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Deaths in the Lesbian, Gay, Bisexual and Transgender United Kingdom Communities Associated with GHB and Precursors

[ Vol. 19 , Issue. 13 ]

Author(s):

John M. Corkery*, Barbara Loi, Hugh Claridge, Christine Goodair and Fabrizio Schifano   Pages 1086 - 1099 ( 14 )

Abstract:


Background: Misuse of gammahydroxybutrate (GHB) and its prodrugs gammabutyrolactone (GBL) and 1,4 butanediol (1,4-BD) has increased greatly since the early 1990s, particularly amongst lesbian, gay, bisexual and transgender (LGBT) individuals in recreational and sexual settings, e.g. ‘chemsex’.

Objective and Method: This paper presents an overview of GHB pharmacotoxicology and provides analyses of cases in the LGBT population associated with the use of these substances extracted from the UK’s National Programme on Substance Abuse Deaths database, to which notification is voluntary.

Results: From 1995 to September 2013, 21 GHB/GBL-associated fatalities were reported. None involved 1,4-BD. Typical victims were: Male (100%); White (67%), young (mean age 34 years); employed (90%); with a drug misuse history (81%). Most deaths were accidental (67%) or related to recreational drug use (19%), the remaining (potential) suicides. The majority of fatalities (83%) occurred in private residences, typically following recreational use; others occurred in specific ‘gay’-oriented locales including clubs and saunas. Three London boroughs accounted for 62% of all notified deaths, reflecting the concentration of both resident and visiting ‘gay’ individuals. However, this may be an artefact of the voluntary nature of the data submission procedure in particular areas. GHB/GBL alone was implicated in 10% of fatalities. The following substances were implicated either alone or in combination in the remaining cases (percentages may add to more than 100%): cocaine (38%); alcohol (33%); amphetamines (29%); ecstasy (29%); diazepam (24%); ketamine (24%); mephedrone (24%). Post-mortem blood levels: mean 660 (range 22 - 2335; S.D. 726) mg/L.

Conclusion: Significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, stimulants, and ketamine. Risk of death is increased due to their CNS-depressant properties. Of these, ‘chemsex’ drugs such as cocaine, mephedrone and ketamine are of note. More awareness is needed in the ‘gay’ community about risks associated with the consumption of such substances.

Keywords:

GHB, GBL, deaths, toxicity, LGBT community, United Kingdom (UK).

Affiliation:

Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hertfordshire, Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hertfordshire, National Programme on Substance Abuse Deaths, Population Health Research Institute, St George's University of London, Tooting, National Programme on Substance Abuse Deaths, Population Health Research Institute, St George's University of London, Tooting, Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hertfordshire

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