The impact of gamma hydroxybutyrate (GHB) legal restrictions on patterns of use: Results from an International Survey

Aims: To conduct an Internet-based survey of gamma hydroxybutyrate (GHB) use and identify differences by respondent residence. Methods: We recruited GHB-knowledgeable persons via `social networking Internet sites'. Individuals (n = 314) or groups (n = 66) were approached based on GHB-use testimonials. Data collected: location, use and reason for cessation (if applicable). Findings: We recruited 155 GHB users. The US respondents (53 of the 70; 76%) compared to the non-US respondents (38 of 85; 45%) were older and more highly educated (p < 0.05) but manifest a three-fold greater adjusted odds of GHB cessation (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.4-6.9; p < 0.05). Of the 80 respondents stating reason for cessation, 36 (45%) cited legal risk, price, or access; 44 (55%) cited health or related concerns. The US compared to the non-US respondents more frequently invoked legal and related concerns (OR 2.5; 95% CI 0.99-6.3; p = 0.05). In a nested analysis, narrowly stated legal (n = 4/5 the US) versus health (n = 6/18 the US) reasons differed by location (p = 0.048, one-tailed). Conclusions: In the US, where GHB has stricter legal penalties, GHB cessation is more likely, with legal and related reasons more commonly invoked for cessation. These findings support a link between the declining US GHB abuse and more stringent restrictions, although other un-assessed factors may also explain this association.