The hidden harms of GHB

What is it?

GHB (gamma hydroxybutyrate) is a drug commonly found in the dance and party scene; often referred to as liquid ecstasy or liquid E.

It was originally produced as an anesthetic in the 1960s but was withdrawn in many countries due to unwanted side effects. Since the 1990s, GHB has gained popularity as an illicit recreational drug.¹

It is a depressant drug that usually comes as a bitter or salty liquid, often sold in small bottles or vials (such as a fish-shaped sushi soy sauce).²

GHB can cause mild highs in smaller doses, with people reporting feelings of euphoria, increased confidence, relaxation and sociability.³

In higher doses, it can cause sedation and memory impairment, and has a history of being used to spike drinks.²

Cause for concern

Compared to other illicit drugs in Australia, the use of GHB is quite rare. However, upward trends have been recorded over the last two decades:

• In 2004, 0.5% of the population reported ever using GHB in their lifetime. In 2016, this had increased to 1%.⁴
• In Victoria, the number of calls received each year by the Alcohol and Drug Information Service (Directline) regarding GHB increased from 31 in 2009 to 176 in 2018.⁵
• In Victoria, the number of ambulance call-outs regarding GHB tripled from 2011 to 2018.⁶

GHB and overdose

Common side effects of GHB can include nausea, headaches, tremors and shaking.²

There are also a number of more serious risk factors associated with GHB use that may result in harmful outcomes, including an extreme risk of overdose. This is because there is very little difference between the amount required for the ‘high’ and the amount required to overdose.²

Doses in excess of 2mls are increasingly toxic and can cause a combination of dangerous symptoms such as irregular breathing, dizziness, confusion, hallucinations, blackouts and vomiting (which can cause aspiration and death).⁷

Harm reduction

There is no safe level of drug use, however people who choose to use GHB should ensure that:

• you do not use GHB alone
• smaller test doses are taken first
• always measure doses (small volume syringes are recommended)
• set limits on the quantity used in a session
• never drink straight out of a bottle or pour a dose straight out of a bottle.⁷

If you suspect that someone has overdosed, always call an ambulance on triple zero (000). If the person is unconscious, place them on their side in a recovery position (this will clear their airways). Paramedics are there to help and will not involve the police unless there is a danger to themselves or others.

GHB in combination with other drugs

People who choose to use GHB should avoid mixing it with other drugs.

The risk of overdose is higher if used at the same time as other depressant drugs and opioids (e.g. alcohol, heroin, and benzodiazepines such as Valium or Xanax),² as the combined depressive effects enforce one another and increase the risk of severe respiratory depression.¹

It is also dangerous to take GHB with other psychostimulants such as MDMA, cocaine and meth/amphetamines. These combined drugs tend to work against each other: GHB slows down signals in your central nervous system (CNS), whilst the stimulant speeds them up. This can cause severe heart strain.⁸

A report into GHB-related deaths in Australia from 2001–2019 found that more than 90% of individuals who died also had substances other than GHB detected in their blood.¹

Dependence and withdrawal

Regular, heavy use of GHB can result in the development of dependence, and if frequent use is suddenly stopped, this can lead to a withdrawal syndrome.^{1, 7}

Features of GHB withdrawal are similar to alcohol, varying from mild to severe. People using regularly but in smaller doses may experience ‘mild’ withdrawal symptoms, such as sweating, nausea/vomiting, headaches and tremors.⁷

People using up to 30mls per day, or more, are at an increased risk of experiencing severe withdrawal symptoms that may require intensive care. This includes anxiety, excited delirium, seizures, delusions, paranoia and visual and auditory hallucinations.^{1, 7}

GBL – an identical companion

Gamma-butyrolactone (GBL) is chemically similar to GHB and sold and consumed in the same manner.⁹ It is also a precursor, which means that it is converted to GHB inside the body after consumption.9 Although its effects are identical, it is two to three times as strong as GHB, and its effects are felt faster.¹⁰

GBL is often referred to as ‘coma in a bottle’.¹¹

The same concerns with GHB remain true with GBL: it is easy to overdose; it should not be taken with other drugs; and, people who frequently use it risk developing a dependence, which can lead to strong withdrawal symptoms if use is suddenly stopped.

When sold illicitly, GBL can often be advertised as GHB.9 This means that someone may take GBL thinking that it is GHB, not realising that is far more potent, with a higher risk of overdose.

Information and support:

For those who decide to use GHB or GBL, it is important that all the risk factors are understood and considered. No level of drug use is safe, but there are strategies that can be put in place to reduce harm.

Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs

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