How is ghb tested for

Segmental hair analysis revealed in both cases GHB peak values, in the fifth segment for the administered subject and in the fourth segment in the DFSA case. The GHB peak values detected in the fifth and fourth segments demonstrated that a single exposure could be detected in hair Figure 2 A and B. A cm black hair shaft was collected and cut into 3-mm long segments 80 segments in total 7 days after the rape and analyzed for GHB. The first three segments closer to the scalp showed the following GHB concentrations: 3.

This mean value represented the baseline GHB level of the woman, whereas the highest GHB concentration detected in the second proximal segment was suggestive of an exogenous GHB administration even taking into account the possible contamination by sweat.

Head hair from to two volunteers was collected on days 9, 14, 25, and 28 for one case and on days 8, 17, 25, 37 for the other case. In both cases, head hair were segmented into 7 mm fragments.

In addition, beard hair of 1 mm length was collected every day. GHB concentrations in head hair were in the range of 0. In beard hair, the measured GHB concentrations were up to 20 times higher than those in head hair falling into the range of 0.

The explanation for these variations of GHB content in beard hair, provided by the authors, was a possible external contamination by sweat. In all the above reported cases, what allowed the authors to confirm the administration of a single GHB dose in hair was the eventual rise of GHB content in targeted hair segments in comparison to the content in the others. However, none of these studies reported which had to be the degree of rise in hair concentration of GHB.

Neither the Guidelines of Society of Hair Testing reported in the degree of this elevation [ 28 ]. Four years after the release of this document, Bertol et al. Two ratios were obtained: 4. Indeed, Bertol et al. The two ratios proposed by Bertol et al. The same authors also calculated month by month the ratios between GHB value in targeted segments and that in the others for up to 12 months, showing a progressive decrease from 5.

The month-by-month decrease of this ratio can be explained by the decay of hair GHB concentration, which occurred during the month timeframe up to Moreover, differently from other drugs of abuse no significant GHB migration in the hair shaft was found.

Differently from the previous study, Shi et al. High GHB concentration was found in the second segment 4. However, no ratio with GHB values in the other segments was provided, making any definitive conclusion difficult Figure 2H. Different from all the above reported studies, is the approach to document a single GHB dose in hair, published by Kintz in [ 22 ], where two different cases were evaluated.

The comparison of the GHB values detected in the first hair segment of these two individuals with the ones of a control group of 12 subjects, in the range of 0. This new approach which is based on the analysis of proximal hair samples non decontaminated from eventual sweat contribution allowed Kintz to obtain a much better discriminating ratio which could be used in routine cases, considering that the risk of GHB passive contamination is limited because the drug is generally used in liquid formulation and not smoked [ 22 ].

In Petersen et al. However, the results obtained in this first study did not look promising [ 30 ]. Only a few reports investigating GHB-glucuronide in different matrices [ 24 ], [ 26 ], [ 31 ], [ 32 ], were published after this study, two of which focused on hair [ 24 ], [ 26 ], Wang et al. The latter two compounds were not detected, whereas GHB was found in the first six proximal segments at significantly higher concentrations compared to the ones measured in last four segments, GHB-glucuronide was detected in all segments in the range: of 0.

In Hanisch et al. The majority of these methods included only quali-quantitaive determination of GHB. Table 2 reports a brief overview of analytical methods applied for qualitative and quantitative analysis of GHB and metabolites in hair.

Therefore, the high variability of GHB concentration in hair does not allow the proposal of a reliable GHB cut-off which can be applied unanimously to all cases to significantly discriminate between endogenous and exogenous GHB. The majority of studies have detected higher GHB values in the hair segment closest to the scalp, demonstrating the contribution from sweat even when hair was correctly decontaminated.

In the light of this occurrence, at least the first 5 mm hair shaft should be excluded from analysis to avoid erroneous conclusions. All the studies investigating the detection of a single GHB dose in hair, except the one of Kintz [ 22 ] where a different approach is presented, indicate that it is necessary to wait a reasonable length of time for collecting hair from a minimum of 7 days up to 1 month or more. The interval of 1 month from the possible exposure was mainly suggested to collect hair and this is the interval of time we recommend.

The segmental analysis of hair into 3 or 5 mm segments and the calculation of a ratio between the targeted segment and the others represent a reliable method to detect single GHB dose in hair and the ratios proposed by Bertol et al. The only two studies [ 24 ], [ 26 ] so far performed, investigating GHB-glucuronide in hair, highlighted that this metabolite does not seem to provide any diagnostic information regarding GHB exposure. Finally, taking into consideration all the studies up to here discussed we wish to propose a practical protocol to be applied in all suspected cases of GHB-FSA, which is presented in Figure 3.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Competing interests: The funding organization s played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. Hair analysis for drug detection. Ther Drug Monit ;—6. Search in Google Scholar. Hair analysis in clinical and forensic toxicology, 1st ed.

Tokyo: Academic Press, Gautam L. Accessed: 2 Jan The importance of hair testing in GHB facilitated sexual assault cases.

J Forensic Leg Med ;—5. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol ;— Clinical applications of sodium oxybate GHB : from narcolepsy to alcohol withdrawal syndrome. Eur Rev Med Pharmacol Sci ;— Blood, brain, and hair GHB concentrations following fatal ingestion. J Forensic Sci ;— Application to document sexual assault. Determination of endogenous levels of GHB in human hair.

Are there possibilities for the identification of GHB administration through hair analysis in cases of drug-facilitated sexual assault? J Anal Toxicol ;— Unusually high concentrations in a fatal GHB case. J Anal Toxicol ;—5. Identification of GHB and morphine in hair in a case of drug-facilitated sexual assault. Forensic Sci Int ;e9—e The salt form of GHB has been marketed in gymnasiums and health food stores due to its ability to stimulate the release of growth hormone..

Additionally, it is a popular euphoriant that is commonly used at raves. As is the case with all sedatives, GHB has been used in many drug facilitated sexual assaults. GHB is metabolized to succinic acid by multiple dehydrogenase enzymes. Metabolic precursors to GHB, gamma-butyrolactone GBL and 1,4 butanediol are also readily available as substances of abuse. Typical illicit use of GHB involves dissolving 2 — 3 grams of powder in water or other beverages. Onset of effects occur within 10 — 30 minutes of ingestion and include euphoria, increased libido, drowsiness, reduced inhibitions, dizziness, nausea and may persist for 2 — 5 hours.

Toxic effects include hypotension, respiratory depression, seizure, unconsciousness, coma, and death. Determination of gamma-hydroxybutyric acid GHB , also known as liquid Ecstasy, in human samples is challenging.

This is especially true if not actually alleging DFSA or another crime. Individuals arrested for driving under the influence who believe they may have been drugged, even if the allegation is made in a timely manner, also report difficulty in getting tests done for drugs like GHB. The availability of an inexpensive field test can alter the landscape of response to drugging allegations dramatically.

As with all drugs, screening tests are not the final word. Screening tests are important indicators of drugs being present. This is followed up with instrumentation tests to establish drug identity definitively and to identify the level of the drug s present. As with all field test kits, they are merely indicators and would be followed up with definitive instrumentation testing in the lab. Vomit is also a potentially valuable source of drug evidence in sexual assault as well as death cases.

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