ADF Position on Gamma-hydroxybutyrate (GHB)

Summary

• GHB is a drug that is becoming increasingly popular, particularly in connection to dance party, rave and nightclub settings.
• Use of GHB carries a high risk of overdose and associated harm.
• Any use of GHB should be approached with extreme caution and measures taken to reduce the risk of overdose.
• Information on the risks of GHB use and advice on how to reduce and minimise these harms should be communicated, in a timely and relevant fashion, to potential GHB users.
• More research is urgently needed into the levels and context of GHB use in the community and the attitudes of those choosing to use GHB.
• All those involved with hosting events where GHB is likely to be used need to do all they can to provide a safe environment. The ADF endorses the recommendation by the Drugs and Crime Prevention Committee regarding appropriate management of such events.

Adopted by the ADF Board July 2004

Background

Gamma-hydroxybutyrate (GHB), also know as GBH, Grievous Bodily Harm, liquid E, ‘G’, or Blue Nitro, is a central nervous system depressant and was originally used clinically as a sedating anaesthetic and to treat sleep disorders. It is categorised as a Schedule 9 substance so its sale, supply, possession and use is prohibited.

It has been used as a recreational drug for over 20 years but its use appears to be increasing. A 2001 Australian study (1) showed 24% of illicit drug users reported ever having used it (compared to 16% in 2000). Use is linked with the dance party community and the gay community, but use also occurs in private homes and other settings. Recently there has been a series of well publicised spates of overdoses at large dance events.

Presentation of ‘overdose’ involves convulsions, depressed breathing and passing in and out of consciousness. It is this extreme presentation of overdose, with users requiring emergency first aid and ventilation that has attracted so much media attention and community concern.

A study into the frequency and context of GHB overdose (2) found that in one group of users over half had overdosed at some time and a third had overdosed more than three times. Those who overdosed were more likely to have used GHB significantly more often than those who had not overdosed. Risk of overdose is directly linked to frequency of use and experience with this drug does not appear to reduce risk of overdose, as is the case with some other drugs.

Other significant factors related to overdose was polydrug use (using alcohol and other drugs along with GHB) and using it on a special occasion such as at a major dance party.

Long term effects are not well known. There is debate about the existence of physical and/or psychological dependency on the drug with some evidence of a discrete withdrawal syndrome.

Availability is wide as it can be manufactured from easy to obtain precursors and is available to buy on the Internet under the guise of products for other purposes (such as CD cleaner). It is a relatively cheap drug with current prices of $5-$10 per dose being reported.

There appears to be a something of a backlash against the use of the drug developing within the dance party community. Some patrons resent the bad publicity and increased attention from authorities that the use of GHB has prompted. GHB is widely viewed as a ‘gutter’ drug that only younger, less experienced dance patrons would choose to use. This is a worrying indication that the use of GHB may be moving to a younger, more vulnerable using population.

Some key questions

What does GHB look like?

GHB usually comes as an odourless liquid, often coloured blue, but can also come as powder or capsules. It has a salty taste.

What are the effects of GHB?

The effects of GHB are similar to alcohol. Small amounts cause lack of inhibition, relaxation, decreased motor skills, heightened libido and sexual disinhibition. Heavier doses cause slurred speech, disorientation, dizziness and nausea. At higher levels, the user may experience convulsions, depressed breathing and pass in and out of consciousness. At extreme levels the user may move into profound unconsciousness, coma, and arrested breathing and death. The main risk is unconsciousness plus vomiting leading to aspiration and suffocation.

How much GHB causes overdose?

The effects of GHB depend, like any drug, on when, how and where the drug is taken; how the user is feeling; what they have eaten; and what other drugs have been taken. Use of alcohol and other sedatives such as benzodiazepines and heroin along with GHB significantly increases risk of overdose. There seems to be a very fine line between what may be considered a ‘safe’ dose and what may cause overdose and even death. As GHB is most often taken in liquid form it is difficult to gauge how strong, concentrated or toxic any given dose may be.

Surely the high risk of overdose would put people off using GHB?

Paradoxically no, the sensation of moving in and out of consciousness has been cited by some GHB users as an attractive side-effect of the drug. Hence the high risk of overdose does not seem to deter the use of the drug in many users.

How can the risk of overdose be reduced?

This is a drug that carries a high risk of overdose compared to most other drugs and is best avoided. Those choosing to use GHB should only use it with extreme caution. Some specific advice for users includes:

• Verify a safe dosage – start low
• Don’t mix use of GHB with other drugs, especially alcohol and other depressants.
• Do not use alone, use with friends who know what to do in an emergency.

What can dance party venues do?

While the management and operators of dance party events may not condone or encourage drug use at their events, there are a number of measures they can put in a place to minimise the harm from GHB and other drug overdose. These include ensuring adequate ventilation, space, access to water and presence of qualified medical assistance. These measures are described in the recently published report on the inquiry into party drug use in Victoria (3) .

References

(1) Australian drug trends 2003; findings of the Illicit Drug Reporting System IDRS. (2004)

(2) Degenhardt, L., Darke, S. & Dillon, P. (2003) The prevalence and correlates of gamma-hydroxybutyrate (GHB) overdose among Australian users. Addiction 98, 199-204.

(3) Drugs and Crime Prevention Committee (2004) Inquiry into amphetamine and ‘party drug’ use in Victoria – Final report. Victorian Government Printer, Melbourne.

Date: 2005-02-09