Short communicationUse, function, and subjective experiences of gamma-hydroxybutyrate (GHB)
Introduction
Gamma-hydroxybutyrate (GHB) is a naturally occurring fatty acid found in mammalian tissue, initially investigated during the 1960s for its potential use in anaesthesia (Mamelak, 1989, Nicholson and Balster, 2001). Subsequently, GHB has been employed, generally informally, for a variety of purposes including the treatment of sleep disorders, depression and anxiety and for symptom relief during alcohol dependence and opiate withdrawal (Bhattacharya and Boje, 2004). More recently, it has gained media notoriety as a drug allegedly used in instances of drug facilitated sexual assault (‘drink spiking’) (ElSohly and Salamone, 1999).
Self-administration of GHB (and its precursor gamma-butyrolacetone; GBL) in the recreational arena is a relatively recent phenomenon (Nicholson and Balster, 2001, Degenhardt et al., 2002) but several reports suggest its use is increasing internationally (Degenhardt et al., 2005). Presentations of GHB and GBL toxicity have also been reported to be increasing at emergency departments across Europe (Mirò et al., 2002, Liechti and Kupferschmidt, 2004). A recently published Swiss study reported that GHB accounted for 12.5% of intoxications with illicit drugs presented to Accident and Emergency departments in 2001, rising to 27.2% by 2003 (Liechti et al., 2006).
Desired effects expected from GHB intoxication include euphoria, relaxation, and increased sensuality and disinhibition (Chin et al., 1998, Liechti et al., 2006, Mirò et al., 2002). However, increased blood concentrations result in cognitive impairment, ataxia, and a lack of awareness of surroundings. In one Australian study of 76 recreational GHB users, half (53%) had experienced an overdose (overdose being defined as loss of consciousness and an inability to be woken) with 75% of those who had used GHB more than 15 times having overdosed at least once (Degenhardt et al., 2002). Deaths from GHB use have been reported in the UK and elsewhere (Jones, 2001, ONS, 2006). In 2004, for example, the Office for National Statistics (ONS) reported that there were three mentions of GHB on death certificates examined in England and Wales (ONS, 2006).
This study investigated the relationship between intentions for GHB use, acute subjective experiences and patterns of use. It was hypothesised that the effects of GHB ingestion would be modulated by self-reported intention of use, situational factors and concomitant use of other substances.
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Methods
One hundred and eighty-nine GHB users, recruited by advertisements hosted on appropriate websites, completed an online questionnaire. In addition to demographic and drug use variables participants were asked to provide information on their GHB use history, subjective experiences, and use functions. Participants were also asked to consider a typical occasion when they had used GHB and asked to estimate the time course of the stages of GHB effects. Principal components analysis (PCA) using
Results
The sample of GHB users (n = 189) consisted of 140 (74.1%) males with a mean age of 29.1 ± 8.6 years. One hundred and twenty two (64.6%) described themselves as heterosexual, 27 (14.3%) bisexual, and 40 (21.2%) homosexual. After GHB the next most frequently reported substances were alcohol (96.8%), ecstasy (92.1%), and cannabis (90.5%). At least 3.3 days (for alcohol) had elapsed since use of any substance.
GHB was most commonly purchased in bottles (63.4%), followed by the powder formulation
Discussion
This study investigated the use and experiences of GHB by a self-selected population recruited via the Internet. Analysis of a survey of acute GHB effects revealed six components: (i) general intoxication effects; (ii) positive intoxication effects; (iii) negative intoxication effects; (iv) negative physiological effects; (v) positive sexual effects; (vi) negative sexual effects. Further work is needed to investigate component scale reliability, but investigation of the association between GHB
Conflict of interest
None.
Acknowledgements
This work was supported by internal funds only.
Contributors. HRS designed the study, conducted the analysis and wrote the first draft of the paper. SE conducted participant recruitment. KW assisted with the analysis. JCC and CMB contributed to the writing of the final manuscript. All authors contributed to and have approved the final manuscript.
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