In light of recent events where it was reported two young men had been hospitalised due to suspected intake of GHB, the following article highlights important harm reduction measures individuals are asked to be mindful of.

While it is always safer not to use chems (drugs/substances), if you chose to, it is vital to be are aware of the risks associated with the substances and know the harm reduction information available.

For the purposes of this article we shall focus upon GBL/GHB which shall be referred to as G throughout the article.

Reducing risks with G

Gamma-Hydroxybutyrate (GBL/GHB/G/Gina) is a dangerous drug. It’s always safest not to take any drugs, but if you are planning to take G it’s very important to be careful of how you take G to minimise the risk of something going wrong. Here are some facts and suggestions to help you look after yourself and your friends.

Physical health risks

• It’s very easy to overdose on G. Overdosing can lead to unconsciousness, coma and death.
• Because G can make people pass out easily, it has been linked with rape and other sexual assaults.
• If not diluted properly, G can burn the mouth and throat when swallowed.

Mental health risks

G can result in short term confusion and disorientation. We don’t yet know what the effects are on the brain from taking these drugs repeatedly.

The importance of good nutrition and hydration prior to, during and after a G taking/after-party session cannot be understated. Snacks and coffee are not adequate to sustain a person throughout the period of chem use and chemsex (after-party) activity. Much like alcohol the chems taken during such sessions deplete not only serotonin but also leave the body physically and mentally exhausted and therefore increase the severity of any withdrawal symptoms, alongside the risk of overdose if the individual continues to take chems.

G Reminder

Because G leaves the system quickly, it might be undetectable in your system by medics if you go under.

Carry a ‘G card’ so medics know what you have taken. A G card can be obtained from the Gay Men’s Health Service, HIV Ireland, the Rialto Community Drug Team, and the Club Drugs Clinic Ireland. It has information on the green side for what to do if someone has taken too much G, and has information on the blue side for the paramedics and emergency medical team. If you don’t have a G card, you could write ‘G’ or’ GHB’ on your hand or the inside of your wrist.

If you no longer take G, you can give the card to a friend or partner who still is.

G and alcohol

Never mix G with alcohol. It can dramatically increase the effects of the drug, leading to a much higher risk of ‘going under’ (overdosing and losing consciousness), vomiting and breathing problems.

If you’ve been drinking earlier in the evening, wait at least a few hours and drink water to help sober up.

Dosing G

Start Low…Go Slow:

Getting an accurate dose of G is crucial. The difference between a desired effect and losing consciousness may only be a matter of less than a millilitre. A tiny bit too much can cause you to lose consciousness.

Always use as low a dose of G as possible and wait until the effects are felt (This can sometimes take between 15 – 20 minutes). Wait at least four hours before taking a second dose.

A common starting dose for G is between 0.5ml and 1ml.

It’s always better to take slightly less G than more, but any dose can still cause serious problems. Everybody reacts differently and it’s not uncommon to be sick the first time you take it.

Each container of G may vary in concentration and strength. There is no way of knowing how concentrated or pure the G is. Starting with a test dose will help calculate further doses.

Some individuals find that the longer they’re awake and doing G, the greater the chances of them passing out. Reducing the amount you do and extending the time between doses can help reduce the chances of this happening.

Measuring G

Use a plastic measuring syringe; never try to average a dose using a spoon or a bottle cap.

A small 1ml syringe is best as it helps reduce the chance of you making a big mistake with a larger 10ml syringe. Syringes can be accessed through Needle Exchange Services such as Merchants Quay Ireland (MQI) Tel: 01 524 0160 or the Ana Liffey Drug Project (ALDP) Tel: 01 878 6899.

G will melt the ink numbers on the syringe which makes it difficult to measure accurately. Putting a small piece of sellotape over the numbers can help stop this – alternatively make sure you have spare syringes to hand.

Always measure and check the dose yourself. Blurry eyesight, low lighting or just being high means it’s easy to make a mistake, so asking friends to watch when you measure a dose is a good idea.

G timing

Accurate timing of doses is crucial. You should wait at least four hours before re-dosing.

Putting a sheet of paper with people’s names, the time and the quantity of dose taken near the G can help you keep track of what you and friends have taken. For example:

Set a timer on your phone or watch each time you take a dose. This will remind you when it’s safer to take another dose.

If you’re ever unsure, or disagree with someone on the timing, stop and wait an hour before doing a dose.

Mixers

Taking G ‘neat’ can cause damage to your mouth, teeth, throat and stomach.

Mixing G with a soft drink like coke or orange juice, followed by a soft drink ‘chaser’, is the common way to take it.

Never drink from a glass of liquid that you find as it could contain dangerous amounts of G – always rinse out the glass and pour a fresh drink yourself.

Storing G

One of the biggest dangers with G is accidentally drinking from the container that G is stored in, meaning you are taking a massive dose which could prove fatal. Always store in a locked cupboard that is out of the reach of children.

To help avoid this:

Store the G in a non-drinking container (such as an ashtray-style small bowl or a brown glass pipette bottle) so people don’t confuse it for a normal drink.

Put the G in a specific place out of the way, so people don’t pick it up thinking it’s a glass of water.

Consider putting a few drops of food colouring in the container of G in order to distinguish it from other drinks.

Dependence

If you have been taking G regularly for long periods of time, you can become dependent and it can be very dangerous to suddenly stop. Withdrawals from G when someone is dependent can happen within 1-2 hours of their last dose, and can progress very quickly to potentially life-threatening conditions.

Get medical advice and support from a drug service, like The Club Drugs Clinic Ireland located in the National Drug Treatment Centre (30-31 Pearse Street, Dublin 2), Rialto Community Drug Team (468 SCR, Rialto, Dublin 8), your GP or Sexual Health Service.

Some of the reasons individuals OD on GHB

From conversations with people, the vast majority of overdoses (OD’s) are accidental but that does not mean they can’t be fatal as, unfortunately, some have. The following includes explanations as to why people OD on GHB and are explained in detail throughout the article.

• Wanting to ‘go under’ due to lack of sleep, and the increased dose taken was too much.
• Body worn out and exhausted after a number of days partying, no sleep, no food.
• Being so high/out of it, quite possibly on more than just G, the person does not know what they are doing due to their mixing of a number of substances.
• Drinking from a glass/bottle/container thinking it was water when it was in fact G.
• Not taking the correct dose.
• Another person dosing you and not knowing your usual dosage.
• Forgetting when you last dosed yourself and therefore taking another dose way too soon.
• Measurement markers on the syringe/pipette have been worn away.

Overdosing

These can be signs someone has taken too many drugs or overdosed:

• feeling very confused, agitated or aggressive for more than 15 minutes.
• chest pain that feels like a heart attack.
• a seizure (which may be like an epileptic fit).
• pale skin, blue lips or blue fingernails.
• making gurgling, snoring or choking sounds.
• no reaction to loud noise or being gently shaken, unable to wake up.
• breathing is shallow or disrupted.
• pulse is slow or very faint.

If someone is conscious:

• If they start to panic and breathe fast, take them to a quiet place where you can sit with them and reassure them they’ll soon be OK. Get them to breathe deeply and slowly.
• Give them sips of water (nothing else).
• Sometimes a cold compress, like ice wrapped in cloth, to the head helps.
• Try not to leave them alone.
• Try not to let them fall asleep or lose consciousness – walk them around.
• If their symptoms are getting worse, ask someone else to get medical help.

If someone is unconscious:

• If someone is no longer conscious don’t hope they’ll eventually come round or sleep it off, if someone is unconscious there is always the risk of death, it is time to call the emergency services on 999 or 112.
• Lay the person on the floor in the recovery position. To place someone in the recovery position:
• Kneel on the floor on one side of the person.
• Place the arm nearest you at a right angle to their body with their hand upwards towards the head.
• Tuck their other hand under the side of their head, so that the back of their hand is touching their cheek.
• Bend the knee farthest from you to a right angle.
• Roll the person onto their side carefully by pulling on the bent knee.
• The top arm should be supporting the head and the bottom arm will stop you rolling them too far.
• Open their airway by gently tilting their head back and lifting their chin, and check that nothing is blocking their airway.
• Stay with the person and monitor their breathing and pulse continuously until help arrives.
• If any injuries allow you to, turn the person onto their other side after 30 minutes.
• Call 112 or 999

Although you might worry about phoning an ambulance by dialling 112 or 999, not doing so could cost someone their life and put you in a far more serious situation.

Don’t leave someone alone unless you have to get help. While you’re gone they could move out of the recovery position.

If you must leave them, make sure it’s not easy for them to roll over onto their back or try to get someone to stay with them until you return.

When the ambulance arrives, tell them (if you can) what the person has taken. The more the medical team know about the situation, the more they can help the person who is in trouble.

They won’t tell the police, your friend’s family or anyone not involved in their clinical care, that your friend has been taking drugs.

Going under on G

If someone’s taken too much G and overdoses, they may fall into a very deep sleep (known as ‘going under’) or become very confused and start convulsing (sometimes called ‘squiffing out’ or ‘G-ing out’). It’s very difficult to wake them until the G wears off.

This coma-like state usually lasts for one or two hours.

If you’re with someone who’s gone under:

• don’t leave them unattended.
• make sure they’re breathing, and continue to check their breathing until they wake up.
• put them in the recovery position (lie them on their side).
• if someone is unconscious and unresponsive, call 112 or 999.

If someone has taken a large amount of G by mistake – perhaps by drinking from an unlabelled container, or by drinking alcohol, then taking too much G and losing consciousness – seek urgent medical attention and call 112 or 999. Both these things can cause a person’s heart rate and breathing to slow down to dangerous levels.

Warning signs to look out for:

• convulsions (going ‘squiffy’ or ‘G-ing’ out).
• slow heart/breath rate.
• vomiting.
• sweating intensely.
• pale skin.

If you notice any of these, call 112 or 999.

Sometimes people might give warning signs that they are close to going under, even if they don’t pass out. These could be:

• acting slightly confused.
• breathing or panting heavily.
• erratic movements.
• difficulty keeping their eyes open.

Overdosing on G is easy to do and very dangerous. Doubling the amount of time in between doing a shot of G (or other drugs) and halving the amount consumed may help to avoid going under or other complicated and troubling situations.

G and other chems (poly-drug use)

GHB has the same/similar effects as benzodiazepines or alcohol, which can result in drowsiness, sedation, respiratory depression and death.

The risk of using GHB/GBL is greatly increased when used in combination with other substances like alcohol, ketamine and prescription tablets.

The use of G with stimulant drugs like Cocaine, MDMA, Mephedrone and Crystal Meth (Tina) is dangerous. Using G with other stimulants may make a person feel more awake. This can mean that someone can take more G than they normally would; increasing the risk of an unexpected overdose. Taking other stimulant drugs can also have an effect on your heart, and you may experience palpitations, chest pains or other symptoms. Remember always to look out for your friends in this regard.

Sexual Assault and Consent

The sedative properties of G can leave a person incoherent or comatose, so they are unable to give their sexual consent. Whether a person unknowingly or willingly takes G, in clubs or at sex parties, they are at risk of sexual assault.

Safer Sex Advice

Using G can increase a person’s sex drive, thereby increasing the risk of having unprotected sex and increasing the risk of acquiring or transmitting HIV and/or other sexually transmitted infections (STIs).

Be prepared – carry your own condoms and lubricant with you at all times – particularly if you know you will be using G.

• Use protection every time you have sex and don’t let anyone interfere with your lubricant as there have been cases of G being mixed with lube.
• Only use a condom once. Never reuse it.
• Get tested regularly for HIV and other STIs. Testing is free in public clinics.

Services & Supports

For a full list of drug and alcohol services see www.drugs.ie/services

HSE
Freephone Helpline:1800 459 459. Drugs, Alcohol, HIV, Hepatitis and Sexual Health Helpline.

Club Drug Clinic Ireland, National Drug Treatment Centre
The Club Drugs Clinic Ireland, situated in the National Drug Treatment Centre, Pearse Street, Dublin 2, is an integrated person centred specialist addiction service including Club Drugs (GHB/GBL, Crystal Meth (T, Tina).
Email: [email protected] 01 648 8600.

Rialto Community Drug Team. 468 SCR, Rialto, Dublin 8. [email protected] Tel. 01 454 0021.

Gay Men’s Health Service
Services for men who have sex with men (MSM) include free HIV and STI testing, free counselling, PEP, free condoms.
Email [email protected] Tel. 01 921 2730. SMS: 087 941 0934

HIV Ireland
Services include free HIV and STI testing, free condoms, free counselling and community support services for people living with HIV. www.hivireland.ie Tel. 01 873 3799.

Belong To Youth Services

BeLonG To is the national organisation for Lesbian, Gay, Bisexual and Transgendered (LGBT) young people between the ages of 14-23. www.belongto.org Tel. 01 670 6223.

Man2Man.ie 
Sexual health information for men who have sex with men. www.Man2Man.ie

Gay Switichboard Ireland
Information and support via phone, email and online chat. Tel:(01) 872 1055 or [email protected]