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GHB, sex and overdose prevention
Written by Andrés Lekanger, Social Educator, Chemfriendly, and doctor Sverre Eika.
GHB is a drug that some people combine with sex, since it gives an increased sex drive and less inhibitions. The risk of overdose is high, and we want to challenge the myth that there are no measures to take that are likely to reduce the risk of GHB overdose.
  • GHB provides a short-term intoxication that is reminiscent of alcohol, but the user is often more clear-minded than when drunk. Some people often combine GHB and sex since the drug gives increased sex drive and less inhibitions.

    This also happens in the chemsex contexts - when queer men organize sex parties where mixing of illicit drugs and sex is the goal. "Party`nPlay", "chems friendly", "chems" are some of the codewords men use to signal their desire to use drugs to maximize sexual pleasure and socializing. Chemsex is spreading, which anyone who logs on to gaysir.no, Grindr or other check men's apps can observe.
  • A common concern when using GHB is overdoses. In London, a gay man dies every 12 days from a GHB-related overdose, which is the main reason why Chemfriendly was established. We are peer-to-peers that prevents overdoses by providing information on the safest possible use of recreational drugs, as well as user equipment.
    We have a website (chemfriendly.no), a facebook group, and a discussion group here at Gaysir. In these we publish short and informative texts on various recreational drugs, risk reducing dosages, prevention of overdoses and what to do if you are in a situation where some is in an overdose.

    There is relatively little research into the safest possible use of recreational drugs. The advice in this Op-ed is based on available studies, but also on user experience obtained from a large user population. So-called empirical knowledge.
  • In most cases a GHB overdoses normally mean that the user falls into a deep, anesthetic-like sleep, for anywhere from fifteen minutes to a few hours. If you have never seen a GHB overdose, it can seem tremendous. Before faling asleep, the person can wander around making monotonous and spasm-like movements. He or she can come up with provocative talk, grunts and otherwise be loud.

    Deadly overdoses are primarily associated with mixing GHB with other intoxicants. We especially want to warn against mixing GHB with so-called central depressant drugs - such as alcohol, benzodiazepines or opioids. This mixture can result in paralyzing of the breathing reflex so you stop breathing! Especially opioids can make you lessen your tolerance of GHB, so even doses that are normally unproblematic can cause overdose.

    Still, be aware that you can die from a GHB overdose where you have not mixed GHB with other intoxicants; if you fall asleep in a position where you have no free airways or are suffocated if you own vomit.
  • In small doses, GHB act as a central stimulant making you more energetic and awoke, while in larger doses it acts as a central depressant and makes you drowsy. It is a short-term drug and after an hour you have half the drug left in your body. The invigorating effect GHB has in low doses makes it easy to be fooled into thinking that the GHB is completely out when it's really only halfway out. This causes many to overdose because they re-dose more than they really need.

    Dosage of GHB is difficult as it often comes complete in a liquid solution and you never know how strong the mixture is. GHB is often available as GBL (and sometimes as BD; 1,4-butanediol). These industrial solvents turn into GHB in the body, are dosed differently and are often stronger in themselves than GHB. They can be identified by their chemical odor if the mixture is strong and they do not taste salty like GHB does, BUT identification can be difficult when diluted. Therefore, you rarely can be sure of what you have obtained, as well as the strength is unknown.
Never try out new GHB alone, but with someone who can take care of you should something happen.
  • If you have not previously tried out the GHB you have obtained, you should start with a maximum of 1 ml and see the effect for at least one hour before taking any more. This is usually too small a dose to cause an overdose. Always use a medicine syringe or other accurate milliliter measurement equipment to measure the correct dose of GHB - never a soda cork or similar. You can contact Chemfriendly if you would like to receive medical syringes and other equipment. Once you know how strong the GHB you have is, you should wait 3-4 hours until the effect of the test dose is completely out, before attempting a larger dose.

    Once you have found your ideal dose, use the stopwatch on your phone to keep track of the time to wait before you take another dose. When one hour has passed since you started to notice the full intoxication effect of the previous dose, you can take a new dose that is only half the starting dose. This provides stable intoxication/high without GHB increasingly accumulating in the blood for each new dose.
  • In case of GHB overdose involving sleep, always call 113. The police do not come, only the ambulance and they are there to help.
    There are two reasons why the ambulance might call the police. That is if they experience violence, or if someone dies - the latter is a good reason to always call 113 in overdose.
    Always place the person in stable lateral position to provide free airways. The AMK (Emergency/Ambulance) Central provides guidance in first aid when calling 113. Never leave anyone who has fallen asleep at GHB alone - this is to prevent abuse or robbery.
  • As the saying goes there is nothing that can make you "resistant" to GHB overdoses, but we want to challenge that myth. Cocaine, MDMA and amphetamines are central stimulants. GHB and stimulant drugs complement each other's effects. This means that you probably can tolerate more GHB if you have a stimulant in your body. This can protect against overdoses and users experience that if they notice that they have gotten too much GHB and start falling asleep, it helps to take centrally stimulating drugs against sleepiness.

    Others take more GHB than usual when taking central-stimulating drugs, since they can tolerate more. The dangers connected to this is if the stimulant leaves the body while you still have a higher dose of GHB in your blood than you normally take. This is especially true of short-acting stimulants such as cocaine (read more about this at Rusopplysningen.no).

    Chemfriendly therefore recommends that if you first mix GHB with a stimulant, mix it with long-acting stimulants, like amphetamines (but be careful not to take too much GHB, especially during the downturn!).
  • Back to the overdose situation: If the person stops breathing and the ambulance is far away, using a central stimulant is likely to wake someone who has overdosed on GHB. However, do not stop giving the mouth-to-mouth method of breathing.

    Chemfriendly talks to users who have been woken up from GHB overdoses by having amphetamine added for example through the nose.
  • Remember
    Central stimulant drugs affect the cardiovascular system, including through increased blood pressure. Cocaine in particular is associated with complications such as cardiac arrest, but also amphetamine can lead to cardiovascular problems. If you do not know the person in the overdose history of their illness, it may be dangerous to give the person an amphetamine / stimulant. Therefore, you should never give people in GHB-related overdoses amphetamines - unless they stop breathing and help is far away.
Published 5th of October 2019,og Gaysir.no: https://www.gaysir.no/#/artikkel/19988
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GHB, sex and overdose prevention
GHB is a drug that some people combine with sex, since it gives an increased sex drive and less inhibitions. The risk of overdose is high, and we want to challenge the myth that there are no measures to take that are likely to reduce the risk of GHB overdose.