With GHB, prevention beats intervention every single time.
A dangerous trend is re-emerging again across Australia, one that demands urgent attention and decisive action. GHB, often called “Grievous Bodily Harm” for good reason, is making a devastating comeback, with alarming new data revealing a troubling shift in who is being harmed.
Recent Australian research published in Addiction shows that GHB-related emergency department presentations in New South Wales have skyrocketed from 24.9 per 100,000 unplanned presentations in 2015-16 to a staggering 101 per 100,000 by early 2024. Hospitals recorded more than 9,600 emergency presentations during the study, and doctors intubated and ventilated about one in five patients.
But here’s what should alarm us most: young women are increasingly bearing the brunt of this crisis. Whilst men still represent the majority of overall cases, women now account for 51% of emergency presentations and 54% of hospitalisations amongst those aged 16-24. This demographic shift represents a fundamental change in the GHB landscape, one that our public health response has been dangerously slow to address.
The Perfect Storm: Policy Failures and Market Changes
Australia’s increasingly permissive approach to illicit substance use, with its over-emphasis on harm reduction at the expense of GHB prevention, has created fertile ground for GHB’s resurgence. This policy failure is compounded by concerning changes in the substances being sold on the street. Police seizure data indicates that 1,4-Butanediol (1,4-BD), a chemical that converts to GHB in the body, has become the predominant substance sold as GHB.
This substitution creates a deadly trap, as drinking alcohol alongside 1,4-BD delays its conversion to GHB — the body processes alcohol first, allowing toxic levels to build up unnoticed. Unaware of this delay, users often take additional doses, believing the substance is weak. The result? A catastrophic backlog of 1,4-BD waiting to flood the system once alcohol processing is complete: a recipe for overdose and death.
A clear warning was issued but went mostly unheeded when the United Kingdom’s Advisory Council on the Misuse of Drugs recommended moving GHB from Class C to Class B, placing it in the same category as cannabis and speed. This recommendation followed high-profile cases involving the UK’s most prolific rapist, Reynhard Sinaga, and serial killer Stephen Port, both of whom weaponised GHB to incapacitate their victims.
Understanding the Threat
GHB (gamma-hydroxybutyrate) is a colourless, odourless liquid that acts as a powerful central nervous system depressant. Marketed under street names like “G”, “juice”, “Gina”, and “fantasy”, it carries an extraordinarily high risk of overdose because the difference between a recreational dose and a lethal dose is perilously small.
The drug’s effects include:
- Respiratory depression, seizures, coma, and death, particularly when combined with alcohol or other depressants
- Rapid physical dependence, with withdrawal posing serious medical risks
- Unregulated strengths making accidental poisoning highly likely
- Amnesia and incapacitation, making it a weapon of choice for sexual predators
Between 2008 and 2018, coroners in England and Wales recorded GHB on 219 death certificates. Experts warn that this figure likely underestimates the true death toll because GHB leaves the body within 24 hours and is rarely tested for in post-mortem examinations.
Why the Harm Reduction Approach Is Failing
An ounce of prevention is worth a pound of cure, especially when the “cure” often arrives too late.
Dr Krista Siefried, Clinical Research Lead at the National Centre for Clinical Research on Emerging Drugs, highlights a key flaw in the current approach: “Because patients are often discharged quickly from the emergency department, there’s little chance to provide harm reduction education in that setting.”
This admission reveals the fatal flaw in over-relying on harm reduction strategies. By the time someone reaches the hospital with GHB toxicity, we’ve already failed them. Emergency departments become revolving doors, with limited opportunity for meaningful intervention before patients are discharged back into the same risky environments.
The regional spread of GHB use further complicates harm reduction efforts. GHB-related emergency presentations in regional or remote areas of NSW increased from just 3.4% of all cases in 2015-16 to 13.8% in the most recent reporting period. These communities often lack the specialised drug services and support networks available in major cities, making GHB prevention education even more critical.
A Prevention-First Strategy
We must shift our focus from managing the casualties of GHB (or any other drug) use to preventing new uptake altogether. This requires a comprehensive, multi-layered approach centred on effective GHB prevention.
Education and Awareness
Young people, particularly young women, need clear, unvarnished information about GHB’s dangers. Public health campaigns must move beyond the outdated narrative of GHB as merely a “chemsex” drug used predominantly by gay and bisexual men. Dr Siefried points out that women are often overlooked in research and public health campaigns about GHB use, except when it’s framed as a “date rape drug.” She stresses that it’s time for that to change.
School-Based Prevention
Mandatory drug education programmes must specifically address GHB’s unique dangers, including its role in substance-facilitated crime, its unpredictable effects when mixed with alcohol, and the deadly deception of delayed-onset substances like 1,4-BD. Young people need practical refusal skills to resist peer pressure and the confidence to intervene when friends are at risk.
Community Vigilance
Venues, event organisers, and individuals must take proactive steps to prevent drink spiking. This includes promoting anti-tampering devices, encouraging people never to leave drinks unattended, and fostering a culture where looking out for one another is the norm, not the exception.
Support Networks and Early Intervention
Accessible helplines, counselling resources, and family support services can discourage experimentation and provide early help before problems escalate. Parents must feel equipped to have honest conversations about substances, safety, consent, and peer pressure.
Law Enforcement and Regulation
Authorities must strengthen policies restricting the supply and distribution of GHB and precursor chemicals like 1,4-BD. The UK’s move to reclassify GHB as Class B demonstrates recognition of the drug’s serious harms. Authorities must prioritise actively monitoring suspected sales, especially on online marketplaces that sell “cleaners” and “solvents” that are actually GBL or 1,4-BD.
Positive Alternatives
Communities must provide young people with genuine alternatives to substance use: healthy social environments, stress management strategies, and engaging activities that don’t revolve around drugs and alcohol.
What Parents and Schools Must Do Now
The rising tide of GHB (and other drug) harm will not recede on its own. Parents and educators must take immediate action:
- Establish clear rules and boundaries regarding parties and substance use, and enforce them consistently
- Teach young people practical strategies to protect themselves from drink tampering and what to do if someone shows signs of GHB toxicity
- Foster open, non-judgmental conversations about safety, consent, and how to handle peer pressure
- Know the warning signs of substance experimentation and where to access help
- Challenge the permissive attitudes that normalise risky drug use
Prevention Must Become Our National Priority
Data from Australia and the UK clearly demonstrates that GHB affects more than just specific subcultures. It is a growing threat that is reaching new populations, spreading to new regions, and claiming new victims, particularly young women who have been largely invisible in our public health response.
GHB poses catastrophic risks that extend far beyond recreational use. From lethal overdoses to its criminal exploitation in sexual assaults and murders, this substance destroys lives with frightening efficiency. Harm reduction strategies, whilst well-intentioned, cannot adequately address a drug with such a narrow margin between intoxication and death, particularly when users are often unaware of what they’re actually taking.
We must lead with GHB prevention: strong, evidence-based education that reaches young people before they encounter GHB. We must combine this with vigilant communities, supportive intervention services, and robust policy responses that restrict supply and hold distributors accountable.
The choice is clear: we can continue down the path of permissive harm reduction, responding to crises as they unfold in emergency departments across the country, or we can adopt a prevention-first approach that stops those crises from happening in the first place.
For the sake of Australia’s young people, and particularly the young women now filling our hospitals with GHB overdoses, comprehensive GHB prevention strategies must become our national priority.
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