'A fine line between euphoria and death': a qualitative study exploring gamma-hydroxybutyrate (GHB) use among people who identify as heterosexual living in Australia.

Summary

Among heterosexual Australians who use GHB, three patterns of use—occasional, regular, or daily—emerged. Four key themes were identified: escapism (managing mental health symptoms, enhancing confidence, facilitating sex, and alleviating body consciousness in women); diverse understandings of overdose, including intentional dosing to achieve unconsciousness and misconceptions about using stimulants to counter toxicity, with fear of police delaying help-seeking; stigma from both drug-using and non-using peers; and gendered harm reduction practices where women protect each other from harms, especially sexual violence. Findings point to gaps in public health education on overdose management and intentional risk-taking.

Study at a glance

Abstract

Harms associated with gamma-hydroxybutyrate (GHB) use have increased recently in Australia. However, research predominantly focuses on the experience of GHB use among LGBTQ + populations. Non-prescribed GHB use has not been well described in heterosexual populations. Research to examine the experience of heterosexual people, including motivations for use, experiences of harms, and utilisation of harm reduction practices, can inform public health messaging. We recruited 26 participants at least 18 years of age, reporting three or more occasions of GHB use in the past 12 months, via a national social media campaign and snowball methods. Semi-structured interviews were conducted via video conference, and analysed using a thematic framework analysis. Nineteen women (73%) and seven men (27%), mean age 29 years (standard deviation 7 years) completed interviews. Participants described three distinct patterns of occasional, regular, or daily GHB use. Across these patterns, four key themes emerged: (1) Escapism: participants used GHB to manage mental health symptoms, counteract stimulant effects of methamphetamine, enhance self-confidence, and facilitate sex. Women described using GHB to alleviate body consciousness/dysmorphia. (2) Diverse understandings and experiences of overdose: participants described a spectrum from mild to life-threatening toxicity. Notably, dosing GHB to achieve unconsciousness (intentional overdose) was a theme that dovetailed with boundary play in our sample. Misconceptions included using stimulants to counter GHB toxicity. Fear of police involvement delayed or prevented help seeking. (3) Stigma: Participants reported stigma from peers who use and do not use drugs. (4) Gendered harm reduction practices: A set of practices centred on women protecting women from harms associated with GHB use emerged, with narrations of heightened vigilance and protective behaviours to reduce risks of sexual violence. In our heterosexual sample of people who use GHB in Australia, we identified novel aspects of GHB use characterised by escapism, intentional risk-taking, and gendered harm reduction strategies, while stigma featured alongside GHB use. Findings highlight gaps in public health education, particularly regarding intentional dosing towards unconsciousness, misconceptions about overdose management, and barriers to help seeking. Targeted, context-specific harm reduction and mental health interventions responsive to these experiences are required.