1. GHB Abuse in the United States Carol Falkowski Director of Research Communications, Hazelden Foundation NIDA CEWG member since 1986 Author: Dangerous Drugs: An Easy-to-Use Reference for Parents and Professionals, Hazelden Publishing, 2000.

2. Measuring Drug Abuse Population surveys Population surveys Hospital ER data (DAWN) Hospital ER data (DAWN) Medical examiner data Medical examiner data Addiction treatment data Addiction treatment data Law enforcement data Law enforcement data Ethnographic studies Ethnographic studies

3. All data systems have limitations NEW drugs of abuse hard to track NEW drugs of abuse hard to track NEW methods of use hard to track NEW methods of use hard to track Existing systems slow to respond Existing systems slow to respond System-wide learning curve System-wide learning curve

4. Community Epidemiology Work Group (CEWG) convened by National Institute on Drug Abuse since 1976 convened by National Institute on Drug Abuse since 1976 modeled by other countries, parts of the world modeled by other countries, parts of the world

5. Community Epidemiology Work Group (CEWG) Early warning epidemiological surveillance network Early warning epidemiological surveillance network Detects new drugs of abuse, patterns of use populations at risk Detects new drugs of abuse, patterns of use populations at risk

6. Community Epidemiology Work Group (CEWG) Researchers from different geographic areas analyze similar data on an ongoing basis Researchers from different geographic areas analyze similar data on an ongoing basis Researchers in 20 US cities write a report on drug abuse trends twice annually Researchers in 20 US cities write a report on drug abuse trends twice annually

7. Community Epidemiology Work Group (CEWG) ME data ME data DAWN emergency room episodes DAWN emergency room episodes Treatment data Treatment data Law enforcement data Law enforcement data Supplemental research and information from multiple sources Supplemental research and information from multiple sources

8. Club Drugs GHB (liquid X, gamma, G, easy lay, Georgia Home Boy, Great Hormones at Bedtime) GHB (liquid X, gamma, G, easy lay, Georgia Home Boy, Great Hormones at Bedtime) MDMA (ecstasy, e, X) MDMA (ecstasy, e, X) Ketamine (Specail K) Ketamine (Specail K) Flunitrazepam (Rohypnol) Flunitrazepam (Rohypnol) Methamphetmine Methamphetmine LSD LSD

9. Progression of GHB in CEWG cities 1990 - Florida Poison Information Center 1990 - Florida Poison Information Center 1990 - 1994 – Miami, NYC reports 1990 - 1994 – Miami, NYC reports 1996 - 6 cities 1996 - 6 cities 2000 - most cities 2000 - most cities

10. User Profiles – Sources of GHB Young partiers – nightclubs, raves Young partiers – nightclubs, raves Young partiers - ? Young partiers - ? Body builders – gyms, Internet Body builders – gyms, Internet People seeking sex, sleep effects – health food stores, Internet People seeking sex, sleep effects – health food stores, Internet Abusers seeking alcohol-like effects – parties, Internet Abusers seeking alcohol-like effects – parties, Internet

11. Patterns of Use Party settings – formal and informal (nightclubs, raves, circuit parties or after sporting events, at friend’s house, etc) Party settings – formal and informal (nightclubs, raves, circuit parties or after sporting events, at friend’s house, etc) In between work-out sessions (body builders) In between work-out sessions (body builders) Predatory use – drug assisted rape Predatory use – drug assisted rape

12. Consequences of Use Deaths Deaths Adverse medical reactions Adverse medical reactions Dependence Dependence

16. States Efforts to Control GHB (as of June 2000) SCHEDULE 1 Alabama, Arkansas, Delaware, Georgia, Hawaii, Idaho, Illinois, Michigan, Nebraska, Nevada, Oklahoma, Pennsylvania, RhodeUtah, Virginia, Wisconsin SCHEDULE 1 Alabama, Arkansas, Delaware, Georgia, Hawaii, Idaho, Illinois, Michigan, Nebraska, Nevada, Oklahoma, Pennsylvania, RhodeUtah, Virginia, Wisconsin SCHEDULE II California, Florida, Indiana, Louisiana, New Hampshire, Ohio SCHEDULE II California, Florida, Indiana, Louisiana, New Hampshire, Ohio SCHEDULE III North Carolina, Minnesota, South Dakota SALE and POSSESSION is a criminal offense in highest penalty group in: Arizona, Colorado, Iowa, Massachusetts, Texas SCHEDULE III North Carolina, Minnesota, South Dakota SALE and POSSESSION is a criminal offense in highest penalty group in: Arizona, Colorado, Iowa, Massachusetts, Texas SOURCE: US Department of Justice, Drug Enforcement Administration, Office of Diversion Control SOURCE: US Department of Justice, Drug Enforcement Administration, Office of Diversion Control

17. Conclusions GHB is a significant and growing drug of abuse GHB is a significant and growing drug of abuse Rapid growth in adverse consequences since 1999 (ER episodes surpass MDMA) Rapid growth in adverse consequences since 1999 (ER episodes surpass MDMA) Multiple user typologies Multiple user typologies Dependence possible Dependence possible