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> I dont understand this part. The potential for overdose on alcohol is high as well. I think that the point about GHB that most people miss is the concept of

by mmt 8y ago

> I dont understand this part. The potential for overdose on alcohol is high as well. I think that the point about GHB that most people miss is the concept of therapeutic index, a term borrowed from the medical world (I've also seen it called "safety ratio" in the context of recreational drugs, especially since they're not being used therapeutically). That is, the amount of GHB required to get the desired effect is very close to the amount necessary for an overdose. > I can go buy a plastic handle for $10 and if i drink the whole thing tonight i'll probably die Merely being easy to obtain doesn't make it easy to overdose, though. That "if I drink the whole thing" is an important part. You do not, for example, need to drink 90% of that bottle just to get "buzzed". I suspect that the average person would feel sufficiently drugged well before making it halfway through (as even a fifth, even spread over an evening, is a lot of booze). With drugs like GHB or ketamine, one needs to do the equivalent of drinking the vast majority of that overdose-quantity-bottle just to get high enough, so it's very easy to go too far accidentally. What's worse, what that amount is, and what that overdose amount is, are weight-dependent, and they can vary at different rates. That's not to say there's no way of alleviating that risk, or at least reducing the possible harm (like maybe only allowing them in clubs adjacent to hospitals), but simply ignoring the legitimate increased accidental OD risk is unlikely to help.

samatman 8y ago
I assure you, you haven't a clue what you're talking about. The therapeutic index for GHB is more than adequate, and ketamine is legitimately difficult to kill yourself with, to the point where the deaths I'm aware of were from drowning. An issue with GHB is that it's distributed in a liquid form that can vary greatly in the amount of water present. When it was available over the counter in the 80s, issues were practically unheard of.
GuB-42 8y ago
AFAIK, the biggest problem with GHB is its synergy with alcohol. Most GHB related deaths also involve alcohol. GHB therapeutic index (8) is just slightly lower than alcohol (10). However, being an illegal substance, you don't really know how potent your stuff is. Ketamine is rather high (38). And BTW, THC (cannabis) as a therapeutic index over 9000. LSD and psylocibin (magic mushrooms) are at 1000, which also makes them virtually impossible to overdose.
- mmt 8y ago
  > AFAIK, the biggest problem with GHB is its synergy with alcohol. Most GHB related deaths also involve alcohol. That's a good point. I had forgotten that base assumption in the club scene, though it was generally much less of an issue in the rave scene, at least during the 90s. > GHB therapeutic index (8) Thanks. Do you have a reference for that? How does that number change with two standard drinks on board? > is just slightly lower than alcohol (10). One of the other properties of alcohol that could make it more difficult to reach a lethal OD, which I already mentioned, is that a symptom of a toxic does is vomiting, which can help prevent it turning into a lethal dose. This is somewhat enabled by the tendency to consume it over time (although "binge" drinking does happen, of course). Can the same be said for GHB? Presumably not, given your next comment. > However, being an illegal substance, you don't really know how potent your stuff is. I think that's an issue for any illegal drug, but it's, arguably, even an issue for alcohol. How many people look at a label to determine proof/%ABV? They're not likely offered the chance with a mixed drink at a bar. > Ketamine is rather high (38). Is that medical or recreational? My understanding (possibly incorrect) is that the recreational dose is generally much higher, or at least less spread out over time, which can significantly affect the ratio. Is there any synergy with alcohol here that affects it? Reading more about "safety ratio", it seems that even just the use of the 50th percentile may not be appropriate to have informed decisions on the relative danger of recreational drugs that are likely to be mixed. ED99/LD1 seems extreme, but maybe not ED80/LD20.
digianarchist 8y ago
It's hard to kill yourself on GHB. GHB combined with alcohol or another suppressant is very very dangerous though.
- mmt 8y ago
  That explains the very strong anti-GHB messaging at alcohol-serving establishments, such as clubs. So, let's assume, for the sake of argument, that we're considering OD risk of recreational drugs, not on their own in a controlled, clinical environment, but, rather, at a club or party, where a sufficient number of people have at least 1 drink already in them and 1 more on the way plus a few cigarettes' worth of nicotine, that we can generalize that to "everyone".

by mmt 8y ago

samatman 8y ago

I assure you, you haven't a clue what you're talking about. The therapeutic index for GHB is more than adequate, and ketamine is legitimately difficult to kill yourself with, to the point where the deaths I'm aware of were from drowning. An issue with GHB is that it's distributed in a liquid form that can vary greatly in the amount of water present. When it was available over the counter in the 80s, issues were practically unheard of.

GuB-42 8y ago

AFAIK, the biggest problem with GHB is its synergy with alcohol. Most GHB related deaths also involve alcohol. GHB therapeutic index (8) is just slightly lower than alcohol (10). However, being an illegal substance, you don't really know how potent your stuff is. Ketamine is rather high (38). And BTW, THC (cannabis) as a therapeutic index over 9000. LSD and psylocibin (magic mushrooms) are at 1000, which also makes them virtually impossible to overdose.

mmt 8y ago
> AFAIK, the biggest problem with GHB is its synergy with alcohol. Most GHB related deaths also involve alcohol. That's a good point. I had forgotten that base assumption in the club scene, though it was generally much less of an issue in the rave scene, at least during the 90s. > GHB therapeutic index (8) Thanks. Do you have a reference for that? How does that number change with two standard drinks on board? > is just slightly lower than alcohol (10). One of the other properties of alcohol that could make it more difficult to reach a lethal OD, which I already mentioned, is that a symptom of a toxic does is vomiting, which can help prevent it turning into a lethal dose. This is somewhat enabled by the tendency to consume it over time (although "binge" drinking does happen, of course). Can the same be said for GHB? Presumably not, given your next comment. > However, being an illegal substance, you don't really know how potent your stuff is. I think that's an issue for any illegal drug, but it's, arguably, even an issue for alcohol. How many people look at a label to determine proof/%ABV? They're not likely offered the chance with a mixed drink at a bar. > Ketamine is rather high (38). Is that medical or recreational? My understanding (possibly incorrect) is that the recreational dose is generally much higher, or at least less spread out over time, which can significantly affect the ratio. Is there any synergy with alcohol here that affects it? Reading more about "safety ratio", it seems that even just the use of the 50th percentile may not be appropriate to have informed decisions on the relative danger of recreational drugs that are likely to be mixed. ED99/LD1 seems extreme, but maybe not ED80/LD20.

digianarchist 8y ago

It's hard to kill yourself on GHB. GHB combined with alcohol or another suppressant is very very dangerous though.

mmt 8y ago
That explains the very strong anti-GHB messaging at alcohol-serving establishments, such as clubs. So, let's assume, for the sake of argument, that we're considering OD risk of recreational drugs, not on their own in a controlled, clinical environment, but, rather, at a club or party, where a sufficient number of people have at least 1 drink already in them and 1 more on the way plus a few cigarettes' worth of nicotine, that we can generalize that to "everyone".