Dear Dr Laura,
Quite a few of my friends do GHB. I’ve tried it too and will probably do it again, most likely on Pride weekend, but I’m scared as you hear some terrible stories. What are the dangers?
Thank you for your question. GHB, also known as G, stands for gamma-hydroxybutrate; there is a very similar drug called GBL (or gamma-butyrolactone) which is converted to GHB in the body after you take it. Both GHB and GBL act as sedatives (a bit like anaesthetic) so can cause drowsiness but can also cause extreme happiness, disinhibition and feeling downright horny. This is why GHB is one of the main drugs (with mephedrone and crystal meth) associated with ‘chemsex’.
GHB (and GBL) usually are sold as clear, colourless liquids in bottles or capsules – both taste a bit salty. A form of GHB is licensed to treat ‘narcoplepsy (excessive sleepiness) with cataplexy (sudden muscle weakness)’. GBL is used for manufacturing a number of chemicals and can also be used as an industrial cleaner or paint stripper.
GHB first hit the press as the ‘date rape’ drug – as one of the drugs associated with spiking drinks and sexual assault. Precise figures are difficult to get as it’s hard to detect and cases are probably under-reported. GHB and GBL are both illegal – see http://www.talktofrank.com/drug/ghb for more information.
As GHB is not regulated it can be difficult to know how strong it is until you have taken too much. That’s why you should take very small amounts and, because it can take up to an hour for the effects to kick in, to not take any more for at least an hour, ideally two hours, after the first ‘dose’.
The problem is that the number of hospital admissions and deaths related to GHB are very likely to be under-reported.
So, what are the dangers?
Alcohol: alcohol has similar effects to G on your nervous system, so taken together you are more likely to pass out or even stop breathing. If you’ve had a couple of drinks you should wait at least an hour before taking G. If you’ve had several drinks, G really is best avoided altogether.
Overdose: the difference between the amount of G you need to take to feel good and the amount you need to take to feel rubbish is very small. You should never guess how much you’re taking – using a syringe to measure precise amounts (a typical dose is 0.5-1.5ml) is best. If you take a second dose less than an hour after the first the risk of overdose is higher because you won’t have processed the first one. Symptoms of overdose include dizziness, vomiting and confusion.
Loss of consciousness: if you are with someone who has collapsed on G, they are not sleeping, they are unconscious! Put them in the recovery position (on their side is safer, in case they vomit), check their pulse and breathing. Some clubs have first aid areas but if not then the safest thing to do is call an ambulance.
Sex: sex isn’t necessarily dangerous, of course, and choosing to take G during sex can be very pleasurable, but G can impair your ability to make decisions and under its influence you may end up taking risks that you wouldn’t usually. This can lead to sexually transmitted infections (STIs), so use a condom and get regular STI check ups. If you are HIV negative and have sex with an HIV positive person who is on treatment with an ‘undetectable’ virus then you cannot get HIV from them (undetectable – untransmittable or U=U!). However, not all people with HIV are undetectable and still many with HIV don’t know they have it – if you are using PrEP (pre-exposure prophylaxis) remember to take it when advised for it to be most effective. If you are having sex on drugs, not only are your inhibitions lowered but your threshold for pain may be higher – this can lead to rectal trauma so, if you can, set boundaries with your partners before you take drugs. Finally, if you are so out of it you don’t know what’s going on, you may not know what sex you’ve had, or with who. In this case, if you are HIV negative and not taking PrEP, you should attend a sexual health clinic or Emergency Department to ask about PEP (post-exposure prophylaxis – taking HIV drugs after a possible exposure), make sure you are hepatitis B vaccinated and have the relevant tests for other STIs after an appropriate interval.
Drug interactions: GHB is broken down by the liver. Some medications, including the HIV medications ritonavir and cobicistat, block the liver pathways that clear drugs including GHB. This results in higher blood levels of GHB and a higher risk of overdose. If you are on these HIV medications you should take a much smaller amount and, depending on the effect, only take more after at least two hours.
The law: it is illegal to drive while impaired under the influence of drugs. If you are prosecuted for a drugs offence it can make it difficult to enter some countries, including the US.
Dependency: it was thought that you couldn’t get dependent on, or addicted to, GHB, but it turns out you can. Regular users can get withdrawal symptoms (including tremors, insomnia, sweating, and anxiety), which can be severe, or even fatal, requiring specialist detox.
So, if you’re going to use G, use it carefully, with little or no alcohol, and set your sexual boundaries first. Ideally have a non-G friend with you who can keep you safe should things start to go a bit topsy turvy.
And if you think your G use is problematic then speak to your sexual health clinic or your GP.
Some London boroughs have access to a specialised Club Drug Clinic http://clubdrugclinic.cnwl.nhs.uk/
Camden & Islington offer GRIP https://www.candi.nhs.uk/services/grip-club-drugs-service
The LGBT service London Friend offers support via Antidote: http://londonfriend.org.uk/get-support/drugsandalcohol/antidote-accessing-our-services/#.Wyi5KSMrL-Y
Dr Laura Waters is an HIV and sexual health consultant at the Mortimer Market clinic and the Boyz Doc. Dr Laura answers your questions every two weeks in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org.