Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4 butanediol (1,4-BD; BDO) : a literature review with a focus on UK fatalities related to non-medical use

Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4 butanediol (1,4-BD) use extracted from the UK’s National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%), young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0 - 6500; S.D. 758) mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.Peer reviewe

MDAI (5,6-methylenedioxy-2-aminoindane; 6,7-dihydro-5H-cyclopenta[f][1,3]benzodioxol-6-amine; ‘sparkle’; ‘mindy’) toxicity : a brief overview and update

Objectives MDAI (5,6-methylenedioxy-2-aminoindane; 6,7-dihydro-5H-cyclopenta[f][1,3]benzodioxol-6-amine; ‘sparkle’; ‘mindy’) is a psychoactive substance, sold primarily over the Internet and in ‘head’ shops as a ‘legal high’. Synthesised and used as a research chemical in the 1990s, MDAI has structural similarities to MDMA and shares its behavioural properties. Recreational use of MDAI appears to have started in Europe around 2007, with a noticeable increase after 2009 in the UK and other countries. Calls to National Poisons Information Services started in 2010, although there were few presentations to Emergency Departments by patients complaining of undesirable physical and psychiatric effects after taking MDAI. Recreational use of this drug has been reported only occasionally by on-line user fora. There is little scientifically-based literature on the pharmacological, physiological, psychopharmacological, toxicological and epidemiological characteristics of this drug. Methods Recent literature (including ‘grey’) was searched to update what is known about MDAI, especially on its toxicity. Results The resultant information is presented, including on the first three UK deaths involving MDAI use in 2011 and 2012. “Serotonin Syndrome” appears to be a possible factor in these fatalities. Conclusion It is vital that any other cases, including non-fatal overdoses, are documented so that a scientific evidence-base can be established for them.Peer reviewe

Repertoires of Distinction: Exploring patterns of weekend polydrug use within local leisure scenes across the English night time economy

Presented here are the first findings of self report surveys of prevalence of illicit drug use by customers in the night time economy of a large English city. Five random sample surveys conducted with dance club customers and three similar surveys with bar customers identified an association between illicit drug use, entertainment type and venue type. Firstly, club customers were significantly more likely to report lifetime, past month and fieldwork night drug use than bar customers. Secondly, distinct and prolific polydrug repertoires were associated with the genres of electronic dance music favoured within different clubs, along with evidence of the growing popularity of emergent drugs such as MDMA powder. Such polydrug repertoires support the notion of culturally, spatially and pharmacologically distinct local leisure scenes operating within the contemporary night time economy; rather than the same broad mass of customers choosing different leisure experiences on different occasions, or the more fluid, ‘neo-tribal’ cultural groupings suggested by some. The paper concludes by suggesting that prolific and enduring weekend polydrug repertoires within local leisure scenes increasingly polarise such scenes from drug use in the general population, with implications for policing and governance, alongside the need for a more nuanced understanding of the night time economy as an analytical concept in social research