Getting high and falling out on GHB

  • by Adam Echelman
  • Wednesday May 11, 2022
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After Franz Lao got sober from Gamma hydroxybutyrate (GHB or G), he became interested in karate again. He sees the process of teaching karate akin to the sponsorship component of the 12-step process, where one recovering person guides another into sobriety. Photo: Adam Echelman
After Franz Lao got sober from Gamma hydroxybutyrate (GHB or G), he became interested in karate again. He sees the process of teaching karate akin to the sponsorship component of the 12-step process, where one recovering person guides another into sobriety. Photo: Adam Echelman

The fall is so quick that most people can only remember where they landed: in someone else's bed, on a park bench, or in a hospital room. In fact, the process is so common with Gamma-hydroxybutyrate (GHB), or "G," that it's called "falling out." If you take just a drop too much G, you become manic and then drop into an almost comatose-like sleep, wherever that might be.

Colin, 53, who asked that his last name not be published, remembers the days of "party and play," when friends would spill in and out of his apartment while mixing G with meth and sex.

"I'd have one partner over. After a while, we'd both get bored of each other, go on to our phones, and scroll on to the hookup apps to see who else was there," he said. In a week, he could have 19 or 20 men to his house over countless hours until the point of exhaustion. Colin figured it was fine because he never used G alone, but sometimes, he would fall out after taking too much. Once he woke up after a party and realized that someone had rifled through his belongings and stolen his credit card and passport. Another time, he woke up in the hospital.

While the federal government primarily considers G a date-rape drug, something that people unknowingly take, numerous men and health providers in San Francisco shared with the Bay Area Reporter that G is also a recreational drug at raves and sex parties in the gay community. At the right dosage, it makes people feel a sense of euphoria and heightens their libido. The most common risk for these gay men is accidentally taking too much and falling unconscious, which can lead to sexual assault and, in some cases, death.

Much like using alcohol or other drugs, someone high on G is unable to give informed consent during sex. Some knock-offs of G take longer to metabolize, leading some people to question if they took enough and then to consume even more. When their words start to blur and their actions become frenetic, well-informed friends take notice and make sure that the person passes out in a way that's safe — in a position where they can continue breathing even if they vomit — and in a place where no one might take advantage of them.

Justin, who asked that his last name not be published, was well-versed in the various knock-off forms of G, like Gamma butyrolactone (GBL) and 1,4-Butanediol (BD/BDO). He had taken care of others when dosing went awry, and others had in turn taken care of him. One night was different though. He went out to dinner with some friends and remembers taking the first dose of G. The next thing he recalls is waking up, strapped to a bed.

He suspects that someone intentionally gave him too much, but his friends denied it. "There's no way that's possible," he doubled-down, feeling gaslit. The experience left him reeling. He entered a drug rehabilitation program afterward, but it didn't last long before he was using G again.

Finding treatment for G

That's in part because G is an addictive substance, which targets a neurotransmitter in the brain called GABA. If someone uses G with enough regularity, their body will panic when it's gone, leading to tremors or seizures. Withdrawing from G can take anywhere from one week to a month.

"Like Valium or benzodiazepines, the way to treat it is to give them something similar and then ween them off," said Ray Ho, managing director of the San Francisco division of the California Poison Control Center. He has handled questions about G since the early 2000s, when circuit parties started to proliferate in the gay community. Back then, he was getting a few calls a month from emergency rooms and doctors who had never seen it before. Those calls are fewer now, and the San Francisco Department of Public Health noted that there hasn't been an increase of G use in patients at Zuckerberg San Francisco General Hospital and Trauma Center. Ho suspects that the drop in calls is most likely because health providers today are just more familiar with it.

LGBTQ substance-use treatment facilities in San Francisco don't offer specialized programs for people who struggle to quit G. The authoritative guide of mental disorders doesn't include any mention of G; the closest equivalent might be "sedative use disorder," which aligns with the use of benzodiazepines. Many local clinics offer services for generalized substance use disorder and are welcoming to individuals who want to participate in their programs, regardless of the particular drug they use. For example, Lao got sober through Alcoholics Anonymous. "I just changed the word 'alcohol' and put 'GHB' in," he said. "But I didn't get the stories."

Newly appointed gay District 6 Supervisor Matt Dorsey also struggled with GHB use in the past along with other drugs like meth and ecstasy. In a recent interview about his becoming a member of the San Francisco Board of Supervisors, Dorsey disclosed to the B.A.R. that in 2000, during the dot-com era, he would take the drugs with other gay men at private social parties in people's homes. He also used drugs equivalent to Xanax to help bring him down off his highs.

"I got that under control but had a couple relapses since then," recounted Dorsey, an avowed alcoholic who has been sober now for the past 19 months.

An important part of the substance treatment process for many people involves sharing their — and listening to others' — experiences about their drug use. To Justin, the fact that there is no designated space for that conversation even at the Stonewall Project, a San Francisco AIDS Foundation harm reduction and substance use treatment program for gay men and trans men, seems to undervalue the role of G in San Francisco's gay community. (The Stonewall Project has discussed adapting one of the alcohol-focused programs, called Cheers Queers, in order to provide specialized support for people who use G in the future). At the very least, said Justin, "I think it behooves those of us who have that [G] in our story to be talking about it more regularly."

If it's not meth, is it a problem?

The Stonewall Project reported that almost half of its 120 clients have used G — but every client who is using G is also using meth. Even though G use is an important piece of many clients' substance experience, meth is usually treated as the more dangerous drug. A central component of the harm reduction strategy at the Stonewall Project is letting users determine how they want help, so many clients choose to stop using meth but to continue with G because the side effects are not as bad, officials said.

Indeed, meth has become a major problem far beyond the LGBTQ community. In 2021, 352 people died from meth-related overdoses in San Francisco, according to the San Francisco Office of the Chief Medical Examiner. Meth also induces psychosis in many users, creating both a widespread mental and physical health crisis for the city.

"In the aughts, when the first meth task force met, it was a problem, and particularly a problematic drug in the LGBT community, but by 2019. ... it was understood to be a huge problem in San Francisco," said gay District 8 Supervisor Rafael Mandelman. He is also the co-author of the 2019 Methamphetamine Task Force report recommending a series of new actions to tackle the "methamphetamine problem."

This graph shows the number of clients surveyed by the San Francisco AIDS Foundation and its Stonewall Project who report using various drugs.  

Some of those recommendations, like the creation of a trauma-informed sobering site and increasing non-law enforcement crisis response professionals, could support people using G as well, but there's no mention of G in the 45-page report. Mandelman explained that, based on the medical information he learned in making the report, meth is uniquely addictive and destructive. But he clarified, "If they're used together [G and meth] and it's exacerbating the meth crisis, that's very interesting and troubling."

By comparison, in 2021, four men in San Francisco overdosed from a mix of drugs that included GHB, said David Serrano Sewell, the chief operating officer of the medical examiner's office. Serrano Sewell noted that the "window of detection of GHB is relatively less than other drugs." If the medical examiner's office receives the body in the right time frame, staff have the tools to detect it. That window, however, is very short: G leaves the body between three and 10 hours: after death.

"People who overdose basically become sedated-looking, someone who had an anesthetic, a deep sleep," the poison control center's Ho said about G and pointed out that it is still used to treat narcolepsy. "As the dose goes higher, there's basically the risk that it suppresses your autonomic function, the ability to breathe on your own. That's where the danger is." Patients can choke on their own vomit, even if they look fine. It's similar to what happens when a person drinks too much alcohol.

At the hospital, doctors monitor a patient who overdoses on G, checking to make sure of the "ABCs:" airways, breathing, circulation. The problems arise when someone has been left behind for more than 12 hours, when they may have contracted pneumonia or other complications in their respiratory system. At that point, the window of detection for an autopsy has already expired too.

Living through G by the grace of God
When he hears stories of gay men who overdose and die on G or meth, Colin wonders if he would have been next. He thinks about the case of Gemmel Moore, 26, who in 2017 was found naked on a mattress in the living room of Ed Buck, a gay West Hollywood socialite and Democratic Party donor. It wasn't until another man died in the same apartment in 2019 and a third person had called 911 before the police arrested Buck. He had coerced at least 10 young, Black men to use dangerous levels of meth, G, and other drugs. Sometimes, Buck would inject them with meth while they lay unconscious. Buck was recently sentenced to 30 years in federal prison following his conviction last July in federal court.

There's also the case of Jaxon Sales, whose parents have called on the San Francisco medical examiner's office and the San Francisco Police Department to investigate the 2020 death of their son, after he overdosed on meth, GHB, and cocaine at the Rincon Hill apartment of an older white man. They allege that SFPD has yet to interview the older man and that staff at the medical examiner's office dismissed their concerns, saying, "the gay community uses GHB." (Serrano Sewell, at the medical examiner's office, previously would neither confirm nor deny that remark.)

"There but for the grace of God go I," said Colin, referring to every time he hears these stories. He is almost one year sober now, but the memories of the highs and lows of substance use still haunt him. After living in San Francisco for 27 years, he feels like the only way to extricate himself from his past is to move away for good. He wants to be a teacher in Nevada.

Meanwhile, Justin stands at the steps of the Castro Country Club, a clean and sober coffeehouse and meeting space in the LGBTQ neighborhood that has been integral to his recovery and that of so many others in San Francisco. He waves to passersby, who all seem to know him, whether they are headed to a nearby gay bar or a 12-step recovery meeting.

"The world seems more beautiful to me the more conversations I have with these folks about what the Castro Country Club means to them," he said and pauses, "I'm getting verklempt." He is back in school at age 41 and is producing a documentary film. It is called "Meet Me at the Club" — a reference to rave and party culture as well as his sober community at the Castro Country Club. "Gay culture has always centered around bars and clubs, and addiction behavior started at the clubs," he explains. "But this 'Club' is a community center."

If you're seeking help, visit the San Francisco AIDS Foundation's Stonewall Project or the UCSF Alliance Health Project.

This is the third in a three-part series on GHB and the gay community. To read the previous articles, click here and here.

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