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6 GHB GHB is an acronym for gamma-Hydroxybutyric acid, which is a substance that is generally sold in liquid form. Popular names for GHB are “liquid E”, “liquid X”, or “G” (Benschop et al., 2009). The effects of GHB are similar to those of alcohol, but the drug can also induce hallucinations and may have a stimulative effect. Even in ‘ordinary’ recreational doses, GHB can have unwelcome effects such as tiredness, forgetfulness, nausea, vomiting and convulsions. In higher doses (overdose), the users can fall into a comatose state. The margin between the recreational dose and overdose is often small. After waking from coma, the patient feels wakeful and alert, but may also be disorientated or aggressive. Dependency may develop with long-term and intensive use of the drug. The ingredients for GHB, such as GBL (gamma-Butyrolactone) and sodium hydroxide (drain unblocker), are easy to procure. GBL is a caustic soda (cleaning agent) that can be ordered online. It its pure form, this substance is stronger than GHB, but usage is dangerous on account of its aggressive characteristics. Taken in undiluted form, GBL can cause irritation and damage to the oesophagus and stomach. 6.1 Recent facts and trends The main facts and trends concerning GHB in this chapter are: • Use of GHB in the general population and among school-goers in mainstream education appears to be relatively rare (§ 6.2, § 6.3). • Pupils attending special schools and juveniles in care have more experience of GHB compared to their peers in mainstream secondary schools (§ 6.3). • In recent years, GHB use appears to have spread from socialising juveniles and young adults in the Randstad urban belt to a larger group of young people in the provinces. These youngsters also use the substance outside of recreational settings (§ 6.3). • In recent years, treatment demand for GHB addiction has increased at a number of organisations for addiction care; however national data are incomplete (§ 6.6). • Between 2003 and 2008 there was a sharp rise in the number of GHB victims seeking help from the emergency services (§ 6.6). • The number of deaths related to GHB is unclear (§ 6.7). • GHB is a relatively cheap drug (§ 6.8). 6 GHB 133
6.2 Usage: general population The results of an Internet survey conducted in January 2009 among over 1,700 people aged 12 and older suggest that GHB use is rare in the general population. • Only one respondent (0.2%) indicated having used GHB in the past 14 days (Meerkerk et al., 2009). 6.3 Usage: juveniles and young adults School-goers Compared to other drugs, few school-goers attending mainstream secondary schools have experience of using GHB. • According to the Dutch National School Survey on Substance Use in 2007, 0.6% of school-goers aged 12-18 have ever tried GHB (Monshouwer et al., 2008). This drug was not surveyed in the 2003 survey. Pupils in special education Table 6.1 shows that pupils attending special schools have considerably more experience of GHB use than their peers in mainstream schools (Kepper et al., 2009). Ever use of GHB among pupils of REC-4 schools, practical education (pro), and learning support education (lwoo), is higher than among pupils receiving mainstream education. Table 6.1 Ever use of GHB among pupils in special and mainstream education, by age group 12-13 years 14-15 years 16 years Special education REC-4 I 4.7% 3.5% 7.1% Pro II 5.7% 5.2% 3.9% Lwoo III 5.0% 3.1% 4.0% Mainstream education 0.3% 0.8% 0.8% Percentage of ever users. Survey year for special education was 2008. Survey year for mainstream education was 2007. I. REC = Regional Expertise Centre. II. Pro =practical education. III. Lwoo = learning support education. Sources: Trimbos Institute; Trimbos Institute/University of Utrecht. Special Groups GHB use among socialising juveniles and young adults is considerably more common than among pupils in mainstream education, although age differences and differences in research methods mean that exact comparisons are not possible. • The few available data from research conducted between 2005 and 2009 show that between 2% and 16% of socialisers have ever tried GHB and between one and four percent have used it in the past month (Table 6.2) (Nabben et al., 2007a; Trimbos Institute/University of Amsterdam, 2010). 134 Netherlands National Drug Monitor - NDM Annual Report 2009
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Netherlands National Drug Monitor N
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Colophon Project Manager Dr. M.W. v
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Preface This is already the tenth A
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5.4 Problem Use 113 5.5 Usage: Inte
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List of abreviations and acronyms 2
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NEMESIS NFU NIGZ NMG NPO NRI NVIC N
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Summary Below is an outline of the
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The number of hospital admissions c
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GHB. In 2008/2009 4.6 percent of fr
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Deaths In the Netherlands, smoking
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Offences by drug users Drug users c
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Opiates Ecstasy Amphetamine Alcohol
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1 Introduction The National Drug Mo
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use, particularly cannabis, under-r
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information is available, this is b
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2 Cannabis Cannabis (Cannabis Sativ
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Figure 2.1 Cannabis users in the Ne
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Figure 2.2 Cannabis use among secon
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Cannabis and problem behaviour •
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Table 2.4 Cannabis use among pupils
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Table 2.5 Current cannabis use in s
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• The sharp increase in treatment
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Trends It is difficult to determine
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• The role of cannabis in all req
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- misuse or dependence on alcohol a
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At the Ambulance Transport Centre (
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• So far, epidemiological studies
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Quality and price The Trimbos Insti
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3 Cocaine Cocaine works as a stimul
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Age, gender and urbanisation level
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Special groups In certain groups of
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Table 3.3 Cocaine use in special gr
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and 7.7% in the U.K (England and Wa
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Table 3.5 Cocaine use among school-
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Figure 3.2 Number of (outpatient) a
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Figure 3.4 Admissions to general ho
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The Netherlands Cause-of-Death stat
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• Little is known as yet about a
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4.2 Usage: general population Heroi
Page 83 and 84: • In the province of Gelderland,
Page 85 and 86: Figure 4.1 Estimates of the number
Page 87 and 88: and syringes exchanged has been reg
Page 89 and 90: • Between 2001 and 2004 the numbe
Page 91 and 92: - misuse of or dependence on alcoho
Page 93 and 94: same time it should be noted that t
Page 95 and 96: International comparison The Europe
Page 97 and 98: The total number of chronic hepatit
Page 99 and 100: • It is thought that risk behavio
Page 101 and 102: the ICD-9 classification. Drug deat
Page 103 and 104: Amsterdam GGD Amsterdam reports the
Page 105 and 106: Figure 4.9 Number of drug-induced d
Page 107 and 108: • Pupils attending REC-4 schools
Page 109 and 110: 5.3 Usage: juveniles and young adul
Page 111 and 112: • In 2008, key observers in Amste
Page 113 and 114: Table 5.3 Use of Ecstasy and amphet
Page 115 and 116: Table 5.4a Use of amphetamines and
Page 117 and 118: Table 5.5a Ecstasy use among school
Page 119 and 120: Ecstasy • The number of (outpatie
Page 121 and 122: Figure 5.3 Numbers registered with
Page 123 and 124: • The same person may be admitted
Page 125 and 126: • The number of requests for info
Page 127 and 128: According to the EMCDDA, in other E
Page 129 and 130: Figure 5.6 Concentration of MDMA in
Page 131 and 132: Table 5.9 Number of samples contain
Page 133: • Consumers who had drug samples
Page 137 and 138: GHB use is more common among juveni
Page 139 and 140: • GHB use among school-goers is l
Page 141 and 142: Table 6.4 GHB incidents registered
Page 143 and 144: • Of the liquid samples sold as G
Page 145 and 146: • Total deaths from alcohol-relat
Page 147 and 148: Figure 7.1 Alcohol consumption amon
Page 149 and 150: Ethnic background • Among seconda
Page 151 and 152: Table 7.3 Percentage of current dri
Page 153 and 154: Table 7.4 Alcohol use in the social
Page 155 and 156: Holiday-makers • Research conduct
Page 157 and 158: Figure 7.3 Heavy drinkers by gender
Page 159 and 160: The countries with the lowest perce
Page 161 and 162: • In France it is more likely tha
Page 163 and 164: Figure 7.6 Age distribution of prim
Page 165 and 166: • In 2008, 337 day-care admission
Page 167 and 168: • In approximately 1,200 admissio
Page 169 and 170: Table 7.9 Estimated number of injur
Page 171 and 172: • On the basis of current researc
Page 173 and 174: Figure 7.10 Deaths from alcohol use
Page 175 and 176: • EU member states have different
Page 177 and 178: • Surveys by the Continuous Surve
Page 179 and 180: Figure 8.1 Percentage of smokers in
Page 181 and 182: 8.3 Usage: juveniles and young adul
Page 183 and 184: Special education Table 8.3 shows t
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Table 8.4 Smokers in the EU-15 plus
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medication, Champix ® , which was
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among passive smoking men, the elev
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Table 8.6 Deaths from lung cancer a
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Since 1 January 2003 it is no longe
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Table 8.8 Cigarette prices and taxe
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eported. These refer to 2007 in the
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Table 9.1 Criminal investigations i
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Table 9.2 Number of dismantled prod
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Table 9.3 Characteristics of suspec
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Figure 9.2 Number of Opium Act case
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Table 9.5 Opium Act cases as a perc
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Disposals by the courts (in the fir
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• Financial orders (Public Prosec
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Table 9.9 Prevalence of new crimina
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10.2 Drug use among offenders Drug-
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• In some two-thirds of cases opi
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I, II Table 10.2 Number of times th
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• The ISD has a capacity of 1,000
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• Although there are some female
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Clinical admission Admission to a h
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Mellow Type of music at raves that
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Secondary diagnosis A secondary or
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Dismissal on policy grounds Decisio
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eintegration and rehabilitation of
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I. Use and problem use Source Targe
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II. Treatment demand and treatment
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IV. Market information Source Targe
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Source Target group/subject Sources
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Appendix C Explanation of ICD-9 and
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Appendix D Websites in the area of
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Ministry for Health, Welfare and Sp
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Appendix E Drug use in a number of
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References Adlaf, E.M., Korf, D.J.,
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Coumans, A.M. (2005). Survival on t
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Ganpat, S., Wits, E., Schoenmakers,
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Knibbe, R.A., Joosten, J., Derickx,
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Monshouwer, K., Smit, F., De Graaf,
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Rigter, H., Van Laar, M. (2002). Ep
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Tweede Kamer der Staten-Generaal (2
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Van Leeuwen, F.E. (1999). Epidemiol
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In the Netherlands various monitori
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