Deaths in the Lesbian, Gay, Bisexual and Transgender United Kingdom Communities Associated with GHB and Precursors

Abstract

Background Misuse of gammahydroxybutrate (GHB) and its prodrugs gammabutyrolactone (GBL) and 1,4 butanediol (1,4-BD) has increased greatly since the early 1990s, particularly amongst lesbian, gay, bisexual and transgender (LGBT) individuals in recreational and sexual settings, e.g. 'chemsex'. Objective and method This paper presents an overview of GHB pharmacotoxicology and provides analyses of cases in the LGBT population associated with use of these substances extracted from the UK's National Programme on Substance Abuse Deaths database, to which notification is voluntary. Results From 1995 to September 2013, 21 GHB/GBL-associated fatalities were reported. None involved 1,4-BD. Typical victims were: Male (100%); White (67%), young (mean age 34 years); employed (90%); with a drug misuse history (81%). Most deaths were accidental (67%) or related to recreational drug use (19%), the remaining (potential) suicides. The majority of fatalities (83%) occurred in private residences, typically following recreational use; others occurred in specific 'gay'-oriented locales including clubs and saunas. Three London boroughs accounted for 62% of all notified deaths, reflecting the concentration of both resident and visiting 'gay' individuals. However, this may be an artefact of the voluntary nature of the data submission procedure in particular areas. GHB/GBL alone was implicated in 10% of fatalities. The following substances were implicated either alone or in combination in the remaining cases (percentages may add to more than 100%): cocaine (38%); alcohol (33%); amphetamines (29%); ecstasy (29%); diazepam (24%); ketamine (24%); mephedrone (24%). Post-mortem blood levels: mean 660 (range 22-2335; S.D. 726) mg/L. Conclusions Significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, stimulants, and ketamine. Risk of death is increased due to their CNS-depressant properties. Of these, 'chemsex' drugs such as cocaine, mephedrone and ketamine are of note. More awareness is needed in the 'gay' community about risks associated with the consumption of such substances.

Mephedrone and Alcohol Interactions in Humans

“…With respect to acute mephedrone intoxication cases, it is notable that in 18.2% of cases, alcohol was also present (EMCDDA, 2016). Indeed, this concomitant use of mephedrone and alcohol in humans has led to several acute toxicities (McGaw and Kankam, 2010) and fatalities (Maskell et al, 2011;Regan et al, 2011;Cosbey et al, 2013;Elliott and Evans, 2014;Loi et al, 2015;Corkery et al, 2017;Papaseit et al, 2017). The latest results for acute drug toxicity presentations from the European Drug Emergencies Network (Euro-DEN) indicate mephedrone as the most common NPS involved (n = 88).…”

A deadly trend in fentanyl fatalities (England, 1998–2017)

“…NPSAD regularly receives information from Coroners on a voluntary basis on deaths related to drugs in both addicts and non‐addicts in England and Wales, Northern Ireland, the Channel Islands and the Isle of Man, as described previously . Reports were also received from the Scottish Crime and Drug Enforcement Agency between 2004 and 2011, and from the General Register Office for Northern Ireland since 2004.…”

“…NPSAD regularly receives information from Coroners on a voluntary basis on deaths related to drugs in both addicts and non-addicts in England and Wales, Northern Ireland, the Channel Islands and the Isle of Man, as described previously. 26…”

Consumo sexualizado de drogas entre hombres que tienen sexo con hombres residentes en España

“…Como resultado de todo lo anteriormente expuesto, el chemsex podría ser un importante motor de VIH y otras ITS (McCall, Adams, Mason y Willis, 2015). Se han descrito, además, otros efectos negativos sobre la salud como el mayor riesgo de muerte por sobredosis de GHB/GBL (Corkery, Loi, Claridge, Goodair y Schifano, 2018;Hockenhull, Murphy y Paterson, 2017) y los problemas de salud mental (Gonzalez-Baeza et al, 2018;Hirshfield et al, 2015;Kirby y Thornbern-Dunwell, 2013;Pakianathan, Lee, Kelly y Hegazi, 2016;Pufall et al, 2018). En Europa, la mayoría de los estudios sobre chemsex se han realizado en el Reino Unido pero en otros países europeos ha sido objeto de muy pocos estudios.…”