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Preventative Medicine Center of Sharon
PO Box 95092 West Connely Blvd.
Sharon, PA 16416
February 25, 1997
Assembly Committee On Public Safety
California State Assembly
RE: Classification of GHB as a Schedule I substance
I was informed today that the Committee On Public Safety is considering classifying GHB as a Schedule I drug with no legitimate medical use. this comes as a surprise since GHB has many clinical indications and has at least 15 Investigational New drug Applications on file with the FDA. I have had clinical experience with GHB for over five years.
I am an Internist by formal training with a certification as an Addictionist by the American Society of Addiction Medicine. I have enclosed my CV with the letter.
I would not take the Committee's time to outline all of the potential medial indications for GHB but describe a few, particularly those within my own experience.
As a physician, particularly one that has dealt with the horror of substance abuse on a regular basis, there are no safe drugs presently on the market that either treat anxiety or insomnia effectively without serious side effects. For insomnia we have the older barbiturates which have an addiciton liability and cause a serious "hangover" in the morning. The benzodiazapines were supposed to be an improvement but they too cause a hangover and potentially can seriously impair memory, particularly in the elderly who are the population generally taking sedative hypnotic agents for insomnia. A newer drug on the market, Ambien does not work well. In the treatment of anxiety, we have the same problems with the benzodiazapines. A newer agent Buspar has not been found to be particularly effective and in my own clinical experience I have found it to create severe dysphoria; hardly a good drug to use for anxiety.
Properly dosed, GHB is a very effective sedative hypnotic without any of the problems of the drugs just described. There is no "hangover" or mental impairment upon arising and the agent is metabolized into natural by products. In fact, GHB has been found in the brain; it may indeed be a neurotransmitter. In a normal population in my experience there is a minimal addiciton liability. Of interest, if anything, GHB can improve memory rather than impairing it.
It has proved very useful for treating people with sleep impaired by myoclonus for which there are no really effective drugs on the market. GHB works very well in getting narcoleptic patients to sleep more efficiently and decreases daytime drowsiness.
Detoxifying patients from alcohol or benzodiazapines, a potentially life threatening procedure, has usually been accomplished with sedative hypnotics such as Valium. I have found GHB to be very safe and useful for this purpose. It is also very effective in dealing with the anxiety and depression attendant with detoxification from cocaine and amphetamines.
As an Addictionist I would say that all patients with a history of addicion are at risk when they use mood altering substances and I would include GHB. However, to date I have not encountered one case of addiction to GHB. One has to make a distincion between drug use, abuse, and addiction which is beyond the scope of this communication.
In our tremendous armamentarium of pharmaceuticals in this country we administer drugs which have serious side effects and potential dangers far in excess of GHB. Moreover, it is rare in medicine to have an agent like GHB with so many beneficial indications with minimal untoward effects.
I am aware of some of the recent media attention given GHB. I have also been aware of the tremendous amount of attention paid by the media on the dangers of air travel and problems with out Air Traffic Control System. I have been flying airplanes since 1992 and feel safer in the air then on the ground in my car where from a statistical standpoint I am more likely to be killed by a drunk driver. Having personally visited ATC facilities I can only say that I marvel at such an amazing system and dedicated staff that do not get the legitimate praise they should receive. I bring up this example because clearly, the media, without a clear understanding of the statistics regarding the safety of air travel or their reluctance to publish them since it would detract from their sensationalist, shock journalism, does the public an injustice in frightening them unnecessarily. I believe this holds true with GHB. A handful of cases is offered by our typically irresponsible media for self serving reasons without consideration of the facts or actual magnitude of the "problem" in relation to the benefits of GHB.
GHB is no different than any other substance available to the public without a prescription whether it be alcohol which is far more toxic and has resulted in countless fatalities, or tobacco. Unfortunately, we live in a nation of sheep who seem incapable of taking personal responsibility and look to our Local and Federal Governments to solve all of their problems and in so doing our essential freedoms are slowly eroded one by one. The world can never be without risk. A harmless object to most people may be turned into a lethal weapon by an individual bent on such intent. I do not feel it is my job as a physician or that of the Public Servants I elect to take a paternalistic role and remove every potentially harmful object from the path of an irresponsible public as one might do with an infant; caveat emptor! We cannot as a society by Legislative Fiat or other means make the world a perfect place without risk. Sadly, in any given population there will be a percentage of people who use, abuse, or are addicted to drugs. Such people will use substances whether they are legal or illegal. We cannot continually remove every substance which has legitimate medical utility to "protect" a particular group that cannot use these substances safely.
I would humbly suggest that the Committee approach this issue with a calm detachment and not react in a reflexive manner to the sensationalized reports that on balance do not compare with the potential effectiveness of GHB. Losing such a relatively safe agent such as GHB would represent a real tragedy.
As a physician who above all else should do no harm, I must say that making GHB a Schedule I substance when it should carry no Scheduled classification whatsover would do grave harm in making unavailable to patients an excellent agent with numerous indications and an excellent therapeutic margin of safety. Additionally, GHB is not legally even classified as a "drug" and once a health care individual knowledgeable in its use has so educated a patient, minimal supervision is indicated.
I hope this information has been helpful. I would have provided more detailed, referenced information had I had more time than an evening to prepare this statement. Please do not hesitate to call or write me should you require additional information.
Sincerely & Respectfully Submitted,
Andrew M. Baer, MD
Ross University, Medical Doctorate (M.D. degree), June, 1986.
Private Practice, Alternative Medicine (Phone: 412-346-6500)
Preventative Medicine Center of Sharon, 92 West Connelly Blvd., Sharon, PA 16146.
Medical Director (Phone: 412-346-6500)
ABL Medical Services, Wholesale Pharmacy
92 West Connelly Blvd., Sharon, PA 15416
Baer, A., & Wathey, R. Covert Forms of Child Abuse: A Preliminary Study. Child Psychiatry & Human Development, 8(2): 115-128, 1997.
Burris, J., Baer, A., Mroczek, W. Successful Use of Captopril in a Patient With Renal Artery Stenosis of a Solitary Kidney. Lancet 1: 1511-1515, 1985.