Overdose prevention among hard-to-reach people who use GHB at home

Mainline explored the personal and environmental characteristics associated with overdosing and the opportunities for risk reduction. Read our studie that was conducted in 2014 and 2015 in the Netherlands and Belgium.

Under investigation was what sort of harm-reduction interventions can be developed with a view to reducing the risk of a GHB-related (Gamma-hydroxybutyrate) overdose and the associated health damage. The study’s conclusion is that the harm reduction measures to be developed are strongly dependent on the subgroup based on the GHB experience, their information needs and their level of knowledge on the topic of overdosing.

Within this study, three distinct groups were identified:

1. People with modest GHB experience
(lifetime use: 1 – 50 times)

are the ones most eager to avoid passing out. This group is interested in hearing stories of other people who use, harm-reduction tips and the long-term effects of GHB.

A possible intervention befitting this often higher educated audience are informative online / offline articles about sex, drugs and health where experiential stories are supplemented with expert knowledge. This group often cites sexual arousal as a motivation for using GHB. Other possibilities include: strengthening bonds within peer groups, such as appointing someone to keep track of time and dosages, and developing a GHB helpline where people can seek advice anonymously.

2. People with considerable GHB experience
(lifetime use: 50 to 200 times)

say they pass out occasionally due to their frequency of use. They are interested in tools that facilitate safer use. Under the influence you lose your inhibitions, your vision and sense of time.

A possible intervention is to distribute syringes with which the dosage can be measured more precisely in millilitres. The use of a timer can also be encouraged. These tools can be integrated with a 'G-app': an application on smartphones with information about GHB and passing out. An added value of an app can be a monitoring function that makes your substance use within the time period visible. With the help of self-control tips, periods of non-use can subsequently be strengthened.

This project had been produced with the financial support from: The European Commission and The Dutch Mental Health Foundation (Fonds Psychische Gezondheid)

3. people with abundant GHB experience
(lifetime use: more than 200 times)

have the highest risk of coma. Although respondents experienced passing out as GHB’s main drawback, at the same time they see it as an unavoidable part of their use. This group has, compared with less experienced subgroups, a knowledge gap in the field of overdose prevention and first aid in the event of an overdose. They wait much longer calling on an ambulance, and don’t bother trying to keep the subject of the overdose awake, choosing instead to ‘just let them be’.

This subgroup, compared to the other groups, have a greater need for information or help
with GHB, especially regarding the long-term consequences and avoiding a relapse. Changing the attitude towards passing out, requires connecting with their world. For example, an in-road could be found in the inconveniences experienced by these people as a consequence of passing out, such as car accidents, house fires and physical discomforts (forgetfulness, weight gain and movement disorders).

How to reach this group with abundant GHB experience at home?

  • Outreach work is a good way to reach this group with abundant GHB experience at home. This takes a lot of time and effort. But even within this study we were able to visit the hidden group at home by making the first contact via professionals and people who use GHB. The direct contact is an important added value for both the professional and the client. In addition to motivating conversations, knowledge quizzes or educational games create ways to actually start the conversation.

  • Also, equipment that encourages safe use, such as dosage syringes and timers, can be provided. Furthermore, this research reveals that people who cite feeling ‘more self-confidence and greater social ease’ as the main motivation for using GHB suffer comas more often. For this reason, it seems like a good idea to work with them to improve their social skills and strengthen their self-regulation mechanisms. Furthermore the use of peers can facilitate knowledge transfer in the language of the target group.

  • Moreover, this method may offer people who used GHB in the past something meaningful to do with their day. To influence the attitude towards passing out, an awareness campaign (in the form of a video) is an appropriate intervention. Finally, it is advisable to examine whether substitution treatment (with a longer half-life than GHB) a good harm-reduction method. People who use may be less inclined to overdose from taking several doses a night in order to get some sleep.

Contactperson: Sanne van Gaalen

Read the study 'Overdose prevention among hard-to-reach people who use GHB at home’

Overdose prevention is of the greatest necessity for the group of people with abundant GHB experience. The recommendation is to start with a ‘Comprehensive GHB Prevention, Harm reduction and Treatment package’ in which existing and developing interventions in the area of GHB complement each other. Although there are currently a lot of interventions, there still exists a gap in the area of prevention. The above-mentioned harm-reduction interventions may be able to meet this need.

Within this research, these people were mostly encountered in villages outside the Randstad*. This group is often not reached by prevention activities at nightlife venues, and in addiction the focus is on abstinence. People who are not (yet) ready for this often fall between the cracks. Harm-reduction can indeed lead to relatively safe and informed use of GHB and overdose prevention can reduce the risk of brain damage or even death.

*) Randstad: This is a combination of four big cities in the Netherlands.

GHB Overdose preventiontool (Intervention video)
With guidance from the results of this research and the feedback from the European partners, Mainline Foundation has developed and tested a pilot intervention video which is made by and for people with abundant GHB experience. This video aims to enhance the knowledge of the risks of overdosing in order to change the attitude towards losing consciousness.
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