TV: Physostigmine/GHB - Catalyst, ABC - 27/05/04 @ 8pm

[Jack]

This will be a story about treatment for GHB overdose. Should be interesting.

[ 27. May 2004, 13:01: Message edited by: Jack ]

[theobromos]

Overdose or alcohol interaction?

[strangebrew]

Overdose treated with low dose intravenous physostigmine. What beats me is that this story seems to be old news. There's a article of Dr.Caldicott's on the net about this treatment dated Jan.2001!

http://groups.msn.com/GHBaddiction/general...459784140192317

They didn't mention the role of alcohol in these cases. Catalyst is only a 1/2hr. program with 3 stories in each episode.

[ 28. May 2004, 00:21: Message edited by: strangebrew ]

[Jack]

For those that missed it here is the transcript:

http://www.abc.net.au/catalyst/stories/s1117405.htm

Narration:

There’s a new party drug sweeping Australia. Its use is on the rise, and so are overdoses.

All sorts of people are taking it, in clubs, bars or even at home.

Paul Dillon:

We really don’t know anything about how many people are using it. We know it is definitely becoming more popular.

Narration:

The drug is GHB or gamma hydroxy butyric acid. It’s also known as GBH, or grievous bodily harm, and with good reason.

David Caldicott:

Well it’s an anaesthetic agent so we use it for example to put people to sleep. I could take your appendix out by giving you a dose.

Narration:

Taking GHB is living on the edge.

Just a few drops is the difference between a safe dose and an overdose.

Every weekend emergency wards around the country are filling up with patients who misjudge their dose.

Staff and life-saving equipment are being pushed to breaking point. So one doctor in Adelaide is looking for a better way to deal with the crisis.

Dr David Caldicott is the Emergency Research Fellow at Royal Adelaide Hospital.

He’s seen a disturbing increase in GHB overdoses over the last few years. He says it’s a big problem, particularly in Sydney.

Paul Willis, Reporter:

And how many cases are we looking at?

David Caldicott:

Oh they’re looking at ten a week easy.

Paul Willis, Reporter:

What’s the main problem for an emergency ward dealing with GHB cases?

David Caldicott:

Well as you can see here we’re a new emergency department and we have 4 resuscitation bays and this is one, and one of the things that many of the GHB cases require is intubation and ventilation. To do that we need an endotracheal tube, which is simple plastic tube, and we need a ventilator, which will breathe for our patient when they stop breathing as they often do with GHB overdoses. But as you can see with only four if you have multiple overdoses coming say for example from a nightclub or a rave all of a sudden you run into a lot of trouble ventilating your patients

Narration:

This is the frightening possibility that hospitals all around the country are facing.

GHB hasn’t always been illegal. It was used above-board for many years as an anaesthetic in hospitals.

So how did a drug that was once used to do good in our hospitals, end up creating a crisis?

In Sydney, Paul Dillon from the National Drug and Alcohol Research Centre has been tracking GHB and its uses before it was made illegal.

David Caldicott:

It was really introduced in Australia through the body building fraternity who had seen some research that was conducted in Japan, which suggested that GHB promoted deep sleep. Deep sleep could actually reduce fat and create muscle. So of course it was particularly attractive to the bodybuilding group.

Narration:

In the 1990’s, GHB started to trickle into the hands of party-goers. That’s when people started overdosing, and it was banned in Australia shortly afterwards.

David Caldicott:

As soon as it was banned it became extremely popular, which is what we tend to find with these sorts of drugs.

Narration:

The GHB people are buying now is no longer pharmaceutical grade. It’s being made from solvents, and this has made David’s problem even worse.

David Caldicott:

These drugs or chemicals are usually taken from industrial sites and therefore not prepared for human consumption.

Narration:

GHB is being taken by people like Sarah, who it takes most weekends.

Sarah:

Once it sort of kicks in to like a full effect, you’ll get a bit of blurred vision and you know, moving around, you feel you’ll get a bit off balance. It gives you that sort of lowered inhibition where you just feel good and you know you just relax, yeah.

Narration:

Sarah always colours her GHB so no one mistakes it for water, and she’s careful to measure out exact doses before she takes it.

Sarah:

There’s rules that you go by to taking GHB. The effects of it are quite enjoyable when you have it like responsibly.

Narration:

But misjudge your dose by a millilitre, and you start feeling the effects of a powerful anaesthetic kicking in.

Sarah:

One time I’ve had it and I felt like if I really wanted to I could probably sit down in a corna and go to sleep.

David Caldicott:

The breathing will slow to a point where the oxygen levels will drop critically in the blood The pulse decreases, the blood pressure decreases.

Narration:

Just a few drops more and sleep becomes a coma.

David Caldicott:

The brain is effectively starved of oxygen and on top of that the muscles which support the airway can go floppy or flaccid and the commonest cause of death from GHB and GHB like compounds is respiratory arrest.

We had an episode in a bar about eighteen months ago where instead of chugging shots of vodka they decided to chug shots of GHB and we had seven simultaneous presentations and that threw our department into absolute chaos purely because we had to try to maintain the airways of all of these people at the same time.

Narration:

The hospital couldn’t go on like this for much longer. They had to find another way of treating GHB overdoses that didn’t tie up the precious ventilators.

David began scouring through old medical journals, hoping that something in the history of GHB might give him a clue.

Then he stumbled across an old, forgotten paper, written almost thirty years ago.

In the 1970’s, two anaesthetists from Dunedin Hospital in New Zealand were using GHB as an anaesthetic, and they were trying to find a way to reverse its effects.

They came across an old drug called Physostigmine, which they suspected might do the trick.

When they tried it, their patients woke up after a few minutes instead of several hours.

But David had a big problem with physostigmine. Over the years it had gained a nasty reputation for causing seizures and even death.

David Caldicott:

So this is physostigmine. It comes as a solution in a vial.

Paul Willis, Reporter:

And it’s had a bit of a bad rap itself though physostigmine?

David Caldicott:

It has but going back into the medical literature the foundations of its bad reputation are very shaky indeed.

Narration:

He double-checked the literature and finally he was sure that the criticisms of physostigmine were based on flawed research.

Then came the moment of truth. He decided to try physostigmine on GHB overdoses.

Paul Willis, Reporter:

Were you nervous about using Physostigmine?

David Caldicott:

Of course. We didn’t know what would happen.

Narration:

To his great relief, it worked.

David Caldicott:

Quite how well it worked surprised us tremendously and that was definitely a grinning moment.

Narration:

So far David has administered physostigmine to GHB overdose patients who are partially awake. Four out of five of these patients have come round without needing to be ventilated.

For the Royal Adelaide Hospital, it’s a huge leap forward.

This new approach won’t stop the overdoses, but it could save lives and will save precious resources in our already stretched emergency wards.

Paul Willis, Reporter:

What would you say to people considering taking GHB?

David Caldicott:

Try another drug. There are lots of other drugs. I don’t advocate drug use but please if you have to take a drug you know use something else. This is an anaesthetic agent. I’m not a drug Nazi but if I was to ban anything it would be GHB and all of its precursors.

[Torsten]

I love this bit. A truely rational person. I wish our politicians were as wise as this guy. If MDMA was legal then no one would bother with G.

David Caldicott:

Try another drug. There are lots of other drugs. I don’t advocate drug use but please if you have to take a drug you know use something else. This is an anaesthetic agent. I’m not a drug Nazi but if I was to ban anything it would be GHB and all of its precursors.

[strangebrew]

Yeah, he seems like a really cool guy. He put himself through med-school in London while working as a bouncer. He'd know the score.

He's also started attending raves.

http://www.mapinc.org/drugnews/v04/n027/a01.html?111

[theobromos]

The Calabar Ordeal Poison alkaloid "had a bit of a bad rap" :D Love it, a slight understatement there.

[strangebrew]

Could one of the more scientifically bent people on this forum please explain why a depressing agent like physostigmine which can produce paralysis, can reverse the affect of an overdose? :confused:

[Guest electro]

SO DOSE SENSITIVE >> ONLY A FEW ML BETWEEN DOSE AND OVERDOSE ....

isnt the dose like multiple GRAMS of the salt ... i mean come on thats a fucking massive dose ...just because it is dissolved in water cos dumbfuck dealers cant keep their hygroscopic drugs dry doesnt mean that its dose range is narrow ... if you dissolved 30 grams of pure methamphetamine 10 ml of water youd have a bloody hard time not overdosing on that too ! ..

It's ld is hugely high too isnt it ... until you mix it with alcohol/depressants

maybe they should ban alcohol (bring back al capone!) .. or i know ... maybe they should LEGALISE IT so people know how much they are getting and so they can be warned that "if you mix this with alcohol/other depressants you are likely to die or have to have a tube stuffed down your throat to breathe for you !"

harm maximisation... the goverments justification for murdering people who dont fit the white anglo drug free mould.

War on drugs - the way the government wins votes for murdering its own citizens through harm maximisation. (if they wont vote right[wing], kill them)