THERE HAVE BEEN about 100 referrals to Ireland’s only GHB-detoxification clinic in recent years.
GHB (gamma hydroxybutyrate) or GBL (gamma butyrolactone), both often shortened to G or Gina, are drugs used socially and for the purposes of chemsex.
Chemsex is the use of drugs such as G, crystal methamphetamine, ketamine and mephedrone to enhance sexual activity.
The practice is usually associated with men who have sex with men (MSM), often involves multiple people and can lead to sexual encounters that last for hours or days. Slamsex is the term used when the above drugs are injected for a more intense high.
As previously reported by TheJournal.ie, there have been at least 15 overdoses from the drug in the last two years.
It’s believed a number of people in Ireland have died from using the drug, but this figure is harder to quantify – G usually only shows up in a person’s system for 12 hours and many toxicology tests don’t screen specifically for the drug.
The number of detoxification referrals jumped from just one in 2014 and five in both 2015 and 2016 to 47 last year (a 4,600% increase since 2014).
Experts have said these figures are worrying – there was a spike in G-use in London about five years ago and the drug is now a huge problem there, with fears Ireland could go down a similar path.
There have been 45 referrals to date in Ireland in 2018. About half of these were first-time referrals, while half involved people who had relapsed.
Highly addictive
G is highly addictive and the relapse rate is about 70% relapse, regardless of how a person detoxes. Some addicts are replacing it with crystal meth or alcohol.
Just over half of the referrals (54%) involved MSM, while 23% were heterosexual males and 23% were heterosexual females.
Most people who were referred used G socially as well as for chemsex:
The age range was from 19-60 years, with the majority of people who were referred being in their late 20s or early 30s.
People who become addicted to G often need a hit every couple of hours. Graham Ryall, Treatment Services Coordinator at the Rialto Community Drug Team, previously told TheJournal.ie: “Genuinely, this is the most difficult substance I’ve ever worked with in over 20 years of addiction treatment.
The dynamics of the drug, what it does to you, what it takes from you – depression, anxiety, isolation – can be crippling.
GHB is a synthetic drug used as an anaesthetic. It comes in a clear liquid or powder form and its potency varies. GBL is sold as a substitute for GHB. It’s found in cleaning solvents and converts to GHB when you swallow it.
GBL was made illegal in 2010 under new laws designed to combat so-called head shop drugs.
If someone ‘goes under‘ while on G:
Warning signs to look out for include:
Chemsex
Dr Kiran Santlal, Registrar in Psychiatry of Substance Misuse at the National Drug Treatment Centre (NDTC) in Dublin, is a member of the Chemsex Working Group.
He helped to set up the G detoxification clinic.
Santlal said the spike in referrals to the clinic is due to both an increase in the number of people who use the drug and an increase in awareness about the clinic’s work.
When Santlal and colleagues first heard of G in 2014, they looked to London for guidance on how to address the issue.
The Irish clubbing scene is about five years behind the London scene, what’s trending in London will be in Ireland five years later – and that’s what we’ve seen with GBL.
Recalling the situation in 2014, Santlal said: “G had been quite popular on the clubbing scene for a few years [in London] already”, necessitating the development of a Club Drugs Clinic.
“It had taken them a few years to develop this type of clinic so for us, in Ireland, getting the G detox clinic in the pilot stage in the matter of a couple of months was a task in itself.”
Santlal said when regular G-usage first emerged in London, some people in the addiction sector viewed it as a sexual health problem (because of the chemsex element) while others who worked in that sexual health believed it to fall under addiction services.
Santlal said Ireland has learned from this and has adopted a very collaborative approach, stating: “This isn’t just one or the other, this is so much bigger than that.”
The Chemsex Working Group – which comprises representatives from the NDTC, the Gay Men’s Health Service, the Ana Liffey Drug Project, the Rialto Community Drug Team, HIV Ireland, BeLonG To, and St James’ Hospital among others – meets every couple of months to discuss how to address the ongoing problem.
Santlal said this level of cross-sectoral interaction is “fairly unique” and recognises how complex the reasons for G-use can be.
The group was in part set up because of a spike in HIV rates among MSM in recent years. G reduces inhibitions and can lead to people engaging in sex without condoms.
The Gay Men’s Health Service runs workshops about chemsex and provides training for healthcare professionals.
Outreach worker Adam Shanley previously told us: “We need to make sure that staff are asking the right questions and providing a supportive environment when people present. They need to be clued in with the language that is used [about chemsex] and the supports that are needed and available.
People need to feel they can open up and have that conversation.
One in four men
A paper, compiled by Dublin-based researchers, published in the International Journal of Drug Policy last year assessed the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland’s only MSM-specific sexual health clinic over a six-week period in 2016.
The response rate was 90% (510/568). One in four men (27%) reported engaging in chemsex within the previous 12 months, and half had taken two drugs during their last chemsex experience. One in five people (23%) reported that they or their partners had lost consciousness as a result of chemsex.
One in four men (25%) reported that chemsex was impacting negatively on their lives and almost one-third (31%) reported that they would like help or advice about chemsex.
‘High functioning addicts’
Many people who take G, at least initially, do so for social reasons – it can create a euphoric effect. Others take the drug due to anxiety; intimacy issues; and, in the case of some gay people, internalised homophobia.
When the G clinic was in its early stages, referrals were generally admitted as inpatients to St Michael’s Ward in Beaumont Hospital, where a bed is available on an elective basis (this ward is generally used by people who need to detoxify from heroin and other substances). However, people in eight in 10 cases are now outpatients.
Santlal said one of the reasons the detox clinic was set up was because of the extremely high doses of benzodiazepines that would be prescribed (at least four times a regular alcohol-withdrawal regimen), noting: “Very few clinicians would have been comfortable prescribing this, especially as an outpatient.”
People referred to the clinic are assessed by a team of experts who look into both their physical and psychological health, as well as related issues which may need to be treated, such as anxiety.
Santlal said most of the individuals who present are not “stereotypical” drug addicts – they’re often young people who are “highly functioning” and holding down jobs.
In general, the detox programme lasts 18-21 days. The patient has to visit the clinic every day during this period, including for about eight hours on the first day.
They are assessed and prescribed medication – usually librium or valium. The individual must have arranged for a non-substance-using friend or family member to monitor them for the first 24-48 hours in case they have a bad reaction or intense withdrawal symptoms and require medical help.
70% relapse rate
The highest risk of relapse is one week post-detox.
Noting the 70% relapse rate, Santlal said G has an amnestic quality and people tend to forget how bad the symptoms can be and often start using again – for various reasons.
If they were previously in G-using circles, they may have lost contact with non-G-using friends. Some people are unable to have sex without it. Others may like the person they are when they’re on it – believing that they’re more charismatic and social.
He said the anxiety and insomnia associated with G-use can last for weeks.
Some of the people who become addicted to the drug have a history of alcohol dependence and, when trying to get clean, start drinking. Santlal is aware of cases where people began to drink up to two litres of vodka a day as a substitute.
He said other people turn to crystal meth when the withdrawal from G becomes too much. It’s becoming such an issue that he wants to expand the G clinic to help people who also need to detox from meth and other chemsex-related drugs.
“The use of crystal meth is on the rise a lot. Some people go from smoking it to injecting it. Then there are issues with using needles, not knowing whose needle is whose,” he told us.
Christmas parties
Looking to the future, Santlal is examining the logistics of establishing a G support group – saying people who are addicted to the drug sometimes struggle to relate with those who are addicted to different substances as G-use is “a very specific problem”.
He also wants to continue raising awareness of the dangers of G and look into setting up a Club Drug Clinic similar to the one in London.
He said this may involve “thinking outside the box” and the chemsex working group has discussed the possibility hiring a party engagement worker – someone who works in and around clubs in the early hours of morning in case anyone overdoses or needs help.
G-use spikes around bank holiday weekends and Santlal is worried there will also be an increase over the Christmas and new year period when people have time off work.
He said some people will engage in “a whole week of partying”, and he’ll be on call over the holiday period if needed.
Want to talk about G or chemsex? Here are some of the support services available:
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