First published in Men’s Style, Spring 2005
IT’S 2AM ON A SATURDAY NIGHT in Sydney’s Darlinghurst and the clubs on Oxford Street throb with bare-chested men. Groups of women totter by on kitten heels, all silky manes and bum-cracks. It’s another long weekend and the mood is euphoric.
At St Vincent’s Hospital, several hundred metres from the heart of the strip, the bat phone is ringing to signal an incoming emergency. Within minutes, a young man, shrouded in tubes and wires, is hauled from the back of an ambulance into the emergency department. The staff descend like flies. It is their second GHB overdose for the night. There will be more before morning.
“We’re sick of it,” says Gordian Fulde an associate professor and the director of emergency medicine at St Vincent’s. “Nobody should walk into a club for a good time and come out horizontal.”
GHB, gamma-hyroxybutyrate, also known as GBH (grievous bodily harm), liquid ecstasy, fantasy and blue nitro is one of the fastest-growing party drugs in Australia today. A recent study, coordinated by the University of NSW National Drug and Alcohol Research Centre (NDARC), found about 20 per cent of regular ecstasy users had tried GHB. In NSW, Victoria and South Australia that figure was closer to 35 per cent, having risen from about 1 per cent in 2000.
First synthesised in 1960, GHB is a fatty acid found in most cells in the body, including the brain. Its has been used as a surgical anaesthetic and childbirth aid, as well as a treatment for sleep disorders and alcohol withdrawal. During the 1980s it became popular with bodybuilders after a Japanese study found it stimulated the release of the growth hormone. At the time it was widely sold in health food stores as a nutrient and natural sleep aid.
Then in 1990, seemingly out of the blue, the American Food and Drug Association banned GHB from over-the-counter sale. The following year, two US scientists reported on GHB’s “tremendous potential for abuse”, after their human guinea pigs unanimously reported a pleasurable sensation after taking the drug.
A series of poisonings documented in the report began to ring alarm bells. However, GHB was not scheduled as a controlled substance by the US Drug Enforcement Administration until 2000, when it became known as a date rape drug in the US media, following the death of 15-year-old schoolgirl, Samantha Reid, who died after her drink was spiked with GHB.
PAUL DILLON, A RESEARCHER WITH NDARC, has been following the GHB trail in Australia for more than a decade. “I first met someone who’d used GHB in 1992,” Dillon says. “At that time, anyone who tried it basically fell over, so no one was really interested. In the mid-’90s, bodybuilders started bringing it into the country. At that time you could get it on the internet, no problem. Kits were arriving in easily identified boxes and weren’t stopped by Customs. It was seen as a supplement.”
In October 1996, 10 people collapsed at a Gold Coast nightclub after taking GHB, which at that time was widely known as fantasy. A week later the Federal Government declared GHB a poison and banned its importation, with the NSW and Queensland governments announcing new penalties for possession and supply of the drug. NSW Premier Bob Carr warned dealers could face fines up to $500,000 or life imprisonment.
Within a month, more than 200 people around the country had overdosed on GHB. “Use just exploded,” Dillon says. “It’s the same old story: make something illegal and, bang, there’s your market.”
Today, GHB is illegal in all states and territories of Australia. “Police consider it as bad as heroin,” Dillon says. But for most users, GHB is a party drug – an extra buzz on a big night out, a come-down cocktail, even a sex aid.
Sydney DJ Will* has been taking GHB on a regular basis for more than three years. He describes the high as “feeling like you’ve had a couple of beers and half an ecstasy pill; euphoric and slightly tipsy”.
Ben, a computer programmer, first took GHB three years ago after a friend sold him some at a party. “It’s an easy-riding drug,” he says. “You don’t feel like you’re doing as much damage as with speed and other drugs. There’s no come down on Monday or Tuesday at work – none of the edgy teeth-grinding of amphetamines.”
Sold in sex shops for years, GHB has been described by many users as an aphrodisiac, with early research highlighting its sexual properties. Justine is a naturopath who used GHB regularly for about a year, after being introduced by her then boyfriend. “It definitely heightens your sexual feelings,” she says. “The sex is usually naughtier, cheekier, warmer and more intimate, and it just keeps going.”
AS WITH MOST PSYCHOACTIVE SUBSTANCES, the effects of GHB vary enormously from person to person and day to day, depending on the setting, your mood, who you’re with, what else you’ve taken, what you’ve eaten, and dozens of other minor variations. The danger with GHB is its steep dose-response curve, which means small increases in dose can have unexpectedly strong effects. “The difference between having a good time and falling unconscious is very close,” says Dillon.
Like many users, Will believes GHB is safe when used with care. “The main reason GHB has such bad publicity now is because you’re getting dealers not informing people about the rules and their ramifications,” he says. “They’re in clubs selling set doses of the same amount to people regardless of their size – an equal measure to a 48 kilogram girl and an 85 kilogram guy. They don’t tell people not to drink alcohol and they don’t tell them about waiting between doses.”
“It’s the only party drug that’s taken in liquid form,” Dillon says, “so it hits very fast with a very quick peak. You only have to drop a little off that peak before you start thinking, ‘I’m not off my face any more, and you’re back for more. Being carried out of a club and waking up in hospital is not something many people are willing to repeat.”
But overdose is common among GHB users. More than half the people interviewed by NDARC in its 2002 survey of users had lost consciousness after taking the drug, with 99 per cent reporting at least one side effect, including dizziness, blurred vision, vomiting, heart palpitations and blackouts. One in 12 users had experienced a fit or seizure.
When someone takes too much GHB, or takes it in combination with alcohol or another central nervous system depressant, such as ketamine or sleeping pills, they tend to fall into a vegetative sleep state. There is much debate about the danger of this state to a person’s health. Studies have shown that GHB sleep mimics natural sleep in many ways. However, medical experts claim the GHB sleep is in fact a kind of coma, in which people can and do stop breathing. On the Glasgow Coma Scale, which measures coma from 15, alert, to three, at which a patient might be considered clinically dead, many of the GHB overdoses brought into St Vincent’s Hospital are threes, says Fulde.
“Most of these people have stopped breathing. They’re officially dead or at the very least deeply unconscious,” Fulde says. “We have to pull out all life support procedures because there may be other things going on – there may be brain haemorrhage because they’ve taken cocaine, perhaps their lungs are damaged, we don’t know. We have to treat each one as someone who’s trying to die on us.
“Then four or five hours later, they wake up and they walk out of here. It’s the weirdest thing watching someone wake up from a GBH overdose. Usually when people have been unconscious or under a general anaesthetic, it takes them some time to wake up; they’re generally very groggy. But with GBH, one minute they’re nearly dead, the next it’s like their circuits are switched back on. Flick, flick, flick.”
In part, that may be due to GHB’s effect on dopamine levels in the brain. The drug works as a dopamine inhibitor and robs the brain of the wake-up chemical, which is stored and released in a wave once it wears off. People who use GHB to aid deep sleep describe what is known as a “dawn effect”, in which they wake up ready for action after four or five hours.
The energising effect of the dopamine, hot on the heels of a deeply unconscious state, may be part of the reason many GHB overdoses have trouble comprehending the seriousness of their situation. “When I arrived this morning, I watched a GBH overdose saunter out of here like he’d just been to Franklins to buy peanut butter,” Fulde says. “It was a complete non-event – something to tell the boys about. We see this kind of response time and again.”
In an attempt to smash the aura of inviolability worn by some GHB users, the emergency staff at Royal Adelaide Hospital in South Australia have been photographing unconscious overdose patients and handing over the evidence as a take-home souvenir of their flirtation with the dark side of drugs.
“Their reactions are variable but they’re generally fairly shocked,” says Dr David Caldicott, a research fellow in the emergency department at Royal Adelaide and one of the country’s leading experts on GHB.
ALWAYS ON THE LOOKOUT FOR NEW WAYS OF COPING with the GHB crisis, Caldicott last year began a controversial new drug treatment for GHB overdose patients, based on a forgotten research paper written 30 years ago by a pair of New Zealand anaesthetists.
The drug physostigmine was used in the 1970s to wake patients up from GHB-induced anaesthesia. Its effects have been seen as unreliable but when Caldicott went back to the medical literature he found the drug’s reputation for causing seizures and even death was based on flawed research. Nevertheless he was surprised at how well it worked; it woke patients after several minutes instead of several hours. Physostigmine is no Narcan, however. “It can only be used judiciously in the right situation for a small subsection of patients,” Caldicott says.
Despite the risks, many regular users remain cavalier about GHB. “It’s never felt dangerous to me,” Will says. “I’ll up my usual dosage by a third if I want to use it to sleep.”
For others, like Sydney journalist Kimberley, one knockout dose is more than enough. “I was at a party with friends and we’d been taking ecstasy and drinking. Later in the night, an acquaintance offered us some GHB, so we took a dose. It felt incredible but the peak was really fast, so an hour or so later we got some more.
“The girl who sold it to us told us about the alcohol rule but I didn’t pay much attention. Before long I felt really drowsy, so I lay down. I was out cold for about three hours. I’ve been taking recreational drugs on a regular basis for 10 years and nothing like that has ever happened to me before. It terrified me.”
According to Caldicott, leaving someone who has overdosed to sleep it off can be a recipe for disaster. “It’s very dangerous for a non-medical person to judge whether or not their friend will be OK sleeping it off at home,” he says.
“In many cases they might be, but there’s the chance they might not. They may not be able to control their gag reflex, in which case they could die a rock star death, choking on their own vomit. They may simply stop breathing.”
MUCH OF WHAT IS BEING SOLD IN AUSTRALIA TODAY is not true GHB, but precursors gamma-butrylactone (GBL) and 1,4-butanediol (1,4-B), which are converted to GHB by the body after ingestion. According to Caldicott, every patient treated for GHB overdose at Royal Adelaide in the past 12 months had taken GBL or 1,4-B, which he warns may be more dangerous than GHB because the effects may take longer to wear off”.
These GHB precursors are industrial chemicals, used in the manufacture of tyres and solvents and are tightly controlled for industrial use but not illegal to possess. Kits and recipes for making GHB are still available on the Internet, but a US crackdown on internet sales in 2002 of GHB and its precursors seized up to 25 million dosage units and led to 175 people being charged.
Michael, a Sydney medical student, was making his own GHB in the late ’90s. He had his home lab raided in 1998 after he ordered a kit online. “A detective disguised as a FedEx guy delivered the parcel,” Michael says. “The detectives come back and seized my lab gear. A year later I was charged with importing a prohibited substance without a licence and fined $2,000. The judge had no idea what GHB was. If the same thing happened now, I would go down big-time.”
Michael describes GHB as a “peak ecstatic experience” and says he would never risk buying it off the street. “I wouldn’t take it unless I made it myself,” he says. Other users have expressed concern at the quality and purity of street GHB. Ben stopped taking the drug after experiencing pain in his liver. “If I could get pure GHB I’d buy some today, but the stuff people are making here is made from industrial chemicals in someone’s kitchen sink.”
Ben also believes the drug is too volatile for recreational use. “I don’t want to put anyone in the place where they have to look after me and I don’t want to contribute to its spread,” he says.
However, clubs may be the safest place to take these drugs, according to NDARC senior investigator Dr Louisa Degenhardt, who warned users against taking drugs such as GHB at home after the results of the most recent national survey of party drug users indicated about 75 per cent of users were taking GHB in private residences, where there are no security guards, bar staff, drug rovers or medical volunteers on hand in the event of an overdose.
Both Fulde and Caldicott have reported a drop-off in the number of GHB overdoses presenting to emergency departments in the past six months and are quietly hopeful that the drug may be heading into a recession. Where St Vincent’s emergency staff would have treated between five and 10 GHB overdoses on an average weekend night last year, currently they are seeing less than half that number.
At raves around the country punters have been spotted wearing T-shirts that bear the slogan “Go home G-Heads”, while members of online chat rooms debate the ethics of GHB use. But according to Paul Dillon, GHB’s reputation may be forcing many users out of the public eye. “I think it’s more popular than ever,” he says, “but users are keeping quiet about it and they’re being much more careful.”
As the drug becomes more established new problems are beginning to arise. Users who take GHB on a daily basis can experience anxiety, insomnia, paranoia, irregular heartbeat, high blood pressure, nausea and vomiting during withdrawal. “We’re seeing an increase in GHB dependence and withdrawal, which can be very dangerous and unpleasant and very difficult to treat,” Caldicott says.
* Names have been changed
Fade to Black: GHB Tips the Scales
In March 2003, Sam Ramoundos, a 35-year-old father of two, died after an alleged drug and alcohol binge that included GHB, ecstasy and diet pills. Ramoundos’s body was found on the floor of a hotel room in Sydney’s Potts Point. His unconscious wife, Alison, was allegedly lying on the bed and covered in vomit. Two of the couple’s friends had been admitted to hospital the previous night after they had collapsed in the street. The group, from the NSW town of Newcastle, had been out celebrating a friend’s birthday in the city.
The case was last year referred to the NSW Department of Public Prosecutions to consider criminal charges against Alison Ramoundos for allegedly failing to seek medical help for her husband after he collapsed in the lobby of the hotel.
Stream of Unconsciousness
For a long time the domain of a very small subculture of gay party-drug users, GHB has become more mainstream in recent years.
Last year, staff in the emergency department of St Vincent’s Hospital in Sydney treated more than 150 people for GHB overdose. In February last year, paramedics treated eight people outside a St Kilda nightclub for suspected GHB overdoses, three of whom required life support. A month later, 11 partygoers at the Two Tribes dance party in Melbourne were hospitalised after overdosing on GHB.
In November last year a report by the Australian Institute of Criminology suggested there had been up to 4,000 incidents of drink spiking in Australia between 2002 and 2003, with up to one third leading to a sexual assault. GHB and the prescription sedative Rohypnol were implicated.
But just how many people have died as a result of taking GHB is unclear. The first study into GHB deaths in Australia and New Zealand, published last year in the Medical Journal of Australia, listed 10 deaths between January 2000 and August 2003 in which GHB was implicated. But according to Dr David Caldicott, one of the authors of the report, those deaths may be the tip of the iceberg. Not only does GHB metabolise fast (it can only be detected for eight hours in blood) but a standard autopsy will not test for GHB toxicity.
In the US, the number of people presenting to hospitals for GHB-related problems rose from 20 in 1992 to almost 5,000 in 2000 and, according to the American DEA, more than 70 people died after taking GHB between 1995 and 2000.