It's easy to see the appeal of GHB – otherwise known as "G". At around £1 per ml it's one of the cheapest drugs available, easy to smuggle into clubs or festivals in small vials or caps, and its effects are similar to a combination of alcohol and MDMA, but without the comedown. If you've ever spent a full weekend hanging out your arse, you'll likely be thinking, "Sounds great, please administer this immediately."
But as the saying goes: if it sounds too good to be true, it probably is. In this case, the downsides of taking just a drop too much include a high risk of death, or at the very least being put into a coma. For this reason, G – a viscous liquid that's both colourless and odourless – is usually measured out and pipetted into water with an oral syringe.
Developed as an anaesthetic in the 1960s, G's only common medical use today is treating narcolepsy or alcoholism, but gamma-butyrolactone – AKA GBL, the precursor that converts into GHB in the body – is now sold legally as stain remover, rust remover or alloy cleaner. In the late 1980s GHB became popular among bodybuilders for its purported ability to increase growth hormone levels, and club kids for its feelings of lowered inhibitions without the sloppiness of alcohol. In the 1990s, it became known as a "date-rape drug". In the 2010s, it hit the headlines after the "Grindr killer", Stephen Port, used it to drug his victims.
Now, it's just another item on the party menu.
"It can potentiate whatever state you're in," says 24-year-old Claire* from London. "It's like having a drink – I might feel more chill or chattier. It can make you horny, but not always. In certain doses, in certain environments, it can give you that rushy, empathetic kind of vibe, but not always. I did G yesterday then went on a bike ride."
GHB use has been prevalent for decades within the LGBTQ+ community, particularly among gay men. In recent years it's become associated with chemsex, where it's commonly used alongside crystal methamphetamine, ketamine, cocaine, cathinones (3MMC, 4MMC), poppers and Viagra. "G isn't stigmatised in the gay community at all," says social worker and GHB expert David Stuart, who is credited with coining the term "chemsex".
That's despite G-related fatalities within the LGBTQ+ community reaching epidemic proportions in the mid to late-2010s, with Stuart noting an anecdotal average of "two deaths every month".
The drug has been less consistently popular outside of the gay community – or perhaps less talked about. In the early-2000s there was a spate of G-related overdoses in the UK and Ibiza, prompting news reports of Brits taking their "drug problems" overseas, but nothing that pointed towards an epidemic.
However, recent data suggests that G use has increased across Europe. According to the Global Drugs Survey, one in four drug-using women and one in six drug-using men reported passing out on G between 2017 and 2018. In Paris, police reported ten G-related comas within three months in 2018, compared to ten throughout the whole of 2017. In the Netherlands, where GHB has become popular in the gabber and hardstyle scene, use has been steadily rising for over a decade. A study by the Netherlands Institute of Mental Health and Addiction revealed the number of patients visiting A&E under the influence of GHB increased by 40 percent between 2009 and 2014, while Amsterdam’s OLVG hospital has seen a 266 percent increase in overdose admissions in the last five years.
These are overall statistics – and we don't know the sexual orientation of the users involved – but Adam Winstock, founder of the Global Drugs Survey, believes GHB is on the rise across the board. "There are more heterosexual people using GHB now than ever before," Winstock explains. "It's starting to move away from its traditional home of gay men and chemsex scenes, but it's still a drug that's rarely used compared to all the other drugs that users are familiar with. I think that's partly because GHB has a reputation for being risky, and I think that's protecting people from using it."
David Stuart adds that there may also be gaps in the data, because LGBTQ+ and heterosexual people typically use different sexual health services. "Twenty years ago we saw lots of gay men in gay communities using it, but they weren't coming forward to get help," he says. "In the early days, if they were coming forward for help, there was ignorance within the drug services. I have to say that straight services still aren't up to scratch on G, so there might be people asking for help and not getting it, so you're not hearing about it."
The Global Drugs Survey 2020 is now live. To take part anonymously, and help researchers understand how and why the world uses drugs, click here.
Without an oral syringe, G is difficult to measure out accurately, and even one millilitre too much can kill you. Usage becomes even riskier when mixed with alcohol or other depressants. Despite its comparatively limited recreational use, G is now the third most common drug-related cause for emergency medical attendance in Europe, after heroin and cocaine. It can be habit forming for regular users – withdrawal is on par with coming off heroin or alcohol: sweating, anxiety, confusion, hallucinations, seizures. Because it's rapidly metabolised and only stays in the body for a short time, withdrawal develops rapidly and, in some cases, can be life-threatening.
"People who start using GHB every day for reasons other than sex or socialisation, to help sleep or to manage the comedown of drugs, can find themselves becoming dependent perhaps within the space of just a few weeks," says Winstock. "Dose for dose, it's one of the most dangerous drugs in the world."
Stuart agrees: "I usually put it this way: a person requires a very unique and finely honed skill set to manage G without too much harm. You'd think the people who are dying are people who are ignorant about how to dose safely, but it's not true. It's just so hard to get it right with that particular drug."
It's reasonable to wonder why anyone takes G at all, but in many ways it has unique advantages over other club drugs. "G can tap into anything," Stuart explains. "It's not just an upper – it's a downer, it's a suicide drug, it's a happy drug, it's a relaxing drug, it's a confidence drug. Most drugs serve only one or two functions. G serves all of them if you use it differently."
Voicemail responses to a VICE UK call-out asking people across Europe about their experiences on G ranged massively, highlighting exactly how unpredictable it can be. Some called it their "favourite drug experience ever", but there were an equal number of cautionary tales. Matt, 28, from Nottingham said: "Some of my friends have been hospitalised and died, some of them even tried to commit suicide off it." Dora, 20, from Manchester said: "Recently my mate passed away on it. He was on G and he fell asleep. Just didn't wake up."
What Dora describes is known as "G-ing out" or "going under" – essentially falling into a very deep sleep until the dose wears off. Losing consciousness on G can cause a person's heart rate and breathing to slow down to dangerous levels. They also run the risk of choking on their vomit if they're not put in the recovery position. G-ing out is particularly dangerous if someone dependent on the drug gets arrested or taken to A&E, because they present as unconscious or disoriented, which most people immediately associate with being drunk.
"They do a drug test, there's nothing in their system, they smell alcohol on their breath – they get put in a cell. Six or seven hours later, that person starts acting bizarrely and the police think they’re acting out," Winstock explains. "That person has GHB withdrawal, and you have to treat it early, preferably in a planned way." This usually involves administering high doses of benzodiazepine sedatives or anti-seizure medications. In the Netherlands, GHB withdrawal is often treated by giving patients pharmaceutical-grade GHB and gradually tapering the dose.
The problem with G becoming more popular outside of the gay community is that its reputation as a "date-rape drug" has saddled it with a stigma that makes education and harm reduction difficult. In certain environments – big clubs or festivals, for example – it makes for a dangerous party culture. G can make users feel incredibly horny and out of control, which is a bad combination. In May of 2018, Scottish DJ Jackmaster sexually harassed several women backstage at Bristol's Love Saves The Day festival after taking G, with one female staff member saying he "crossed the boundaries of acceptability, regardless of the fact he was clearly off his head" (Jackmaster later issued a statement apologising for his actions).
"When we first identified G 20-plus years ago in the gay community, the first evidence was in clubs," says Stuart. "We saw people [on G], club promoters becoming a little alarmed at people collapsing or falling asleep, and talk within the community. What we're seeing in the straight community now is the same early signs: club promoters and security at straight clubs talking about it anecdotally."
The fact there are syringes involved – even though they're oral syringes – introduces a fear factor for some people. "As soon as people see a syringe, they start freaking out," says Claire. "When people get past the stigma, end up trying it and get a taste for it, there's no education or support. The stigma pushes it further underground."
Jack*, 24, from London, agrees: "If you're talking about it and people do recognise it, they’ll either go to its use as a date-rape drug, or they'll go to the Grindr killer, because those are the two most prominent things that have been in the media. There's a lot of assumption that, if you're using it, you're using it for some sort of nefarious or manipulative reason, which makes you less likely to tell people what you’ve taken."
Obviously, that's not good. If someone goes under but their friends don't know what they've taken, they might not know how to handle it. With less stigma comes better awareness around harm reduction, making it more likely that people will get the help they need. As with all drugs, however, de-stigmatisation means nothing if it's not supported by education and responsibility.
"Social acceptability of drugs is never a good thing if it exists in a vacuum of self-care," Stuart stresses. "Stigma is always bad, but the de-stigmatisation of something should always happen in a climate where self-care is nurtured and harm reduction information is widely available."
*Names have been changed for confidentiality.