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Freestone J, Ezard N, Bourne A, Brett J, Roberts DM, Hammoud M, Nedanoski A, Prestage G, Siefried KJ. Understandings, attitudes, practices and responses to GHB overdose among GHB consumers. Harm Reduct J 2023; 20:121. [PMID: 37660058 PMCID: PMC10475182 DOI: 10.1186/s12954-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.
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Affiliation(s)
- Jack Freestone
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
- ACON, 414 Elizabeth Street, Surry Hills, NSW, 2010, Australia.
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| | - Adam Bourne
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
- Australian Research Centre for Sex Health and Society, La Trobe University, Building NR6., Bundoora, VIC, 3086, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Mohamed Hammoud
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
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Morrison C, Lee JP, Gruenewald PJ, Marzell M. A Critical Assessment of Bias in Survey Studies Using Location-Based Sampling to Recruit Patrons in Bars. Subst Use Misuse 2015; 50:1427-36. [PMID: 26574657 PMCID: PMC5062950 DOI: 10.3109/10826084.2015.1018540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Location-based sampling is a method to obtain samples of people within ecological contexts relevant to specific public health outcomes. Random selection increases generalizability; however, in some circumstances (such as surveying bar patrons), recruitment conditions increase risks of sample bias. We attempted to recruit representative samples of bars and patrons in six California cities, but low response rates precluded meaningful analysis. A systematic review of 24 similar studies revealed that none addressed the key shortcomings of our study. We recommend steps to improve studies that use location-based sampling: (i) purposively sample places of interest, (ii) use recruitment strategies appropriate to the environment, and (iii) provide full information on response rates at all levels of sampling.
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Affiliation(s)
- Christopher Morrison
- Pacific Institute for Research and Evaluation, Prevention Research Center; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Juliet P. Lee
- Pacific Institute for Research and Evaluation, Prevention Research Center
| | - Paul J. Gruenewald
- Pacific Institute for Research and Evaluatio. Prevention Research Center
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Brennan R, Van Hout MC. Gamma-Hydroxybutyrate (GHB): A Scoping Review of Pharmacology, Toxicology, Motives for Use, and User Groups. J Psychoactive Drugs 2014; 46:243-51. [DOI: 10.1080/02791072.2014.921746] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Rebekah Brennan
- Post-graduate student (RB), Coordinator Substance Abuse Research Centre (MCVH), Waterford, Ireland
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Abstract
In recent decades, methamphetamine developed a peculiar geographic distribution in the United States, with limited diffusion in the Northeast. While use within gay clubs received attention, methamphetamine in club subcultures more broadly remains less clear. Using quantitative and qualitative data, we provide a descriptive assessment of methamphetamine use in club subcultures. Methamphetamine use in club subcultures often has instrumental purposes. The context of initiation into methamphetamine use and its close connection to cocaine shape later patterns of use. Viewing meth solely as a gay party drug misses a significant part of the population and may misguide public health strategies to reduce methamphetamine use in the Northeast.
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Affiliation(s)
- Brian C Kelly
- 1Department of Sociology, Purdue University , West Lafayette, Indiana , USA
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Dew BJ, Elifson KW, Sterk CE. Treatment Implications for Young Adult Users of MDMA. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2006.tb00010.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Brown PC, Alfonso J, Dunn ME. γ Hydroxybutyrate use: exploring the influence of outcome expectancies through memory modeling. Am J Addict 2011; 20:127-36. [PMID: 21314755 DOI: 10.1111/j.1521-0391.2010.00113.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gamma hydroxybutyrate (GHB) has been linked to overdose, criminal surreptitious administration, the need for emergency medical care, and fatalities worldwide. To begin to identify and understand the motivational factors that lead to the use of GHB, the present investigation utilized methods that have been successful in identifying potential expectancy targets and have been incorporated into prevention and intervention strategies successful in reducing high-risk alcohol use. In the present investigation, GHB expectancies were elicited from 926 voluntary participants aged 18-60 at a university in the southeastern United States to develop the GHB Expectancy Questionnaire (GHBEQ). The GHBEQ was subsequently administered to a different sample of 1,373 participants aged 18-55 in order to empirically derive the possible organization of GHB expectancies in memory, including likely paths of GHB expectancy activation. Findings suggest differences in GHB expectancies based on use history and sex. These results can be used to understand differences in GHB use for men and women, and to develop expectancy-based prevention and intervention programming to prevent and reduce its use in high-risk populations.
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Affiliation(s)
- Pamela C Brown
- Department of Psychology, University of Central Florida, Orlando, FL 32816, USA.
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Elifson KW, Klein H, Sterk CE. Young adult Ecstasy users who forego necessary medical care: a fairly common occurrence with important health implications. J Psychoactive Drugs 2010; 42:63-71. [PMID: 20464807 DOI: 10.1080/02791072.2010.10399786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examines the practice of foregoing necessary medical care in a population of young adult Ecstasy users. The objectives are to (1) investigate how the failure to receive needed medical care is related to drug-related outcomes, and (2) identify factors that are associated with receiving versus foregoing needed medical care. Face-to-face, computer-assisted, structured interviews were conducted with 283 active young adult Ecstasy users in Atlanta, Georgia between August 2002 and October 2007. Study participants were recruited using a targeted sampling approach. Results indicated that almost one-third of the young adult Ecstasy users interviewed did not receive the medical care that they needed during the preceding year. Foregoing such care was associated with a variety of adverse drug-related outcomes, including experiencing a greater number of negative effects from using Ecstasy, experiencing a larger number of drug dependency symptoms, a greater likelihood of ever having binged on Ecstasy, and a greater likelihood of being classified as a "high end" polydrug abuser. Several factors were found to be associated with a greater tendency not to receive the medical care they needed, including race (not being African American), educational attainment (having completed at least high school), self-identification as belonging to the lowest socioeconomic status grouping, low self-esteem, and having experienced sexual abuse during one's formative years.
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Affiliation(s)
- Kirk W Elifson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Scheier LM, Abdallah AB, Inciardi JA, Copeland J, Cottler LB. Tri-city study of Ecstasy use problems: a latent class analysis. Drug Alcohol Depend 2008; 98:249-63. [PMID: 18674872 PMCID: PMC2630416 DOI: 10.1016/j.drugalcdep.2008.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 05/30/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St. Louis, Miami, U.S. and Sydney, Australia. A satisfactory model typified four latent classes representing clearly differentiated diagnostic clusters including: (1) a group of sub-threshold users endorsing few abuse and dependence symptoms (negatives), (2) a group of 'diagnostic orphans' who had characteristic features of dependence for a select group of symptoms (mild dependent), (3) a 'transitional group' mimicking the orphans with regard to their profile of dependence also but reporting some abuse symptoms (moderate dependent), and (4) a 'severe dependent' group with a distinct profile of abuse and dependence symptoms. A multinomial logistic regression model indicated that certain latent classes showed unique associations with external non-diagnostic markers. Controlling for demographic characteristics and lifetime quantity of Ecstasy pill use, criminal behavior and motivational cues for Ecstasy use were the most efficient predictors of cluster membership. This study reinforces the heuristic utility of DSM-IV criteria applied to Ecstasy but with a different collage of symptoms that produced four distinct classes of Ecstasy users.
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Affiliation(s)
- Lawrence M. Scheier
- LARS Research Institute, Inc., Las Vegas, Nevada USA 89135,Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arbi Ben Abdallah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James A. Inciardi
- Center for Drug and Alcohol Studies, University of Delaware, 2131 Ponce de Leon Blvd., Suite 430, Coral Gables, FL 33134
| | - Jan Copeland
- National Drug and Alcohol Research Center, University of New South Wales, 2052 Randwick Campus, 23 – 32 King Street, Randwick NSW 2031 Australia
| | - Linda B. Cottler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA,Address Correspondence to: Washington University School of Medicine, Department of Psychiatry, Epidemiology and Prevention Research Group (EPRG), 40 North Kingshighway, Suite 4, St. Louis, Missouri, 63108 USA. Tel.: (314) 286-2252, Fax: (314) 286-2265, E-mail:
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Parsons JT, Grov C, Kelly BC. COMPARING THE EFFECTIVENESS OF TWO FORMS OF TIME-SPACE SAMPLING TO IDENTIFY CLUB DRUG-USING YOUNG ADULTS. JOURNAL OF DRUG ISSUES 2008; 38:1061-1081. [PMID: 20686625 DOI: 10.1177/002204260803800407] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Time-space sampling has been used to generate representative samples of both hard-to-reach and location-based populations. Because of its emphasis on multi-tiered randomization (i.e., time, space, and individual), some have questioned the feasibility of time-space sampling as a cost-effective strategy. In an effort to better understand issues related to drug use among club-going young adults (ages 18 to 29) in the New York City nightlife scene, two variations of time-space sampling methods were utilized and compared (Version 1: randomized venue, day, and individuals within venues: Version 2: randomized venue and day). A list of nightlife venues were randomized and survey teams approached potential participants as they entered or exited venues to conduct brief anonymous surveys. Over the course of 24 months, 18,169 approaches were conducted and 10,678 consented to complete the brief questionnaire (V1 response rate = 46.0%, V2 response rate = 62.5%). Drug use was fairly common, with nearly two-thirds of the sample reporting having ever tried an illegal drug and more than half of drug users specifically tried either MDMA/ecstasy and/or cocaine. There were few differences between young adults surveyed during Version 1 and Version 2. Time-space sampling is an effective strategy to quickly detect and screen club drug users. Although caution is urged, elimination of the third tier of randomization (i.e., individual level counting) from time-space sampling may significantly improve response rates while only minimally impacting sample characteristics.
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Sanders B, Lankenau SE, Bloom JJ, Hathazi D. "Research chemicals": tryptamine and phenethylamine use among high-risk youth. Subst Use Misuse 2008; 43:389-402. [PMID: 18365939 PMCID: PMC2536767 DOI: 10.1080/00952990701202970] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tryptamines and phenethylamines are two broad categories of psychoactive substances with a long history of licit and illicit use. Profiles of users of recently emerging tryptamines and phenethylamines are nonexistent, however, since surveillance studies do not query the use of these substances. This manuscript describes the types, modes of administration, onset of use, and context of use of a variety of lesser known tryptamines and phenethylamines among a sample of high-risk youth. Findings are based upon in-depth interviews with 42 youth recruited in public settings in Los Angles during 2005 and 2006 as part of larger study examining health risks associated with injecting ketamine. Youth reported that their use of tryptamines and phenethylamines was infrequent, spontaneous, and predominately occurred at music venues, such as festivals, concerts, or raves. Several purchased a variety of these "research chemicals" from the Internet and used them in private locations. While many described positive experiences, reports of short-term negative health outcomes included nausea, vomiting, diarrhea, disorientations, and frightening hallucinations. These findings, based upon pilot study data, move toward an epidemiology of tryptamine and phenethylamine use among high-risk youth.
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Affiliation(s)
- Bill Sanders
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Hollywood, California 90028, USA.
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Abstract
"Club drugs" encompass a diverse range of substances. Although efforts have been made to determine the extent of club drug use among the general population, it is equally important to assess patterns of use among key target populations from which drug trends typically diffuse. This paper describes the results of a survey focused upon club drug use among club-going young adults in NYC. Time-space sampling generated a sample of 1,914 club-going young adults (ages 18-29) who provided data on their use of six key club drugs: ecstasy, ketamine, cocaine, methamphetamine, GHB, and LSD, as well as data on their gender, sexual orientation, race/ethnicity, and other demographic variables. Club-going young adults report drug use at high rates-70% report lifetime illicit drug use and 22% report recent club drug use. Rates of club drug use differ by gender, sexual orientation and race/ethnicity. Male gender is predictive of ketamine, GHB, and methamphetamine use, while female gender is predictive of cocaine use. Gay/bisexual orientation and White race are predictive of the use of several club drugs. Greater health promotion efforts are warranted among this population. Intervention programs and campaigns should tailor specific drug messages to differentially target various segments of dance club patrons.
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Affiliation(s)
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY 10021 USA
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