The party and date-rape drug known as 'G', 'juice' and 'fantasy' has a low overdose threshold - and use in Australia is on the rise.
Deaths related to GHB - a central nervous system depressant called 'gamma-hydroxybutyrate' - have increased tenfold since 2013, says an Australian-first study from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney.
The number of hospitalisations has more than tripled.
Researchers said their findings, published in Addiction , reinforced the need to improve prevention, treatment and harm reduction strategies for GHB.
"What we're seeing is a clear and accelerating trend - harms from both GHB and its precursors 1,4-butanediol (1,4-BD) and gamma-butyrolactone (GBL) are rising rapidly," said Associate Professor Amy Peacock , Deputy Director of NDARC and senior author of the study.
"These numbers are a cause for alarm. Without targeted action, the situation will only worsen, and more people will be harmed."
At low doses, GHB's effects include euphoria, increased libido and lowered inhibitions, while at higher doses it acts as a depressant, slowing down breathing and heart rate.
The difference between a dose that produces euphoric or relaxing effects and one that causes loss of consciousness is small.
A/Prof. Peacock said harm reduction messages should focus on the dangers of taking multiple doses and mixing GHB with other substances, noting the drug's relatively low overdose threshold and heightened risk of dependence.
"Repeated dosing can quickly lead to overdose because GHB builds up in the body faster than people realise," A/Prof. Peacock said.
"And using it with alcohol, ketamine, or other depressants greatly increases the risk of respiratory depression and loss of consciousness."
Repeated dosing can quickly lead to overdose because GHB builds up in the body faster than people realise. And using it with alcohol, ketamine, or other depressants greatly increases the risk of respiratory depression and loss of consciousness.
An uptick in use across Australia
As part of the study, the team used coronial, treatment and hospital data, population surveys and interviews with people who use illicit drugs to identify trends in GHB use, harms and treatment between 2013 and 2023.
While rates of GHB use are relatively low compared to other illicit drugs such as MDMA, cocaine and methamphetamine, the proportion of Australians reportedly using GHB is rising.
The proportion of Australians aged 14 years and over reporting lifetime use increased 0.9% to 1.2% over the study period, while past 12-month use increased from 0.07% to 0.2%. In addition to the increase in GHB-related deaths, rising from fewer than six deaths in 2012-13 to 52 deaths in 2021-22, the authors also found worsening rates of non-fatal harms.
For instance, GHB-related hospitalisations more than tripled from 5.3 to 19.1 cases per 100,000 people over the study period.
The number of drug treatment episodes for GHB also increased from 0.7 to 8.4 per 100,000 people over the study period.
"While the frequency of GHB use remained low and stable among those we interviewed, it's important to note that even infrequent use still has the potential to cause harm," A/Prof. Peacock said.
There is also a need to develop more effective treatment options, expand treatment access, and improve public health messaging to prevent further increases in GHB-related harms.
"Education around how to recognise and respond to a GHB overdose is important, regardless of frequency of use or dependency," A/Prof. Peacock said.
"We must also recognise it's not just young adults going to nightclubs or gender and sexuality diverse communities but a broad range of people who use GHB."
People can access free and confidential advice about alcohol and other drugs by calling the National Alcohol and Other Drug Hotline on 1800 250 015.
