GHB-related emergency department (ED) presentations and hospitalisations in NSW increased substantially in the last decade, with young women accounting for a larger proportion of toxicity and overdose cases over time, according to new research in Addiction.
The demographic shift in GHB use and harms was also demonstrated by the rising number of presentations to regional and remote EDs across the state.
Dr Krista Siefried, study author and Clinical Research Lead at the National Centre for Clinical Research on Emerging Drugs (NCCRED), said understanding these trends was crucial to reducing drug-related harms.
"This study highlights the need to extend public health and harm reduction education related to GHB use, in particular for women and those living in outside major cities," Dr Siefried said.
"GHB is most often discussed for its use as a party drug and to facilitate sex, particularly among gay and bisexual men, but our findings suggest we may need to shift our focus to include other groups.
"Women are overlooked in research and public health campaigns when it comes to GHB use, except in the context of it being used as a 'date rape drug' – it's time for that to change."
As part of the study, Dr Siefried's team analysed ED presentations at 88 hospitals and statewide hospital admissions data going back to 2015 to describe patterns in GHB-related availability, use and clinical harms.
More than 9600 GHB-related ED presentations were recorded over the study period, rising from 24.9 per 100,000 unplanned presentations in 2015-16 to a rate of 73.7 per 100,000 in 2022-23, and 101 per 100,000 from July 2023 to January 2024 (latest available data).
While men represented 62% of these presentations, women accounted for 51% of cases among those aged 16-24, with a clear trend of women accounting for a larger proportion of ED presentations over time.
GHB-related ED presentations in regional or remote areas also increased from 3.4% of all cases in 2015-16 to 13.8% in the most recent reporting period.
Of the 6420 GHB-related hospitalisations in the study period, men accounted for 57% of admissions overall but women accounted for 54% of admissions in the 16-24 age group.
About one in five hospitalisations required intubation and ventilation, and a similar proportion were admitted to intensive care for an average duration of one day.
"Given the short admission times and discharge home from ED, there are limited opportunities to provide harm reduction education in this setting, which means the focus for such education and interventions is best placed outside the hospital," Dr Siefried said.
"These include harm reduction strategies for safer GHB use – such as starting with low doses, avoiding polydrug or alcohol use, and monitoring breathing and consciousness of peers – as well as around sexualised drug use in terms of communicating openly about consent and boundaries."
Dr Siefried added that the increase in GHB-related harms could be related to changes in the substances sold, with a subset of police seizure data – also analysed in the study – indicating that 1,4-Butanediol (1,4-BD) was the predominant chemical being sold as GHB.
The body converts 1,4-BD into GHB, but this process can be delayed if an individual has also been drinking, as the alcohol is metabolised by the body first.
"The danger here is when the person using this substance is unaware of this delay and begins taking additional doses because they think the GHB they're using is weak," Dr Siefried said.
"As a result, there's a high risk of GHB toxicity and overdose, because there is this backlog of 1,4-BD waiting to be converted into GHB once the body has finished dealing with the alcohol.
"While the police seizure data is just a marker of what is happening in illicit drug markets, it may be prudent to include warnings in public health campaigns and education material about the potential risk of a 'delayed high' when using GHB."
What is GHB? GHB, also known as "G", "juice", "Gina" and "fantasy", is generally a colourless, odourless and bitter or salty tasting liquid that is used recreationally as a party drug and to facilitate sex.
At low doses, it can cause effects such as euphoria, increased libido and lowered inhibitions but it has also been linked to sexual assault and rape.
The drug also carries a high risk of overdose, as the difference between a recreational dose and an overdose is very small.
