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.