17 year-old Hillory Farias of La Porte, Texas died on August 5th, 1996. She was the first person to be widely publicized as a "GHB death," -- and since GHB had been used in human experiments for 40 years prior to that, and was considered a safe and non-toxic endogenous substance, she was probably the first person whose death was attributed to the drug at all (rumors that River Phoenix had ingested large quantities of GHB before his death in 1993 have been debunked). This writeup examines the story of her death, recounts my investigation of the chemical and forensic facts, and explains both old and new evidence suggesting that her death was not caused by GHB. Numbers in parentheses refer to citations at the bottom.

As her relatives reported it, Hillory had spent the previous night at a nightclub with a friend. They had been drinking Sprite, which could easily have been adulterated while they weren't looking. Later on, Hillory drove home, said goodnight to her grandmother, and went to bed. The next morning, her grandmother was unable to wake her up. She was rushed to the hospital, but within a few hours she was dead. The coroner's examination revealed that her blood contained 27mg/kg of GHB(1), which is far in excess of the normal concentration. The conclusion was that her drink had been drugged, probably by an individual seeking to drag her off and rape her. Since GHB was already being touted as a dangerous and unpredictable drug by the authorities, no one questioned that it could have killed her. She became a rallying point for the anti-drug and anti-date-rape movements, and the 2000 law which eventually placed GHB on Schedule I was subtitled "The Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000"(2) (but see xyrem for an interesting exception).

If you're only familiar with GHB as a date rape drug, the story is plausible. But if you've studied the history of GHB as a medicine and recreational drug -- especially the years-long, large scale, government-approved narcolepsy trials(3) -- nothing makes sense.
  1. GHB comes on quickly - A person taking a large dose of GHB can expect to feel relaxed, confused, or sleepy within 30 minutes. Hillory Farias spent several hours at the club and drove home. Her grandmother reported that her behavior seemed normal. This profile -- a long period of inactivity followed by strong, fatal effects -- is completely uncharacteristic of GHB(4).
  2. Her friend shared her drink: Hillory's friend reported having shared the infamous poisoned soda. The friend did not die, nor did she experience any of the usual effects of GHB ingestion.
  3. The dose was minuscule - 27mg/kg converts to around 1.6 grams. A mild dose of GHB, on the low end of those used in the narcolepsy study, is 2-3g. Recreational users have been known to take 10g or more without any dangerous effects.
The most damning evidence, however, is this: the coroner screwed up. A second autopsy revealed that Hillory had experienced a coronary thrombosis, dying as a result of a blood clot. It turned out that Hillory had suffered from a congenital heart defect, which could have killed her at any time!(1)

But what of the GHB in her blood? For a long time, I wondered if she'd had the supreme bad luck to be drugged and to have a heart attack on the same night (or if, perhaps, she'd taken the GHB voluntarily). Then, investigating an unrelated letter to the editor in a chemistry journal(5), I made a shocking discovery: GHB sometimes shows up in cadavers! A lab testing people who had died from non-drug-related causes found blood concentrations of GHB up to five times higher than those found in Hillory Farias. Not all corpses contain high levels of GHB, but -- barring a necrophiliac wandering around the lab -- this evidence suggests that Hillory's high GHB levels may have been endogenous after all.

GHB's natural role in the brain is to regulate energy use. For example, some mammals produce high levels just before going into hibernation(6). GHB has also been proven to reduce brain(7) and organ(8) damage from hypoxia (lack of oxygen). It stands to reason that if the brain were slowly being starved of oxygen, as it probably did when Hillory's heart stopped, it might produce GHB as a natural protectant. I don't know of any proof of this phenomenon, but it is more consistent with the available evidence than the standard story.

Hillory's family thinks so too. While some of them have joined the anti-GHB crusade (and the anti-date-rape crusade, which I have no objection to!), other members sued the coroner for incompetence, and took a public stand against the demonization of a drug as useful as GHB.

1. Raul Farias' congressional testimony: http://commdocs.house.gov/committees/judiciary/hju62309.000/hju62309_0.HTM
2. http://users.lycaeum.org/~ghbfaq/hr2130.html
3. Scrima, L., Hartman, PG, Johnson, FH Jr, et al.: The effects of gamma-hydroxybutyrate on teh sleep of narcolepsy patients: a double-blind study. Sleep 1990; 13:479-490
4. Regrettably, journals tend not to publish this kind of materal! However, I operated the internet GHB FAQ for three years, and received numerous personal communications from users who had taken doses at this level without incident. Furthermore, a review of all published cases of GHB toxicity reveals that most "GHB deaths" actually involved combination with alcohol, which is widely acknowledged as dangerous. For a brief meta-review of the literature, see the American Academy of Sleep Medicine's report at http://www.asda.org/PDF/Ghb.pdf
5. Fieler, Erin; Coleman, Daniel; Baselt, Randall. "Gamma-hydroxybutyrate concentrations in pre- and postmortem blood and urine". Clinical Chemistry. 1998. 44(3). 692.
6. Mamelak, Mortimer. "Gamma-hydroxybutyrate: an endogenous regulator of energy metabolism". Neuroscience and Biobehavioral Reviews . 1989. 13. 187-98
7. MacMillian, V.. "The effects of Gamma-hydroxybutyrate and gamma-butyrolactone upon the energy metabolism of the normoxic and hypoxic rat brain". Brain Research. 1978. 146(1). 177-187.
8. Boyd, April; Sherman, Igor; Sabil, Fred. "The protective effect of gamma-hydroxybutyrate in regional intestinal ischemia in the hamster". Gastroenterology. 1990. 99. 860-862.

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