Rising harm from party drug ‘cause for alarm’

An Australian-first study is prompting ‘cause for alarm’ over potential rising harms from the drug gamma-hydroxybutyrate (GHB), reinforcing the need for prevention and harm-reduction strategies, as a GP expert calls for improved follow-up care.
 
The UNSW Sydney’s National Drug and Alcohol Research Centre (NDARC) study reveals that despite relatively low use compared to other illicit drugs such as MDMA, cocaine and methamphetamine, GHB’s popularity is rising.
 
Often taken as a party drug, the liquid-form depressant carries a small margin of error to its narrow therapeutic dose range.
 
GHB-related deaths have increased 10-fold since 2013, the NDARC study reveals, while the number of hospitalisations more than tripled.
 
Using survey data from 2013–24, the authors found while use of the illicit drug overall remained low, people aged 14 years and over reported an increase in lifetime use from 0.9% to 1.2% over the study period, while past 12-month use increased from 0.07% to 0.2%.
 
There were significant increases in GHB-related hospitalisations from 5.3 in 2012 to 19.1 per 100,000 people a decade later, and GHB-related deaths rose from less than six in 2012 to 52 in 2022.
 
Treatment episodes where GHB was the principal drug of concern also increased across the study period, from 0.07 episodes to 8.4 per 100,000.
 
The authors say their findings demonstrate ‘a clear and accelerating trend’ that GHB harms are rising rapidly.
 
‘These numbers are a cause for alarm,’ lead author Associate Professor Amy Peacock, Deputy Director of NDARC, said.
 
‘Without targeted action, the situation will only worsen, and more people will be harmed.
 
‘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.’
 
RACGP Specific Interests Addiction Medicine Chair, Dr Hester Wilson, said GPs have a key role in both harm-minimisation conversations and follow up after overdose and hospital emergency department (ED) presentations.
 
‘One of the issues we see clinically is people overdosing, ending up in the ED, waking up and discharging themselves without accepting follow up,’ she told newsGP.
 
‘In this case their GP could potentially be the one health professional they see after the overdose who gets the discharge summary and who can help send harm-minimisation messages.’
 
Dr Wilson says one of the concerns with taking GHB is the narrow therapeutic dose range.
 
‘If you take too little, it does nothing. You take too much, you become unconscious. An ambulance is called,’ she said.
 
‘It’s not long acting so they’re supported in the ED. Then they might wake up and say, “What am I doing here? I don’t have an issue with drugs and alcohol”, and they leave.’
 
But for those patients who have a GP recorded in their symptom notes, that discharge is sent to them, and the opportunity for conversations arises.
 
‘I’d be quite proactive, because it’s my patient who has overdosed and I’m worried this is going to happen again,’ Dr Wilson said.
 
‘Here is the chance for the GP to say to their patient, “I got this from the ED, saw this happened, and just really want to check in about how you’re going, and if you are going to take drugs in the future what will you put in place to make sure you’re okay? Because there is a real risk”.
 
‘It’s part of our holistic care as GPs. These people don’t want to come to harm, they just want to have a good time. So for us, there’s a pivotal role in being part of that conversation.’
 
In some jurisdictions with active drug-testing programs, GHB can be tested at large events such as music festivals, although Dr Wilson says it is one of the ‘more challenging’ substances to analyse due to its liquid form and high-potency variability.
 
A recent alert of pure methamphetamine found in a GHB sample came with the warning of an ‘extremely high’ potential for accidental overdose.
 
While the NDARC authors note a ‘significant concern’ about potential rising harms from GHB through measuring broader patterns of use and national trends, it can be applied to support harm reduction.
 
They call for implementation of ‘acceptable and tailored’ prevention and harm-reduction strategies for key populations, and stronger national monitoring efforts.
 
‘Education around how to recognise and respond to a GHB overdose is important, regardless of frequency of use or dependency,’ Associate Professor 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.’
 
For Dr Wilson, a long-time advocate for harm reduction, she views drug use through a healthcare lens.
 
‘It’s not up to me to decide whether you want to take risk-taking behaviours or not. What I want to ensure, as your GP, is that you don’t come to harm, and you have access to good information to make informed choices,’ she said.
 
‘Anything we can do to support patients to help make safer decisions, that is part of what we do as GPs. It doesn’t mean you need to have an in-depth knowledge of all the drugs, you just need to be open to those conversations and to supporting people in a non-judgemental way.  
 
‘We have these opportunities as trusted GPs to support our patients to have good lives and not come to harm – we are part of people’s communities.’
 
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