FACING THE FACTS ON FANTASY

Potentially fatal designer drugs appear faster than the politicians
can outlaw them. MATHEW DEARNALEY looks at the latest substances to
make tragic headlines.

We all want a good time, and young people like to experiment with how
to get it.

The latest drug-related death, of a promising young Auckland
engineering student at the weekend, is pitting the medical profession
against a subculture which purports to be able to manage the risks of
ingesting mind-altering substances.

Auckland Hospital's intensive care unit deals with three to eight
patients each weekend admitted comatose after taking the party drug
Fantasy or other sleep and euphoria-inducing variants.

Importers and distributors of one of those variants, One4B, claim
they are trying to encourage the measured use of such substances to
combat the unregulated abuse of illicit and impure drugs such as
Fantasy.

Intensive care specialist Dr Tony Smith acknowledges street-level
efforts to introduce "a degree of quality control" to the drug scene,
but says it would be naive in the extreme to think people would
always follow dosage instructions.

The Health Ministry is meanwhile repeating its warning not to consume
any products containing 1,4, butanediol (One4B) or
gamma-hydroxybutyrate (GHB, GBH or Fantasy) while a committee of
experts wrestles with how to classify this pharmacological cornucopia.

What is Fantasy?

Gamma-hydroxybutyrate (GHB) or sodium oxybate, otherwise known as
Fantasy, Grievous Bodily Harm or Liquid Ecstasy, was first used in
the United States as a surgical anaesthetic but abandoned in the
1970s after causing erratic breathing in patients.

More recently, it has been investigated as a treatment for the sleep
disorder narcolepsy and for alcohol and opiate dependence, an
attribute highlighted by promoters of its yet-to-be-outlawed One4B
associate.

Fantasy is commonly a colourless, odourless liquid sold in small
bottles, but it has also been seen in powder and capsule form.

One4B ends up in the body as a version of GHB, although distributor
Mark Barlow, whose company is called Outerspace, says it metabolises
into carbon dioxide and water in three to five hours, leaving no
toxic residue.

Who takes it?

Two groups of people are generally known to take Fantasy. Those in
the dance or club scene use it for its euphoric and sedative effects,
one of which Mr Barlow describes as a "warm and tingly feeling."

Detective Senior Sergeant Colin McMurtrie, head of the Auckland drug
squad, describes them as "the yuppie, disposable-income ravers" who
also take the more expensive and illegal Ecstasy.

Some bodybuilders also use Fantasy to promote "slow-wave sleep,"
during which the Health Ministry says a growth hormone is secreted
from the pituitary gland.

Mr Barlow says he uses the One4B variant for both purposes, up to six
times a week, although he recommends at least one rest day in case
the pituitary gland becomes lazy and stops making its own growth
hormone.

He says the pituitary generally stops making the hormone after the
age of about 30. As a 32-year-old, he believes he needs the drug to
keep building lean muscle tissue, and claims to have shed 7.5kg since
starting to use it.

But he does not take it several times a day like his Timaru-based
importer, James McNee, who told the Herald yesterday that he had
dosed himself half an hour earlier and was in fine fettle to run his
business.

That sounds like a glowing advertisement. What about some of the less
desirable effects? According to the ministry, feelings of enhanced
confidence and euphoria can also be accompanied by nausea, dizziness
and drowsiness.

With higher doses, the initial euphoria is replaced by powerful
effects that can include confusion, agitation, hallucinations,
seizures, vomiting, stiffening of muscles, disorientation,
convulsions, unconsciousness and respiratory collapse.

Effects become noticeable 10 minutes to one hour after taking the
drug, and can last a day or longer.

"There appears to be a fine line between the amount that is required
to achieve the desired effect and that which leads to coma," says the
ministry.

"Because there is often no way of knowing the strength of Fantasy,
there is the added danger of overdosing."

Although the death of Auckland University student Shawn Brenner on
Saturday was the first in New Zealand linked to Fantasy, at least
three fatalities have been reported in the United States.

Dr Gill Hood, the intensive care specialist on duty at Auckland
Hospital when the comatose Mr Brenner was admitted, says Fantasy is
responsible for far more emergencies than Ecstasy because of its
anaesthetic properties.

"GHB is basically an anaesthetic, and if people want to go around
giving themselves anaesthetics there is a very fine line between a
feeling of elation and being deeply comatose - the dose is different
for every person."

Dr Hood says the drug was abandoned as an anaesthetic in the 1970s
after it caused some patients breathing difficulties, and safer
substitutes were found.

What about long-term effects?

The ministry says very little research has been done into Fantasy's
long-term effects, although it believes people can become physically
or psychologically dependent on the drug.

Mr Barlow believes any addiction is more likely to prove
psychological, and says his product has proven successful in weaning
people off substances such as Ecstasy and alcohol.

Is there a safe dose?

Mr Barlow's company says on its website that the recommended dose of
One4B is 10 millilitres on an empty stomach, and no more than 30ml
should be taken in a three-hour period or 75ml in a day.

An optimum dose is usually between 15ml and 25ml every three hours,
but the website adds that this also depends on body mass and
metabolism, with women generally needing less than men to feel the
effects.

It says overdosing is not pleasant, although allegedly not toxic,
"and more is not better."

The website warns epileptics and people with conditions such as
severe hypertension or cardiovascular disease never to take the drug.

Dr Hood says it is dangerous to suggest there is any safe dose unless
a person is in hospital under the care of a qualified anaesthetist.

She suggests there are a number of other safer recreational drugs
available, but is loath to identify any for fear of encouraging
unprescribed drug use.

On no account should alcohol or drugs such as barbiturates,
anti-convulsants or tranquillisers be taken with Fantasy.

What should you do if someone overdoses?

Fantasy and its variants are depressant drugs, so Mr Barlow suggests
giving them food and stimulants such as caffeine.

He says One4B gives users greater warning, about 45 minutes, of an
overdose than 30 minutes with Fantasy.

People who take yet another variant called GBL (gamma butyrolactone),
rumoured to be circulating in Auckland clubs, can receive just a few
minutes' warning before blacking out.

One4B allows people time to find a place to sleep off the effects, he says.

Dr Smith at Auckland Hospital says it is too late to pump the
stomachs of overdose victims once Fantasy starts working on the brain.

"All we can do is make sure they don't choke, and look after their
air passages and breathing."

He acknowledges that alcohol and a wide variety of other drugs can
cause death through choking on vomit, but says that for all the
people who get "plastered" while drinking every night, only about one
a month ends up at his intensive care unit.

That compares with three to eight a weekend who arrive comatose from
Fantasy or its variants, though he concedes that there have been few
One4B overdoses since publicity in January.

He is annoyed by a suggestion from Mr McNee in Timaru that there is a
readily available antidote.

Mr McNee quoted a scientific publication from 1976 to the Herald as
claiming success for a substance called physostigmine in arousing
people when GHB was used as an anaesthetic.

But Dr Smith describes it as "one of those olden-day therapies for
poisoning when people didn't know any better - we wouldn't consider
it now except for very rare cases."

What is the legal status of these drugs?

Fantasy was declared a prescription-only medicine last year under the
Medicines Act, allowing penalties of three months in prison or a $500
fine for possession, and six months' jail or a $1000 fine for dealing
or possession for supply.

The police are hoping for heavier penalties if it is classified under
the Misuse of Drugs Act, following recommendations yet to be
determined by a ministerial advisory committee due to meet for the
first time on May 29.

One4B remains legal, pending such a classification, although the
Health Ministry is due to recommend next week whether its suppliers
should be prosecuted under the Food Act or Medicines for putting
consumers at risk.

Mr Barlow withdrew sachets from sale pending the investigation, which
the ministry says has been slow because of the reluctance of some
people who have ended up in hospital to allow analysis of blood
samples taken at the time.

But Mr Barlow disclosed yesterday that he was still supplying 1,4,
butanediol in bottle form to distributors who knew how it should be
used.

He obtained the product, as a recognised compact disc cleaner, from
Mr McNee's company.