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GHB, GBL & Related Compounds: Literature Review

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GHB, GBL & Related Compounds: Literature Review ACMD Advisory Council on the Misuse of Drugs An assessment of the harms of gamma-hydroxybutyric acid (GHB), gamma-butyrolactone (GBL), and closely related compounds November 2020 1 Contents 1. Introduction ................................................................................................................................... 4 2. Previous ACMD advice and legal status of GHBRS- UK ..................................................... 5 3. Chemistry and pharmacology ................................................................................................... 7 GHB ................................................................................................................................................... 7 GBL.................................................................................................................................................... 8 1,4-BD ............................................................................................................................................... 8 GHV/GVL .......................................................................................................................................... 9 4. Therapeutic and other legitimate uses of GHBRS ............................................................... 10 Therapeutic uses ........................................................................................................................... 10 Industrial/commercial uses .......................................................................................................... 10 5. Recreational use........................................................................................................................ 12 Routes of administration of GHB and related compounds ..................................................... 12 Availability of GHB and related compounds ............................................................................. 14 6. Prevalence and patterns of GHBRS use ............................................................................... 15 England, Wales, Scotland and Northern Ireland ...................................................................... 15 UK .................................................................................................................................................... 19 Globally ........................................................................................................................................... 20 Pharmacosex and chemsex ........................................................................................................ 22 7. Physical health harms .............................................................................................................. 24 Mortality .......................................................................................................................................... 24 Emergency department presentations and hospital admissions ........................................... 28 Neurological, cardiovascular and respiratory harms ............................................................... 30 Gastroenterological symptoms ................................................................................................... 32 Withdrawal syndrome (physiological and psychological dependence) ................................ 32 Polydrug use with GHBRS ........................................................................................................... 35 Chemsex and men who have sex with men ............................................................................. 36 8. Mental health harms ................................................................................................................. 39 Intoxication, delirium, psychosis, mood disorders and anxiety .............................................. 39 Memory disorder............................................................................................................................ 39 Intensity of withdrawal on cessation of drug use ..................................................................... 40 9. Social harms .............................................................................................................................. 41 Crimes facilitated by GHBRS ...................................................................................................... 41 Murder ............................................................................................................................................. 42 Drug-facilitated sexual assaults .................................................................................................. 42 2 Acquisitive crimes.......................................................................................................................... 44 Personal relationships .................................................................................................................. 45 Stigmatisation ................................................................................................................................ 45 GHBRS impaired driving .............................................................................................................. 46 Other................................................................................................................................................ 46 DFSA victim support ......................................................................................................................... 47 10. Conclusions and recommendations .................................................................................... 49 Monitoring: surveillance and data ................................................................................................... 49 Toxicology .......................................................................................................................................... 51 Enforcement ....................................................................................................................................... 51 Classification of GHBRS under the Misuse of Drugs Act 1971 (MDA) ................................. 51 Scheduling of GHBRS under the Misuse of Drugs Regulations 2001 (MDR) ..................... 52 Prevention and treatment ................................................................................................................. 53 Treatment ....................................................................................................................................... 55 Staff education and training ......................................................................................................... 56 Individual treatment interventions ............................................................................................... 57 Information and awareness for at risk groups .......................................................................... 57 Annex A: Chemical structures of the compounds being considered in this report ..... 59 Annex B: Quality of evidence ...................................................................................................... 60 Annex C: International legal status of GHBRS ....................................................................... 61 Annex D: Anecdotal evidence ..................................................................................................... 62 Annex E: Options and views considered for classification and scheduling .................. 63 Annex F: List of abbreviations used in this report ................................................................ 65 Annex G: ACMD membership, at time of publication ........................................................... 68 Annex H: Membership of the ACMD’s Drug use in the Lesbian, Gay Bisexual and Trans-gender (LGBT) Community Working Group ................................................................ 70 References ........................................................................................................................................ 72 References prior to 2015 ........................................................................................................... 82 3 1. Introduction 1.1. In January 2020 the Home Secretary commissioned the Advisory Council on the Misuse of Drugs (ACMD) to review the evidence for the classification of gamma- hydroxybutyric acid (GHB), gamma-butyrolactone (GBL) and related compounds under the Misuse of Drugs Act 1971 (MDA), and the scheduling of these compounds under the Misuse of Drugs Regulations 2001 (MDR). 1.2. In February 2020 the ACMD notified the Home Secretary that it would expect to provide initial advice by autumn 2020 and would also provide advice on other approaches that the available evidence suggests would be of value in reducing the availability, demand, and harms of GHB, GBL and closely related compounds. 1.3. The Home Secretary’s commission had been prompted by the suspected usage of GHB or a closely related compound in the criminal cases of Reynard Sinaga, and (separately) Stephen Port and Gerald Matovu. 1.4. This report reviews the evidence of harms of GHB and related compounds that have emerged since the ACMD’s last significant assessment of the risks of GHB and its prodrugs, GBL and 1,4-butanediol (1,4-BD) in [ACMD, 2008a]. The aim is to enable the ACMD to assess the level of harms associated with these compounds and to make recommendations to mitigate these harms
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