Drug Test Anal 2021; 13:1635-1649. [PMID: 33991073 DOI: 10.1002/dta.3097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/24/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022]
Abstract
In crimes facilitated by γ-hydroxybutyric acid (GHB) administration, the frequent occurrence of anterograde amnesia of the victims as well as the short detection window and variations of endogenous GHB concentrations complicate obtaining analytical proof of GHB administration. Because elevated endogenous organic acid concentrations have been found in the urine of patients with succinic semialdehyde deficiency (leading to accumulation of GHB in human specimens) and after GHB ingestion, we searched for an alternative way to prove GHB administration via detection of elevated organic acid concentrations in blood plasma and urine. We collected blood and urine samples from narcolepsy patients (n = 5) treated with pharmaceuticals containing GHB sodium salt (1.86-3.72 g GHB as free acid per dose). Although GHB was detectable only up to 4 h in concentrations greater than the commonly used cutoff levels in blood plasma, 3,4-dihydroxybutyric acid (3,4-DHB) could be detected up to 12 h in blood plasma in concentrations exceeding initial concentrations of the same patient before GHB ingestion. Furthermore, four of the five patients showed an increase above endogenous levels described in the scientific literature. In urine, GHB concentrations above commonly used cutoff levels could be observed 4.5-9.5 h after GHB intake. Creatinine standardized initial concentrations were reached again for glycolic acid (GA), 3,4-DHB, and 2,4-dihydroxybutyric (2,4-DHB) acid at 6.5-22, 11.5-22, and 8.5-70 h after GHB intake, respectively. Therefore, 2,4-DHB, 3,4-DHB, and GA are promising and should be further investigated as potential biomarkers to prolong the detection window of GHB intake.
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Affiliation(s)
- Theresa Küting
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Bianca Schneider
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Anna Heidbreder
- Medical University Innsbruck, University Hospital for Neurology, Innsbruck, Austria
| | - Michael Krämer
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Pouria Jarsiah
- Institute of Forensic Medicine, University of Mainz, Mainz, Germany.,Special Laboratory, Medical Care Centers, Dr. Eberhard & Partner, Dortmund, Germany
| | - Burkhard Madea
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, University of Bonn, Bonn, Germany.,Institute of Forensic Medicine, University of Mainz, Mainz, Germany
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12
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Felmlee MA, Morse BL, Morris ME. γ-Hydroxybutyric Acid: Pharmacokinetics, Pharmacodynamics, and Toxicology. AAPS J 2021; 23:22. [PMID: 33417072 PMCID: PMC8098080 DOI: 10.1208/s12248-020-00543-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a short-chain fatty acid present endogenously in the brain and used therapeutically for the treatment of narcolepsy, as sodium oxybate, and for alcohol abuse/withdrawal. GHB is better known however as a drug of abuse and is commonly referred to as the "date-rape drug"; current use in popular culture includes recreational "chemsex," due to its properties of euphoria, loss of inhibition, amnesia, and drowsiness. Due to the steep concentration-effect curve for GHB, overdoses occur commonly and symptoms include sedation, respiratory depression, coma, and death. GHB binds to both GHB and GABAB receptors in the brain, with pharmacological/toxicological effects mainly due to GABAB agonist effects. The pharmacokinetics of GHB are complex and include nonlinear absorption, metabolism, tissue uptake, and renal elimination processes. GHB is a substrate for monocarboxylate transporters, including both sodium-dependent transporters (SMCT1, 2; SLC5A8; SLC5A12) and proton-dependent transporters (MCT1-4; SLC16A1, 7, 8, and 3), which represent significant determinants of absorption, renal reabsorption, and brain and tissue uptake. This review will provide current information of the pharmacology, therapeutic effects, and pharmacokinetics/pharmacodynamics of GHB, as well as therapeutic strategies for the treatment of overdoses. Graphical abstract.
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Affiliation(s)
- Melanie A Felmlee
- Department of Pharmaceutics and Medicinal Chemistry Thomas J Long School of Pharmacy, University of the Pacific, Stockton, California, USA
| | - Bridget L Morse
- Drug Disposition, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Marilyn E Morris
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, 304 Pharmacy Building, Buffalo, New York, 14214, USA.
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13
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Chan ASW, Tang PMK. Application of Novel Psychoactive Substances: Chemsex and HIV/AIDS Policies Among Men Who Have Sex With Men in Hong Kong. Front Psychiatry 2021; 12:680252. [PMID: 34335329 PMCID: PMC8316596 DOI: 10.3389/fpsyt.2021.680252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, The Hong'Kong Polytechnic University, Hong Kong, China
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
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14
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Küting T, Beier N, Krämer M, Madea B. Methyl-4-Hydroxybutyrate and Ethyl-4-Hydroxybutyrate as Potential Markers for Simultaneous Consumption of GHB/GBL and Alcohol: Preliminary Investigations. J Anal Toxicol 2020; 44:818-828. [PMID: 32780806 DOI: 10.1093/jat/bkaa096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
γ-Hydroxybutyric acid (GHB) and its corresponding lactone γ-butyrolactone (GBL) are misused as knock out (k.o.) drugs. The short detection window and the major inter- and intra-individual variations of endogenous GHB concentrations in commonly used matrices such as blood and urine complicate the analytical proof of an exogenous GHB/GBL administration. We searched for an alternative way to prove an exogenous GHB/GBL administration via detection of methyl- and ethyl-4-hydroxybutyrate, which could arise in alcoholic solutions after spiking with GHB/GBL. A liquid chromatographic-triple quadrupole mass spectrometric method was developed and validated to quantitatively determine methyl- and ethyl-4-hydroxybutyrate in alcoholic beverages (limit of detection [LoD]: 5.8 and 3.4 ng/mL, respectively). A sample collective of alcoholic beverages (n = 47) revealed natural occurring amounts of ethyl-4-hydroxybutyrate (<LoD-approx. 3980 ng/mL) with higher concentrations particularly found in wine samples. Nearly no ethyl-4-hydroxybutyrate was observable in spirits/liqueurs and no methyl-4-hydroxybutyrate was detectable at all. A moderate correlation was shown between the ethyl-4-hydroxybutyrate concentration and the pH-value in wine samples (pH 2.9-3.7, n = 29) as well as between the ethyl-4-hydroxybutyrate concentration and the GHB concentration in all measured beverages (GHB: < limit of quantification [LoQ]-11.4 µg/mL, n = 47). A dependency on alcohol content could not be observed. A voluntary intake (n = 1) of 750-mL wine naturally containing high amounts of ethyl-4-hydroxybutyrate (approx. 2010 ng/mL) revealed no observable GHB-ester concentrations in blood and urine. Furthermore, an experiment simulating a beverage that could potentially be used in a drug-facilitated crime (DFC) case showed ethyl-4-hydroxybutyrate concentrations exceeding the concentrations naturally observed in beverage samples. However, in order to evaluate whether ethyl-4-hydroxybutyrate could be useful as marker for the co-consumption of GHB/GBL and alcohol and to prolong the detection window of unintended GHB/GBL intake, further experiments have to be performed.
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Affiliation(s)
- Theresa Küting
- Department of Forensic Toxicology, University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany
| | - Niklas Beier
- Department of Forensic Toxicology, University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany
| | - Michael Krämer
- Department of Forensic Toxicology, University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany
| | - Burkhard Madea
- Department of Forensic Toxicology, University of Bonn, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany
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15
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Ciarimboli E, Pirani F, Beck R, Zaami S. The health threat of γ-butyrolactone (GBL): Hair analysis in a case of intoxication. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Donnadieu-Rigole H, Peyrière H, Benyamina A, Karila L. Complications Related to Sexualized Drug Use: What Can We Learn From Literature? Front Neurosci 2020; 14:548704. [PMID: 33328844 PMCID: PMC7732585 DOI: 10.3389/fnins.2020.548704] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
Chemsex is described as the use of specific psychoactive substances (PS) during sexual activity to sustain, enhance, disinhibit or facilitate the sexual experience. It preferentially concerns men who have sex with men (MSM). They use new synthetic substances like cathinones, methamphetamines, gamma-butyrolactone/gamma-hydroxybutyrate (GBL/GHB), ketamine, and cocaine. The prevalence of chemsex varies from 3 to 31% during lifetime. The Internet has participated significantly in the evolution of sexual behaviors, both in terms of sexual dating and the availability of new synthetic substances. The advent of geolocation applications contributed to the development of chemsex. The literature describes many complications linked to these sexual practices; the main clinical effects related to cathinones consumption were psychiatric symptoms; agitation, hallucinations, anxiety, suicidal ideation, paranoia, and confusion. Regular GBL/GHB consumption alter cognitive functions, particularly memory and emotion management. Use of these drugs in party and play is dramatically associated with high-risk sexual behaviors. The prevalence of hepatitis B, hepatitis C syphilis, and HIV is higher in men who use methamphetamine and Viagra and/or who declared they practiced slamming, chemsex, and fisting. Other sexually transmitted infections (STIs) such as gonorrhea have increased with methamphetamine and GHB/GBL use. Actually, the care of individuals who practice Chemsex in a problematic way is currently not codified, but the use of integrative and specific interventions is necessary.
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Affiliation(s)
- Hélène Donnadieu-Rigole
- Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France.,INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France
| | - Hélène Peyrière
- INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France.,Addictovigilance Center, Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Amine Benyamina
- Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Universitaire Paul-Brousse (APHP), Villejuif, France.,Paris-Saclay University, Saint-Aubin, France
| | - Laurent Karila
- Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Universitaire Paul-Brousse (APHP), Villejuif, France.,Paris-Saclay University, Saint-Aubin, France.,Unité de Recherche PSYCOMADD, Villejuif, France
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17
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Jarsiah P, Kueting T, Roehrich J, Germerott T, Remane D, Toennes SW, Scholtis S, Krumbiegel F, Hess C. GHB related acids (dihydroxy butyric acids, glycolic acid) can help in the interpretation of post mortem GHB results. Forensic Sci Int 2020; 316:110536. [DOI: 10.1016/j.forsciint.2020.110536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
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18
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Violence against women and drug-facilitated sexual assault (DFSA): A review of the main drugs. J Forensic Leg Med 2020; 74:102020. [DOI: 10.1016/j.jflm.2020.102020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
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19
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20
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Rinaldi R, Bersani G, Marinelli E, Zaami S. The rise of new psychoactive substances and psychiatric implications: A wide-ranging, multifaceted challenge that needs far-reaching common legislative strategies. Hum Psychopharmacol 2020; 35:e2727. [PMID: 32144953 DOI: 10.1002/hup.2727] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/21/2022]
Abstract
The ever-growing number of novel psychoactive substances (NPS) that have been surfacing globally, as well as related changes in drug abuse trends, undoubtedly constitute a difficult and multifaceted challenge for psychiatry. The intake and abuse of such substances has been linked to a risk of psychopathological disturbances, which stem from imbalances of a range of neurotransmitter pathways and receptors. Through an analysis of relevant research articles and reviews (particularly those outlining NPS neurological and cerebral mechanisms of action and psychopathological consequences arising from NPS abuse; research papers more closely focused on chemical/pharmacological aspects have been ruled out), through a systematic analysis of Pubmed, Medline, PsycLIT and EMBASE literature, as well as data released by health care institutions and drug enforcement agencies (among which the World Health Organization, the United Nations Office on Drugs and Crime, the European Monitoring Centre for Drugs and Drug Addiction, Eurojust, the Novel Psychoactive Treatment UK Network, the Court of Justice of the European Union), the authors aimed to elaborate on the most relevant data relative to NPS-related psychiatric effects, focusing on the conceptual and definition-related complexities inherent to NPS, clinical management and motivations for NPS use; moreover, an effort has been made to highlight the possible measures in order to tackle the unremitting rise of such elusive and potentially harmful substances.
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Affiliation(s)
- Raffaella Rinaldi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Departmental Section of Legal Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Bersani
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Departmental Section of Legal Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Departmental Section of Legal Medicine, "Sapienza" University of Rome, Rome, Italy
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21
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Busardò FP, Gottardi M, Pacifici R, Varì MR, Tini A, Volpe AR, Giorgetti R, Pichini S. Nails Analysis for Drugs Used in the Context of Chemsex: A Pilot Study. J Anal Toxicol 2020; 44:69-74. [PMID: 30855673 DOI: 10.1093/jat/bkz009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/23/2018] [Indexed: 11/12/2022] Open
Abstract
Nail analysis can be performed as a substitute or complement to hair analysis for the retrospective determination of psychotropic drugs consumption in forensic contexts. The application of nail analysis in a "chemsex" context is reported herein. An ultra-performance liquid chromatography-tandem mass spectrometry method was developed to quantify the most common drugs of abuse, synthetic cannabinoids, synthetic cathinones and GHB in fingernails and toenails of individuals presumptively using these drugs in music and sex settings. Results were compared to the concentrations measured in hair. Nail and hair keratin matrices were digested with VMA-TM3® buffer reagent and underwent a solid phase extraction before chromatographic separation with reversed phase columns and a linear gradient elution with 5 mM ammonium formate and acetonitrile, for detecting classic drugs of abuse, or 0.1% formic acid and methanol, for detecting synthetic cathinones, synthetic cannabinoids, and GHB. Analytes were detected with a triple quadrupole mass spectrometer operated in multiple reaction monitoring mode after positive electrospray ionization. Nails of individuals practicing "chemsex" contained at least three different psychoactive drugs, and up to eight drugs simultaneously. Identified drugs included cocaine, benzoylecgonine, cocaethylene, delta-9-tetrahydrocannabinol, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine, ketamine, norketamine, mephedrone, methylone, 4-methyletcathinone, methcathinone, γ-hydroxybutyric acid (GHB) and γ-butyrolactone. Most used drugs were MDMA and GHB followed by cocaine and ketamine. Drugs concentrations ranged from 0.1 to 690 ng/mg in fingernails. In the two individuals who also provided toenails, concentrations were always higher in fingernails than in toenails, while in two other individuals who donated also hair, concentrations in this latter matrix were either higher or lower than those measured in fingernails. This study demonstrated that nails may well represent an appropriate non-conventional biological matrix to provide additional information in forensic toxicology.
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Affiliation(s)
- Francesco Paolo Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, Via Conca 41, 60126 Torrette di Ancona, Ancona, Italy
| | - Massimo Gottardi
- Comedical S.r.L. Trento, Va della Cooperazione 29, 38123 Trento, Italy
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
| | - Anastasio Tini
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Viale Regina Elena 366, 00161, Rome, Italy
| | - Anna Rita Volpe
- Laboratory of Pharmacology and Toxicologyy, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 67100, Coppito (AQ), Italy
| | - Raffaele Giorgetti
- Section of Legal Medicine, Università Politecnica delle Marche, Via Conca 41, 60126 Torrette di Ancona, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
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22
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Raposo Pereira F, McMaster MTB, Schellekens A, Polderman N, de Vries YDAT, van den Brink W, van Wingen GA. Effects of Recreational GHB Use and Multiple GHB-Induced Comas on Brain Structure and Impulsivity. Front Psychiatry 2020; 11:166. [PMID: 32300311 PMCID: PMC7142256 DOI: 10.3389/fpsyt.2020.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS The regular use of gamma-hydroxybutyrate acid (GHB) can induce GHB-induced comas. Other substance use disorders are associated with alterations in brain structure and impulsivity. Here we aim to investigate if these are also modulated by either regular GHB use or GHB-induced comas. METHODS In a sample of human males, structural and diffusion neuroimaging data were collected for 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without GHB-induced comas (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). The structural brain parameters were analyzed macroscopically using voxel-based morphometry and microscopically using tract-based spatial statistics (TBSS) and tractography. Impulsivity was assessed with the Barrat Impulsivity Scale. RESULTS In comparison to the other two groups, the GHB-Coma group showed a higher fractional anisotropy in the body of the corpus callosum and a lower mean diffusivity in the forceps minor (i.e., whole-brain TBSS analysis). No macrostructural differences nor microstructural differences, as assessed with tractography, were observed. The GHB-Coma group also reported higher impulsivity, which was more strongly associated with white matter volume and fractional anisotropy in tracts involved in impulse control (post-hoc analysis). GHB use per se was associated neither with differences in brain structure nor with impulsivity. CONCLUSIONS The results suggest that multiple GHB-induced comas, but not GHB use per se, are associated with microstructural alterations in white matter and with higher self-reported impulsivity, which in turn was associated with white matter tracts involved in impulse control.
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Affiliation(s)
- Filipa Raposo Pereira
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Minni T. B. McMaster
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, Netherlands
| | - Nikki Polderman
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Yvon D. A. T. de Vries
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
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23
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Marinelli E, Beck R, Malvasi A, Faro AFL, Zaami S. Gamma-hydroxybutyrate abuse: pharmacology and poisoning and withdrawal management. Arh Hig Rada Toksikol 2020; 71:19-26. [PMID: 32597141 PMCID: PMC7837237 DOI: 10.2478/aiht-2020-71-3314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/01/2019] [Accepted: 03/01/2020] [Indexed: 12/19/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a central nervous system depressant primarily used as a recreational drug of abuse, but also for the treatment of narcolepsy with cataplexy in adult patients and as an adjuvant for control of alcohol withdrawal syndrome. The main aim of this review is to summarise updated knowledge about GHB pharmacokinetics and pharmacodynamics, acute poisoning, and clinical features of GHB withdrawal syndrome, its diagnosis and medical treatment. The most common clinical signs and symptoms of acute poisoning include sleepiness to deep coma, bradycardia, hypotension, and respiratory failure. Therapy is essentially supportive and based on continuous monitoring of vital signs. GHB withdrawal syndrome shares patterns with other withdrawal syndromes such as alcohol withdrawal and is sometimes difficult to distinguish, especially if toxicological tests are GHB-negative or cannot be performed. There are no official detoxification protocols for GHB withdrawal syndrome, but its therapy is based on benzodiazepine. When benzodiazepine alone is not effective, it can be combined with barbiturates or antipsychotics. Information about abuse and distribution of GHB and its precursors/analogues among the general population is still limited. Their prompt identification is therefore crucial in conventional and non-conventional biological matrices, the latter in particular, to clarify all the issues around this complex molecule.
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Affiliation(s)
- Enrico Marinelli
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Renata Beck
- Department of Anaesthesia, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Alfredo Fabrizio Lo Faro
- Section of Legal Medicine, Department of Excellence SBSP, University “Politecnica delle Marche” of Ancona, Ancona, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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24
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Pichini S, Di Trana A, Torrens M, Scherbaum N, Zaami S. Editorial: New Trends of Substance Abuse: Looking for New Psychotropic Effects of Chem Sex Drugs, Cognitive Enhancers, and New Psychoactive Substances. Front Psychiatry 2020; 11:612192. [PMID: 33329162 PMCID: PMC7719771 DOI: 10.3389/fpsyt.2020.612192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Annagiulia Di Trana
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marta Torrens
- Departament de Neuropsiquiatria, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Simona Zaami
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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25
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Rodríguez-Nuévalos S, Costero AM, Arroyo P, Sáez JA, Parra M, Sancenón F, Martínez-Máñez R. Protection against chemical submission: naked-eye detection of γ-hydroxybutyric acid (GHB) in soft drinks and alcoholic beverages. Chem Commun (Camb) 2020; 56:12600-12603. [DOI: 10.1039/d0cc05387b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chemosensors for naked-eye detection of the submission drug GHB in beverages.
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Affiliation(s)
- Silvia Rodríguez-Nuévalos
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)
- Universitad Politècnica de València
- Universitat de València
- Spain
| | - Ana M. Costero
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)
- Universitad Politècnica de València
- Universitat de València
- Spain
- Departamento de Química Orgánica
| | - Pau Arroyo
- Departamento de Química Orgánica
- Universidad de Valencia
- Burjassot
- Spain
| | - José A. Sáez
- Departamento de Química Orgánica
- Universidad de Valencia
- Burjassot
- Spain
| | - Margarita Parra
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)
- Universitad Politècnica de València
- Universitat de València
- Spain
- Departamento de Química Orgánica
| | - Félix Sancenón
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)
- Universitad Politècnica de València
- Universitat de València
- Spain
- CIBER de Bioingeniería
| | - Ramón Martínez-Máñez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM)
- Universitad Politècnica de València
- Universitat de València
- Spain
- CIBER de Bioingeniería
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Delineation of chemsex patterns of men who have sex with men in association with their sexual networks and linkage to HIV prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 75:102591. [PMID: 31756695 DOI: 10.1016/j.drugpo.2019.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/04/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have shown that men who have sex with men (MSM) and who engage in drug use in sexualized contexts (chemsex) were more likely to be HIV positive. Their social networks and adoption of HIV prevention measures have, however, not been fully investigated. We aim to compare the sexual behavior, HIV prevention efforts and social networks of MSM by the intensity and patterns of their drug use. METHODS Data from respondents of a community-based, cross-sectional survey (PRiSM) conducted among MSM in Hong Kong in 2017 were collected retrospectively. Characteristics of MSM engaged and not engaged in chemsex were compared in logistic regressions, delineated by latent class analysis (LCA) and compared in multinominal logistic regression. FINDINGS Of 4133 respondents, 3044 were sexually active with an HIV prevalence of 6.5%. The prevalence of chemsex engagement in the preceding 6 months was 12%, after excluding use of poppers or erectile dysfunction agents (EDA) alone. Four types of drug user were identified by LCA: Minimal (mainly poppers), low-threshold (mainly poppers and EDA), medium-threshold (mainly methamphetamine, GHB, poppers and EDA) and intense (extensive use of different types of drug). Medium-threshold and intense drug users were more likely to be HIV positive, be diagnosed with sexually transmitted infections, make gay friends through mobile apps and sex parties, and intend to take pre-exposure prophylaxis (PrEP). Medium-threshold drug users had a more influential role in their social network, as shown by their higher centrality in mobile apps network. CONCLUSION Chemsex engagement in MSM is significantly associated with HIV infection in Hong Kong. The HIV transmission risk could however be offset by the inclination of MSM belonging to medium-threshold and intense drug users to take PrEP, should the intervention become accessible to the community. Further mobile apps could be a good channel to access MSM who are medium-threshold drug users.
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Ameline A, Blanchot A, Arbouche N, Raul JS, Kintz P. Aspect toxicologique d’un phénomène en plein essor : le chemsex. Description d’un cas médico-légal aux conséquences fatales, impliquant la 4-MEC. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.medleg.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Pellegrini M, Bolino G, Varì MR, Giorgetti R, Pichini S, Busardò FP. A fatal chemsex case involving γ‐butyrolactone and 4‐methylethcathinone. Drug Test Anal 2019; 11:1465-1470. [DOI: 10.1002/dta.2677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Manuela Pellegrini
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Giorgio Bolino
- Unit of Forensic Pathology, SAIMLAL DepartmentSapienza University of Rome Rome Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Raffaele Giorgetti
- Section of Legal Medicine, Department of Excellence SBSPUniversity Politecnica delle Marche of Ancona Ancona Italy
| | - Simona Pichini
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Francesco Paolo Busardò
- Section of Legal Medicine, Department of Excellence SBSPUniversity Politecnica delle Marche of Ancona Ancona Italy
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Trombley TA, Capstick RA, Lindsley CW. DARK Classics in Chemical Neuroscience: Gamma-Hydroxybutyrate (GHB). ACS Chem Neurosci 2019; 11:3850-3859. [PMID: 31287661 DOI: 10.1021/acschemneuro.9b00336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a naturally occurring short-chain fatty acid that rose to prominence as a popular club drug in the 1990s. Originally developed as an anesthetic in the early 1960s, it was later sold as an over-the-counter dietary supplement before becoming a rising substance of abuse in the following decades as one of the "date rape" drugs. Despite its abuse potential, there has been a recent surge in therapeutic interest in the drug due to its clinical viability in the treatment of narcolepsy and alcohol abuse/withdrawal. Its interactions with the GABAergic framework of higher mammals has made it the prototypical example for the study of the chief inhibitory mechanism in the human central nervous system. Though relatively obscure in terms of popular culture, it has a storied history with widespread usage in therapeutic, recreational ("Chemsex"), and some disturbingly nefarious contexts. This Review aims to capture its legacy through review of the history, synthesis, pharmacology, drug metabolism, and societal impact of this DARK classic in chemical neuroscience.
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Affiliation(s)
- Trevor A. Trombley
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Rory A. Capstick
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Craig W. Lindsley
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Chemistry, Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
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Prospective Investigation of the Performance of 2 Gamma-Hydroxybutyric Acid Tests: DrugCheck GHB Single Test and Viva-E GHB Immunoassay. Ther Drug Monit 2019; 42:139-145. [PMID: 31318841 DOI: 10.1097/ftd.0000000000000677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gamma-hydroxybutyric acid (GHB) is a recreational drug with central nervous system depressing effects that is often abused. A urine GHB point-of-care test can be of great diagnostic value. The objective of this prospective study was to determine the performance of the new DrugCheck GHB Single Test and the Viva-E GHB immunoassay for urine samples in emergency department patients. METHODS Patients presented to the emergency department of the OLVG hospital in Amsterdam with a Glasgow Coma Scale score <15 and potential drug of abuse intoxication were included in the study. Between June 2016 and October 2017, 375 patients were included. Using the DrugCheck GHB Single Test (Express Diagnostics Int'l, Blue Earth, MN) and the Viva-E GHB immunoassay (Siemens Healthineers, The Hague, the Netherlands), patients' urine samples were tested for GHB (cutoff for a positive result, 10 or 50 mcg/mL GHB). To ensure quality, the results obtained were compared with those generated using a validated gas chromatography method. The tests were considered reliable if specificity and sensitivity were both >90%. Possible cross-reactivity with ethanol was investigated by analyzing ethanol concentrations in patients' samples. RESULTS Seventy percentage of the included patients was men, and the median age was 34 years old. The DrugCheck GHB Single Test's specificity and sensitivity were 90.0% and 72.9%, respectively, and using 50 mcg/mL as a cutoff value, its specificity and sensitivity improved to 96.7% and 75.0%, respectively. Serum and urine ethanol levels in the false-positive group were significantly higher compared with those in the true-negative group. The specificity and sensitivity of the Viva-E GHB immunoassay (cutoff value of 50 mcg/mL and excluding samples with ethanol levels ≥2.0 g/L) were 99.4% and 93.5%, respectively. CONCLUSIONS The DrugCheck GHB Single Test's specificity was sufficient, whereas its sensitivity was poor, making it unsuitable for use at point-of-care. Contrarily, using 50 mcg/mL as the cutoff value and excluding samples with ethanol levels ≥2.0 g/L, the Viva-E GHB immunoassay showed acceptable results to detect clinically relevant GHB intoxications.
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Case report: Another death associated to γ-hydroxybutyric acid intoxication. Forensic Sci Int 2019; 299:34-40. [DOI: 10.1016/j.forsciint.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 11/21/2022]
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Castro AL, Dias AS, Melo P, Tarelho S, Franco JM, Teixeira HM. Quantification of GHB and GHB-GLUC in an 1,4-butanediol intoxication: A case report. Forensic Sci Int 2019; 297:378-382. [PMID: 30797604 DOI: 10.1016/j.forsciint.2019.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Gamma-hydroxybutyric acid (GHB) is an endogenous compound with known action at the neural level. Its psychoactive effects led to an illicit use context including recreational purposes, muscle building effects in bodybuilders and drug-facilitated crimes, specifically in sexual assaults. Besides the misuse of the main compound, there are precursors like Gammabutyrolactone (GBL) and 1,4-butanediol (1,4-BD), usually non controlled substances, becoming a much easier way to obtain the target-compound. The authors present the first reported intoxication case in Portugal with 1,4-Butanediol, including the quantification of GHB and GHB-GLUC in serum, by GC-MS/MS TQD. A suspicious liquid and a serum sample were sent by an hospital ER and analysed by GC-MS-single quadrupole and GC-MS/MS TQD, respectively. A methodology including protein precipitation and GC-MS/MS TQD analysis was used to detect and quantify GHB and GHB-GLUC in serum. Toxicological analysis revealed the presence of 1,4-Butanediol in the liquid and GHB [171 mg/L] and GHB-GLUC [13,7 mg/L] in serum. The victim reverted the coma with no neurological sequelae. This was the first detected case, in Portugal, with 1,4-Butanediol, suggesting that it is important to be aware that consumers have different options to obtain illicit compounds, such as GHB. On the other hand, GHB-GLUC was identified and quantified for the first time in a real case, due to intoxication. This case highlights the importance of analysing all samples for active compounds, precursors and metabolites that can lead to the main intoxication origin.
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Affiliation(s)
- André L Castro
- National Institute of Legal Medicine and Forensic Sciences, Forensic Chemistry and Toxicology Service, Portugal; Abel Salazar Biomedical Sciences Institute, University of Porto, Portugal.
| | - Ana S Dias
- CICECO, Department of Chemistry, University of Aveiro, Portugal
| | - Paula Melo
- National Institute of Legal Medicine and Forensic Sciences, Forensic Chemistry and Toxicology Service, Portugal
| | - Sónia Tarelho
- National Institute of Legal Medicine and Forensic Sciences, Forensic Chemistry and Toxicology Service, Portugal
| | - João Miguel Franco
- National Institute of Legal Medicine and Forensic Sciences, Forensic Chemistry and Toxicology Service, Portugal
| | - Helena M Teixeira
- Department of Research, Training and Documentation of the National Institute of Legal Medicine and Forensic Sciences, Portugal; Faculty of Medicine, University of Coimbra, Portugal
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