[wavefunction]

Not to blow up my own spot but the bit about GHB being a powerful CNS depressant is just as true about alcohol and it strikes me as a bit dramatic.

There are reasons why researchers are interested in pursuing it as a potentially helpful tool for opium addicts, and focusing on the prurient aspects of a substance is exactly what makes research into _controlled_ therapeutic use of GHB or Cannabis or psilocybin so hard to do in this country.

[malandrew]

I also found that part very dramatic as someone who has a GHB prescription for cataplexy. Does the drug have a checkered past? Yes, but a lot of the public sentiment towards it is the result of journalistic histrionics.

For years it was sold over the counter at GNC to body builders because of its impact on prolactin levels in the body, and AFAIK it is the only known substance that mimics natural sleep. It improves REM sleep and stages 3 & 4 of slow-wave sleep.

I myself have one of the few known cases of very very mild cataplexy, so I don't absolutely have to have GHB to function, but for most people who also test positive for the HLA marker DQB1*0602 and have severe cataplexy, GHB is an absolute life saver. These people don't really experience and long term psychological effects as would be implied by the scare words used in the paragraph describing GHB. Yes, it has powerful CNS depressive effects and can be lethal in high doses, but those effects are pretty much only applicable while under the influence of the drug and not after your body has metabolized it and flushed it from the body.

[saalweachter]

Reading the backs and forths of various drugs and medical treatments over the years has left me with two overall lessons:

* A drug with horrific potential side effects can be worth it, if the condition it is treating is worse. For instance, a drug which can cause strokes might be worth it to prevent horrible seizures, but not to prevent mild hay fever.

* Even if a drug can be abused, it doesn't change the fact that some people legitimately need it. You see this most in pain management, where people who need powerful pain killers just to function face criminal charges and roadblocks to getting the medicine they need.

[nknighthb]

> the bit about GHB being a powerful CNS depressant is just as true about alcohol

In the US, a "standard drink" is 14 grams of pure alcohol. It's the equivalent of a typical can of beer.

3.5 grams of GHB can trigger unconsciousness, and 7 grams is potentially lethal.

If this is "just as true", I think our definitions of truth are wildly different.

EDIT: If you feel the need to reply to this comment, please read the entire thread first and realize there's nothing "between the lines" of the comment. I have no agenda here. I'm not making a policy argument. I'm not advocating for or against GHB or any other substance. You don't need to tell me what the LD50 is for any particular substance (chances are I already know).

[threedaymonk]

Potency is a pretty misleading comparison. There are drugs that are prescribed in μg (mcg) doses, and drugs that are prescribed in mg - mistaking μg for mg has caused deaths.

The LD50 of caffeine for an average male is about 14 g. That's the same (in terms of mass) as the alcohol in a beer. Does that make caffeine more or less "powerful"? It takes something like a hundred cups of coffee to reach caffeine's LD50; for alcohol, it's slightly over one bottle of strong spirits. Despite caffeine's higher potency, it's a lot easier to kill yourself by drinking too much whisky than too much coffee.

[nknighthb]

I cannot begin to understand what point you're trying to make. The person I was replying to was explicitly comparing the potency of GHB to alcohol, both depressants commonly encountered in a highly concentrated form.

Making this about caffeine or any other substance that can be lethal in small amounts seems a non-sequitur.

[shabble]

There seem to be 2 confused issues in this (sub)thread.

Firstly, the Therapeutic Index argument (ratio of effective dose to dangerous/fatal dose), for which the 2 drugs are (very) roughly equivalent, based on some back-of-envelope estimates (~10:1 for EtOH, 14:1 - 3:1 for GHB).

The second is the 'commonly encountered form' argument, which I think was your main point, and appears to be misunderstood. Alcohol, with the benefits of being legal and easily available, is available in known purity solutions anywhere from 1~90%.

The biggest problem (AFAIK) with things like GHB in a bar/club environment is the fact it must be concentrated enough to be small enough to easily smuggle in/out. It has specific other unfortunate properties as well, like being very destructive to many types of plastic. Dosing with an eye-dropper into an existing drink is apparently quite common, and I can easily imagine this leading to accidental overdosing in a crowded/loud/intoxicated environment. You must also account for the fact that there's not nearly the same quality control in terms of purity from batch to batch, which combines badly with the low Therapeutic/Effective Index.

The other difference is, even if your bartender is serving you 180 proof rum, he's probably not going to let you chug the whole bottle of it, regardless of demand.

[mikeash]

The point is that what we generally consider as "power" or "potency" is more than just effect per unit mass. We don't generally consider capsaicin to be more powerful than alcohol even though, purely on the basis of how much you have to ingest, it's far easier to kill yourself with it.

[threedaymonk]

To be slightly pedantic, I used the term "potency" specifically because that does have a pharmacological meaning: it's a measure of drug activity in terms of concentration. "Power", on the other hand, is a rather ill-defined concept.

[nknighthb]

> what we generally consider as "power" or "potency" is more than just effect per unit mass

Um, OK, that may be true for you, and maybe even for society at large, but I've personally never heard such a thing before right now. It's certainly not how I would define the words.

To address the point I think you're trying to make (which still doesn't make much sense to me), in the forms they are commonly encountered in, GHB is unquestionably much more dangerous/"powerful" than alcohol. So I still don't see why my comment attracted this sort of argument.

[wavefunction]

Dangerous? Alcohol has much more systemic toxicity than GHB in general. Consider if you consumed 3.5 grams of tylenol. You will die. Does that make it more "powerful" or "dangerous" than alcohol?

That is the point we are trying to make.

[vilhelm_s]

In this case it was used as a treatment for opium addiction, right? A doctor prescribing a given drug will specify a suitable amount to get the desired effect. One drug might be more dangerous than another e.g. because it has a more narrow therapeutic index, but surely not because it has a bigger effect for a given mass of drug, or because it is "commonly encountered" in big doses?

[pstuart]

> much more dangerous

Only if taking the same amounts, which is ludicrous.

Alcohol is plenty dangerous already and we're all ok with that.

[peteretep]

Your head is liable to E-X-P-L-O-D-E when you hear that there's a drug for sale - nationwide - that's a CNS depressant, where 1 gram of is FATAL. Can you believe that? And yet they sell this thing called "nicotine" to people as young as 16!

Perhaps effect per weight is a shitty measure?

[nknighthb]

Ugh. I was going to just step out, but I can't let this pass, because it's incredibly insulting.

I'm not arguing for the banning of a substance. I'm not arguing one substance is subjectively better than another. I don't care that GHB or any other drug is being used in studies.

You're reading something into my comments that simply is not there. Please stop it.

[peteretep]

What was your comment about then? You appear to be comparing simply effect per weight, and drawing conclusions from that?

[nknighthb]

My comment was about what was, in my view, an objectively inaccurate characterization of alcohol being "just as powerful" a CNS depressant as GHB. That is all it was. If you want to argue about something else, I'm not the opponent you're looking for.

[peteretep]

If you were right, people would routinely refer to nicotine as being the most powerful street drug, given it's punch-per-gram ratio.

[wavefunction]

Well, a "dose" of GHB is more like 1 gram or less, so I'm not talking about equivalency by weight. Now I really am blowing up my spot ;)

I should also note my experience was back in the 90s when it was still legal in my locale

[mikeash]

Just comparing quantities isn't all that useful. Availability needs to be compared, and how much one would "usually" take.

With 7 grams being potentially lethal, it's roughly similar to Tylenol (not recommended to exceed 4 grams), caffeine (foolishly extrapolating the LD50 in rats to a human puts the lethal dose at around 10 grams), aspirin (similar to caffeine), and a lot better than capsaicin (foolishly extrapolated lethal dose around 2 grams).

[nknighthb]

Since you and threedaymonk both seem to be making a similar argument that makes absolutely no sense to me in context, I'll just point you at my reply to him.

[mcguire]

Technically, though, you are supposed to get informed consent from the subjects. The link from the article:

http://www.scribd.com/doc/114822452/Halikas-Scandal-News-Rep...