GHB use among Australians: characteristics, use patterns and associated harm

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Abstract

The aim of this study was to examine the characteristics of gamma-hydroxybutyrate (GHB) users, their GHB and other drug use patterns, and the harms associated with GHB use. Seventy-six GHB users were recruited and administered a structured interview on GHB use and related harms. GHB users appeared to be a stable, highly educated and well-functioning group. They had had extensive experience with a range of drugs, and GHB was typically used in conjunction with other drugs. Despite the fact that most GHB users had not had a long or extensive experience with GHB use, the proportion reporting significant negative side effects when using GHB was high (99% reported at least one), and the mean number of side effects ever experienced was 6.5. Notably, half (52%) reported becoming unconscious, 53% reported vomiting, 58% reported profuse sweating, and 8% reported having a fit or seizure. The high rate of problems reported by a group with limited use of this drug suggests that in a context of polydrug use, GHB use is associated with significant risks to users.

Introduction

Gamma-hydroxybutyrate (GHB) is a naturally occurring fatty acid that occurs in the human body that was first synthesised in 1960 (Nicholson and Balster, 2001). Early research suggested that GHB produced sedation and anaesthesia, indicating it is a central nervous system (CNS) depressant, with some similarities to other CNS depressants such as benzodiazepines (Kam and Yoong, 1998, Nicholson and Balster, 2001). The effects of GHB appear to be highly dose-dependent (Galloway et al., 1997), with small increases in the amount taken leading to a dramatic increase in effect.

Drug discrimination studies have revealed that cross-substitution occurs between GHB and alcohol, with some concluding that the discriminative stimulus effects are most similar to those of alcohol (Colombo et al., 1995, Nicholson and Balster, 2001). Some studies have suggested that GHB enhances the CNS depressant effects of both alcohol and other sedative/hypnotic drugs, and may enhance the effects of opioids (Nicholson and Balster, 2001).

GHB has been used as a sleep aid for persons with sleep disorders (Chin et al., 1992, Mamelak, 1989), as an anaesthetic (Nicholson and Balster, 2001), as a growth promoter and weight loss aid (Chin et al., 1992, Friedman et al., 1996), and research is examining the effectiveness of GHB as a treatment for alcohol dependence and opioid withdrawal (Kam and Yoong, 1998, Nicholson and Balster, 2001).

Clinical research and case studies have reported that adverse effects of GHB include dizziness, nausea, weakness, confusion and agitation, drowsiness, and coma (Chin et al., 1992, Dyer, 1991, Galloway et al., 1997, Nicholson and Balster, 2001). Clinical studies and early use of GHB as an anaesthetic indicated it might also induce seizure like activity (Dyer, 1991), although there has not yet been direct substantiation of this possibility using EEG assessment. Adverse effects have been reported at doses between 2 and 30 g of GHB powder (Chin et al., 1992). There is some evidence that tolerance to and physical dependence upon GHB may develop, suggested by a withdrawal syndrome that may include insomnia, muscular cramping, tremor and anxiety (Galloway et al., 1997); and there have been published case reports of GHB dependence among chronic heavy users (Craig et al., 2000, Friedman et al., 1996, Galloway et al., 1997).

In recent years, there have been increasing reports of the use of GHB as a recreational drug (Australian Bureau of Criminal Intelligence, 2000, Whitten, 2001). In its illicit form, GHB is also known as GBH, ‘grievous bodily harm’, ‘Georgia Home Boy’, ‘fantasy’, ‘liquid ecstasy’, ‘Liquid E’ and ‘Liquid X’. The U.S. Drug Abuse Warning Network (DAWN) data system has also shown dramatic increases in the number of mentions in accident and emergency departments of persons identified as having overdosed on GHB or having GHB-related problems: from 20 in 1992 to 2960 in 1999 (Whitten, 2001). There have also been increasing reports of overdose deaths related to GHB use in the U.S., most of which have also involved other drugs (Marwick, 1997), although there has been one published case attributed exclusively to GHB use (Centers for Disease Control, 1997). As in the U.S., evidence of GHB use in Australia has arisen largely from anecdotal reports of persons being admitted to accident and emergency departments after overdosing on GHB. Since illicit manufacture of GHB leads to inconsistent potency, and since there is a variable individual response to GHB, the dangers of adverse reactions and perhaps overdosing may be particularly increased for recreational users.

While there have been some case reports of the effects of GHB among users (Craig et al., 2000, Friedman et al., 1996, Galloway et al., 1997), and some evidence from clinical studies concerning the cognitive, emotional and behavioural effects of GHB (Kam and Yoong, 1998, Nicholson and Balster, 2001), to our knowledge, there has been no research on the characteristics of recreational GHB users, nor of the context and patterns of use among this group. Furthermore, there has been no previous attempt to examine the frequency with which users report the side effects that have been associated with GHB use, such as loss of consciousness, nausea, vomiting and sweating. It is also unclear whether dependent GHB use is an issue among recreational users. This study therefore aimed to do the following:

  • 1

    Determine the characteristics of GHB users.

  • 2

    Assess patterns of GHB use and associated polydrug use.

  • 3

    Assess the perceived benefits and costs of GHB use.

  • 4

    Examine whether recreational users were likely to meet criteria for dependence upon GHB.

  • 5

    Document the nature and extent of any GHB-related adverse effects.

Section snippets

Procedure

Participants were volunteers who were paid A$30 for their involvement in the study and were recruited between January and June, 2001. They were recruited from a range of sources: advertisements in local newspapers, snowball sampling (consecutive recruitment), interviews on local and national radio stations, postings on Internet bulletin boards, and recruitment through the AIDS Council of New South Wales (NSW). While the sample was originally intended to include users in Sydney, NSW, early

Sample characteristics

A total of 76 GHB users were recruited. Most users were male (79%), and the mean age of the sample was 27 years (SD 6.7; range 17–50 years). Education levels were high among this group, with 90% having completed high school, and almost eight in 10 (78%) having completed courses following school. Most were currently employed or enrolled in tertiary education (89%). A history of incarceration or of treatment for a drug use problem was rare among this group (each 3%). A significant proportion of

Discussion

This convenience sample of recreational GHB users appeared to be a well-functioning and educated group who had only recent involvement with GHB use. While it is possible that the short use careers of this sample of GHB users could reflect a high rate of discontinuation among persons who use GHB, it is certainly supportive of anecdotal evidence that GHB use has only recently become more widespread as a recreational drug in Australia (Australian Bureau of Criminal Intelligence, 2000). It is also

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