Saturday, 25 March 2017

My cousin, heroin and how his death shaped how I work with young people today

One of the questions I am most often asked by students, teachers and parents alike is why I got into this area and why I am so passionate about the topic. There are really two parts to the answer - the first, fairly boring and uninteresting and the second, deeply personal ... 

The boring part is simply that I fell into it - there was no grand plan and I certainly never saw myself as ending up working in the alcohol and other drug field. Ask anyone I went to school (or teachers college or university) with  and they would say I was most probably the last person they would imagine would end up in that area. I trained as a primary school teacher, taught for a number of years and then left, moving through a number of jobs until finally ending up working at the National Drug and Alcohol Research Centre (NDARC) at UNSW. Schools would occasionally call the Centre and ask for a researcher to give a presentation to students and, not surprisingly, no-one was interested. One day, someone suggested I do it ... and that's how it all started ...

For the first few years it was simply something I did - it certainly wasn't a passion. In one of my previous jobs I had developed drug education resources so I knew the literature. 'One-off' presentations by outside speakers were not effective, with the classroom teacher being the best person to deliver drug education. Don't get me wrong, I loved working with young people again, but I didn't necessarily believe that I was making much of a difference - I didn't think I could ... That all changed in the year that my family discovered that my cousin David was using heroin ...

You often read about 'troubled' young people – that definitely described David. Red-haired, freckled and slightly overweight, he had always been self-conscious and really didn't know where he fitted in the world. My extended family, including David, all lived in the UK (my parents emigrating to Australia when I was 10) and so when they discovered that he was using heroin in 2000 they immediately asked if I would travel home to try and assist him to get onto some sort of drug treatment program. At that time he was 27-years-old.

Understandably, the whole family, but particularly my aunt (his mother), was devastated when David's heroin use was discovered. She came from a generation that simply did not understand illicit drug use. Although she had heard of heroin, it was something that characters in a movie or a television soap opera used, definitely not her son. When I flew to the UK it was as much to support her as it was to assist David to find a suitable program. She had so many questions and did not know where to go for the answers. She had done all the right things – she had gone to a counsellor, she had looked for a local parent support group – but she was confused and felt terribly alone. She was living in a different world to that of David, and regardless of the phenomenal love they had for each other, the chasm that was between them in terms of drug knowledge and experience was proving extremely problematic. When I arrived, my first priority was to stop my aunt from continuing to go to David's dealer to buy the heroin for him, as she innocently believed that, if she got caught, she wouldn't get into trouble because the drug wasn't for her. She was only helping her son - how could she get into trouble for that?

David and I immediately bonded. My family had moved to Australia when I was 10 and, although I had met him a number of times on previous visits, I really didn't know him at all. He always had problems in the years that I got to know him but, regardless of the issues, I found him to be a wonderful, caring human being. He was fascinated with what I did for a living and was always asking me questions about a whole range of substances. All of us had been completely unaware of his extensive drug use history. He had been using drugs for years, had tried almost everything and had even become involved in organised crime and trafficking. Like most drug users, however, he had no desire to hurt himself as a result of his drug use and although his behaviour could be extremely self-destructive, he was keen to find out as much as he could about the 'story' behind a range of drugs so that things would not go wrong. He told me over and over again that he would have loved to have been given the opportunity to hear some of the information I was sharing with him when he was younger. When I asked him what was wrong with the drug education he did receive from school and the like, one thing he said particularly resonated with me - "They kept telling me what they thought I should know instead of what I actually wanted to know ..."

From that day on I started to change how I present to young people, particularly in terms of the messaging I developed. It's no wonder that young people don't listen to us when it comes to this area, so much of the information we provide is designed to shock and scare. Drug education is about so much more than information provision, but it is a part of it - we need to make sure what we are providing them is credible and useful. We rarely, if ever, ask teens what they want to know in this area, instead focussing on trying to ensure that they never go near drugs. When I started to go into schools and ask students what information they would like, the overwhelming response was how to look after each other. Most of them drink or take drugs to have a 'good time', they certainly don't have any desire to hurt themselves or anyone else. What did they need to do if something went wrong? If we give them information like that, it still lets them know about the risks and hopefully illustrates that 'no use' is the best and safest option, it's just provided in a way that is more palatable to young people. When I started to change the messaging, the response from students changed dramatically ...

David died from a heroin overdose in 2007. He was 34-years-old. My cousin was a great success story in so many ways. Although he had had relapses he had found real happiness in the last year or two of his life. He had met someone and the last time I saw him he told me his life had never been so together. Six months before he died he had saved enough money to travel overseas with the girl he cared so much about and his life appeared to be heading in the right direction. We will most probably never really know what went wrong but regardless of what happened I know he is in a better place.

When I wrote my book in 2009 I dedicated it to David and his mother, my Aunty Pat (who sadly passed away last year). Both had been looking for answers to a whole range of questions about drugs for a long time. I don't think my aunt ever really got the answers she so desperately wanted and needed - I don't think any parent who loses their child ever does - but I did often say to her that it was my time with David that truly shaped what I do today. It certainly didn't stop her hurting (she never recovered from his death) but she truly appreciated that David's story and even his death had resulted in something positive ... 

Saturday, 18 March 2017

'Helicopter parenting': Take the quiz and see where you fit on the 'parenting continuum'

Parents have it tough! In many ways, when it comes to parenting, you're damned if you do and you're damned if you don't ... We constantly tell parents that they need to be involved in their child's life, to be interested in what they do, know their friends, where they're going and what they're doing, but at the same time we warn about the risk of 'overparenting'. This is a term used to describe a situation when parents are so protective of their children, so desperate for them to succeed in life, that they will do everything in their power to help them on their way and avoid anything potentially unpleasant. There have been a number of different types of overparenting identified over the past 20 years, with American media describing these over-zealous Mums and Dads as 'rescuers', 'white knights' 'snowplough' or 'bulldozer' parents and most recently 'lawnmower parents'. Interestingly, Scandinavian commentators have referred to this as 'curling parenting', using their unique sport to describe parents who 'sweep' away all difficulties!

But it is the term 'helicopter parenting' that has received the most attention. First coined way back in 1990 in a series of parenting books, it refers to "overly involved and protective parents who constantly communicate with their children, intervene in their children's affairs, make decisions for their children, personally invest in their children's goals, and remove obstacles their children encounter" according to those who have studied the phenomenon. Research has found that these parents are likely to be well-educated, dual-income Baby Boomers (although they are now being seen across all social classes) who have a range of resources at their disposal (e.g., money, time and skills) with which to overindulge their children.

Experts believe that helicopter parents behave this way because "they confuse love, protection, and caring" and try to prevent their child from failing in any aspect of their life. As a result, 'normal' parental concern is taken to a dysfunctional level. In a school setting, examples of this behaviour include calling teachers to demand a better grade for their teen, making excuses and accepting responsibility for bad behaviour and doing their child's homework for them. Here are some classic examples of helicopter parenting that I have either been told about or actually seen in the school setting:
  • a parent of a 15-year-old girl calling the school to complain about her daughter getting into trouble after not handing in an assignment on time, telling the teacher that it wasn't her daughter's fault. She (the mother) had had a headache the night before the assignment was due and that had put undue stress on the whole family. She demanded that the teacher apologise to her daughter and that she was given an extension
  • a number of years ago, the dance festival 'Big Day Out' used to be held on a weekday in Adelaide. Many of the schools I visit there would tell of their great frustration when large numbers of their students (particularly those in Year 11 and 12) would be absent on the day and then would turn up with notes from their parents claiming that they were sick! One school had almost 25% of their Year 12 group not show up one year ...
  • a father of a 16-year-old boy contacted me by email and asked for my assistance with his son's major research project. He sent me through a series of questions that he wanted me to answer and when I wrote back and asked if he could get his son to actually send the email and touch base with me (as I thought that was a key part of the actual project), he replied in the following way (and this is a quote!) - "He is very busy at the moment and very stressed. He doesn't have the time to contact the key informants so his mother and I have shared the load a little .."
  • a girls' school recently had their swimming carnival and had over one-third of their Year 10s not attend, with parents calling the school on the day to say their daughters were unwell
Now I get the swimming carnival thing ... I would have paid my parents to call the school and say I was sick on that day (and don't get me started on the athletics carnival - I think I would have considered selling my soul to the devil to get out of going to school on that day!) - but there was no way, absolutely no way, my parents would have done that. Lying to the school about your child being sick to avoid something they don't like is not a good idea and, although it may seem like you're 'protecting' them in the short term, there does appear to be a long-term impact as a result of this parenting behaviour. But when it comes to bizarre parents in this area, my all-time favourite story is as follows:

A teacher had gone to the local shopping centre at recess and happened to spot one of her students sitting in a coffee shop with a couple of other young people she did not know. She was not in school uniform. It so happened that she had noted this girl absent earlier in the day and knew that the school had not been informed that she would not be attending. She called the school and it was confirmed that the girl's parents had not informed the school of her absence. A phone call was then made and the mother answered the phone. She was then told that her daughter had been seen at the shopping centre and asked was she aware of it. What happened next was truly bizarre. Instead of saying 'yes', she knew and she had given permission for her daughter to have the day off (which would have been so easy to do), she told the Year 10 Co-ordinater that the girl was sick and upstairs in bed! The teacher assured her that she wasn't and the mother then claimed that she was in her daughter's room and was looking straight at her! What was so amazing was that by this time the teacher at the shopping centre had approached the student and was talking to the girl almost at exactly the same time as the mother claimed she was in bed ... The girl was truanting and, instead of supporting and thanking the school for letting her know, she lied to try to ensure that her daughter did not get into trouble ...

In the US there is currently a great deal of research being conducted on the impact of such parenting practices, particularly around their transition into adulthood (i.e., going to college or starting in the workforce). In their 2014 paper, Odenweller and colleagues wrote the following:

"What we do know is that children are being overindulged; and it does not seem to be a result of social economic classes but rather too much, over-nurturing, and soft structure. These three things have lead to a delay in the child’s transition into adulthood. It appears that children who are overindulged either have a prolonged time in the transition to adulthood period or never actually leave the emerging adult stage."

Even though this comes from a 'good place' - this is not healthy parenting. All any parent wants is for their child to he 'happy, healthy and successful' - that can't happen if they never become fully-functioning adults. I get why parents do this - everyone wants their child to have so much more than they did when they were young. They also want to keep their kids safe, no-one wants to see their child suffer in any way. Conflicts with teachers, not doing well at school, being bullied by their peers - I can't imagine what it must be like for a parent to have the person they love most in the world experience these problems and, of course, you need to do what you can to protect them. But, as already stated, don't confuse 'love, protection and caring' with dysfunctional 'overparenting'!

Little work, if any, has been conducted on what effect this behaviour has on young people during their early teens. When it comes to its impact on alcohol and other drug use, I have not been able to find any research on the area apart from a study that links helicopter parenting to children's use of recreational painkillers and anxiety and depression medications. As I have said many times before, the available evidence suggests that 'authoritative parenting ' (i.e., rules, consequences, bound in 'unconditional love') is most probably the best way to go and helps prevent, or at the very least, delay early drinking and illicit drug use.

So are you a 'helicopter parent'? There's a great little online quiz (just 10 quick questions) developed by the BBC that provides an insight to what type of parent you are. Once completed, it tells you where you sit on the 'parenting continuum'. The article also contains some really wonderful messages for parents who are struggling to get the balance right between loving and caring about your child and overparenting (e.g., it's okay for your kid to be bored, arguing and having a fight about something can be healthy and taking risks is normal and necessary). I have included the list below ...
  • the fun of boredom. Despite what your child may think, boredom is a gift! In these days of constant stimulation the brain can get overloaded
  • the power of sorry. Teach your child to be responsible for their own behaviour. Urge them to identifying how they can right the wrong
  • conflict resolution. Humans are wonderful in their diversity of values and opinions and, as a consequence, we all argue and it can be healthy
  • step back if you want them to step up. In this often hectic world of balancing work and parenting, it can be quicker to do it yourself. Don't!
  • educate yourself. A vital role of a parent is to prepare your child to live independently in the 21st century. Learn about opportunities and issues
  • embrace difficulty. Life is challenging so foster resilience in your child by not shielding them from problems or negative emotions
  • be risk takers. Life is risky. Let your child experience (controlled) risk so that they become risk aware and self sufficient
  • hug it out. Like other close bonds, the parent-child relationship is built on neurochemicals. So play, laugh, hug and talk to keep your bond strong.

As I always say, parents an only do the best they can do at the time. It is important to remember, however, that for your child to become a resilient adult who is able to cope with the world, they are going to have to fail, suffer hardships and experience setbacks. That is how they learn. That said, beating yourself up when you make mistakes helps no-one, least of all your child. As the BBC article says so eloquently:

"You don’t have to be the perfect parent, whatever that is, just a good enough one. We are all human and, however many children we may have, we are all still learning what is the best way to parent each child, so be kind to yourself!"

References:
Machin, A. (2017). Take the test: Am I a helicopter parent? (http://www.bbc.co.uk/guides/zs976yc#z87s3k7) accessed 18 March, 2017.

Odenweller, K.G., Booth-Butterfield, M. & Weber, K. (2014). Investigating helicopter parenting, family environments, and relational outcomes for millenials. Communication Studies 65, 407-425.

Friday, 10 March 2017

A practical guide to hosting a safe teen party at your home: All the things you've never thought of ...

Hosting a party or gathering for teenagers is a huge responsibility. You want those attending to have fun but, at the same time, it is your responsibility to provide a safe environment for that to take place. Things can go wrong. It is important to consider all the possible risks and put things into place to ensure the safety of not only your guests and your family, but also your neighbours and the wider community. The greater the planning, the more likely it is that things will run smoothly. 
The parties that are being put on by parents today are very different to those that many of us remember from our teens. Firstly, many of them are much larger events, with 60-80 teens on the invite list not being unusual (I can't personally see why any teen would ever need to have that many people but that's me - what do I know?). Secondly, where many of us only ever attended parties with people we knew well, today with the advent of the 'plus one' event, the mix of teens arriving at your door can vary greatly. No longer do you just see 15 and 16-year-olds at a 15th birthday party - girls are highly likely to bring their 17 or 18-year-old boyfriend (and possibly even their friends) and, as a result, the dynamics change dramatically!
So if you have actually made the decision to host an event at your home, what do you need to do to prepare for the night ahead to ensure it is as safe as possible for all concerned? I'm talking the actual 'nuts and bolts' here … As with any party it will be necessary for you to set-up during the day. This will involve decorating and laying out the party area, as well as ensuring that any equipment that needs to be used through the night is checked. If you are planning on hosting an event here are some of the basic things that many parents rarely, if ever, consider:
  • lock any side fences or gates – you want to limit the number of access points there are to the party to just one, i.e., the front door, or wherever you have made the entrance. Talk to your neighbours about locking or at least blocking access to their back gardens for the night as well – that may help to reduce any issues that they may experience
  • if possible, lock doors to areas of the house that you do not want accessed – if there are no locks, use furniture to block access
  • limit the amount of furniture in accessible areas – seating should be made available but it is best to use garden furniture (if you don't have enough of your own, borrow or hire some). Host parents often find their furniture damaged, even after the most sedate party
  • remove valuables from areas where guests do have access
  • ensure that electronic devices such as iPads, smartphones and computers are put away and are not left out, even in areas where guests do not have access
  • check garden for any hazards that guests could trip over, e.g., hoses, gardening equipment
  • if you have a pool, check that fencing is locked and secure – if you are allowing guests to swim, make sure you have a responsible adult in the pool area at all times
  • put your car in the garage and secure it – if you don't have a lock-up garage or you have more cars than garage-space, drop your car off at a nearby neighbour's house
  • secure your pets or take them somewhere else for the night
  • make a visit to as many of your neighbours as possible reminding them about the party – ensure that they have your mobile number so that if they have any concerns through the night, they can call you

Although some of these measures seem extreme, it is better to be safe than sorry. The vast majority of young people would never consider stealing from parents hosting a party, however, uninvited guests do make their way into these events (and remember, there are potentially all those 'plus ones' that no-one really knows anything about!) and, as a result, valuable property can sometimes be stolen. 
As the host, you are an important role model. As such, it would be wise to not drink alcohol yourself. Not only does it set a good example for those attending, it also ensures that you can deal effectively with any incidents that may occur through the night. Make sure you have your mobile on you at all times, ensuring that you can call for assistance should you need it, or your family or neighbours can get in contact with you.
Some of the things that need to be watched through the night include:
  • in addition to employed security or other adult, ensure you always have someone on the door or entrance area to the party that knows many of the invited guests – the beginning of the party this should be your son or daughter, but as the night progresses, this job should be handed over to a close friend who is able to provide advice
  • make yourself available to any parent who wants to meet you when they drop off their child
  • actively supervise – if you told other parents that you would be 'supervising' the event, make sure that's what you do. This is not about being intrusive and ruining your child's life – let your teen know beforehand how you plan to supervise and stick to that – they'll certainly let you know if you're stepping over the line!
  • check toilets regularly to ensure that they are working properly and are fully stocked
  • watch for signs of intoxication and act accordingly
  • ensure that food is always available
  • be mindful of noise levels – not just the music but also around guests arriving and leaving
  • stick to the stated finishing time – if you said the party was finishing at 11.00pm, it needs to be well and truly finished by that time. Music goes off and someone stands at the door watching the guests as they leave – hopefully being picked up by their parents and not simply walking off down the road

As I said, this is truly 'nuts and bolts' stuff - the practical things you need to do as a host to ensure the smooth running of a teenage party, as well as the safety of all who attend. I haven't even touched on issues around alcohol and how to deal with things such as gatecrashers, intoxicated young people arriving at the party and what to do if invitees try to bring alcohol into the party. I'll leave that for another time ... The sad part is that I hear from parents (as well as young people) who didn't consider the 'basics' and things went wrong. Parents who had prized possessions destroyed, teens having their valuables stolen and their pets hurt, as well as families having long-standing friendships with neighbours damaged - we may not be talking about deaths here, but they are all traumas that could have been avoided with just a little planning.

There is no handbook on how to be the perfect parent, you can only do the best you can do at the time. The same is true when it comes to holding an incident-free teenage party. There are guidelines that you can follow, some of which have been outlined. Without doubt the best thing you can do to reduce risk is to make the event alcohol-free. If a parent believes that this is not an option for their child at their stage of development, they need to make sure they take every precaution to make the party as safe as possible for all concerned.

Friday, 3 March 2017

Does where you live make a difference to your child’s potential alcohol and other drug use?

In Australia we know a great deal about the prevalence of drug use, particularly when compared to other countries in the world. The statistics that we have are often provided for particular states and territories, but you rarely see them broken down into greater detail than that. There are many reasons for this, but most importantly, the more detail given, the greater the chance of being able to identify who provided the information. This is particularly true of data on secondary school students' drug use. Even though people often request more detailed information on the drug use in a particular area, it is rarely, if ever, given as this could lead to a particular community being identified and result in the schools (or school) and their students in that area being labelled as having a 'drug problem'.

That said, we do have enough information to suggest that there are certain areas where we are far more likely to see particular drug use than others. For parents, this means that the area you live in could impact on the drugs your child may come into contact with and possibly consider using. There are three factors that relate to the risk of a particular drug being used by a young person, all of which, to some extent, may be influenced by the area in which you live:

  • availability of the drug
  • cost of the drug and/or how much money the young person has at their disposal
  • cultural acceptance of drug use by the peer group

Without doubt, there are some drugs that are easier to get in some areas than in others (although this has changed in the past 20 years as distribution networks have become more sophisticated and the web has allowed many substances to become far more accessible). Cannabis is possibly the best example here, with the far north coast of NSW acknowledged as one of the 'centres' of cannabis use in Australia, mainly due to the fact that there is a great deal of the drug grown there and particular cultural groups with positive attitudes towards cannabis have gravitated to the area since the 1970s. More recently, we've learnt more about the devastating impact that ready access to 'ice' has caused in small, regional centres across the country.

It is important to note, however, that even in areas where certain drugs are more available, they are not falling out of the sky! You still need to know someone to get them. As much as the media would love to tell you that there are evil drug dealers hanging out at the end of the schoolyard, this is not the case, and illicit drugs are not always that easy to come by. Drugs are not 'everywhere' and regardless of the perceived ease of availability of drugs in particular areas, it's not usually as simple as just walking down the street and being able to buy a gram of cannabis or a couple of ecstasy pills! Certainly there are a few places in the country where there are (or have been) 'street drug' markets (e.g., Kings Cross in Sydney, Nimbin on the far north coast of NSW) but these are few and far between and certainly not the norm.

Although access is important, in my experience, it is the amount of money teens have at their disposal that is one of the greatest risk factors in this area. I know parents in higher socio-economic areas don't like hearing this, but I see a far wider range of illicit drug use occurring in the wealthier parts of the country because to put it bluntly, these kids have the money!

One thing that many people forget is that drugs continue to be expensive. In fact, Australian drug users continue to pay more for most illicit drugs than those in other parts of the world. It is true that some drugs are now much cheaper than they used to be, particularly ecstasy/MDMA, but most illicit drugs are way out of the price range for most young people to use regularly (or they simply have other priorities when it comes to where to spend the money they do have). It is not until they have some sort of income stream that they can afford to outlay a sizeable proportion of their wages on drugs (one of the reasons why you see illicit drug use rise dramatically once they leave school). We rarely talk about it, but money (or lack of it) is one of the major barriers to young people experimenting with alcohol and other drugs. That is why I'm always surprised when I hear of parents handing out large sums of money to their teenage children, or not monitoring where their part-time job income is going.

But what about those kids who don't have much money? Well, firstly, I can pretty well guarantee that you will not find teens in lower socio-economic areas downing bottles of vodka and whiskey on a regular basis. They simply don't have the money to cover the cost. This is why you so often see crime associated with drug use amongst this group. Now that's not to say that there are not alcohol or other drug problems in these areas – it's just that they're different problems, often combined with a whole range of other social issues. Those with less money are going to be drinking cheaper alcohol products with higher alcohol content to ensure intoxication (e.g., cask wine or 'goon' as it is often called). As far as other drugs are concerned, if they can afford to buy anything they are going to be looking for a substance which gives them the 'bigger bang for their buck'!

The final thing to consider is the cultural acceptance of drug use by the peer group. It may take some time (as well as a little heartbreak and rejection), but during adolescence teens will identify with a particular group of friends that they will socialise with. Their choice of friends is not always something parents are comfortable with but realistically there is very little you can do about it, particularly if you want to maintain a positive relationship with your child. Some peer groups have a greater acceptance of drug use than others, with some frowning on the use of one particular drug, while encouraging the use of another. There are others that do not find drug use of any kind acceptable.

Cannabis use, for example, is closely linked to the surf scene and, although not all young people involved in surf culture will use the drug, it is highly likely that they will come into contact with it at one time or another. The same is true for the dance scene. If you live in or around the centre of any major city, or in a regional university centre, there is every chance your son or daughter may attach themselves to this scene. Whether or not a young person involved in the dance scene decides to use drugs or not, it is important for parents to know that it is highly likely that their child will come into contact with drugs if they regularly attend dance events.

So with those things in mind, what can you do to best protect your teen if you do live in a high-risk area (either with specific cultural or social issues or where there's simply lots of money)? Here are just a couple of suggestions:
  • talk about your concerns with your teen - acknowledge that they may find themselves in situations where drugs may be available, simply because of where they live or the group they associate with. Discuss what they could do in these situations and, if possible, use your own personal experience and how you dealt with a similar issue
  • keep the lines of communication open and let them know at every opportunity that they can come to you and talk about anything at anytime
  • ensure you make it clear to them that if there is greater access, there is always greater policing and the increased chance of getting caught. Talk about random breath testing (RBT) and roadside drug testing and why these law enforcement strategies are more likely to be seen in some places than others. A similar discussion can be had around drug detection dogs and their use in particular areas. What does this mean for your teen?
  • you can't choose your child's friends but you can certainly voice your concerns and set rules and boundaries around behaviour, particularly when it comes to potential drug use. If you are concerned about their peer group, try not to be judgemental and criticise their friends, but, at the same time, don't be afraid to let them know how you feel and why you are worried
  • most importantly, make it very clear where you stand about the use of alcohol and other drugs. As much as you may believe your views do not matter to your child, research shows that parental influence is still a major factor in the decisions most young people make

The area in which you live will almost certainly make a difference to the drugs your child comes into contact with. At the very least, monitoring where they go and who they're with, as well as how much money they have at their disposal, can make it far more difficult for them to access those drugs that are available. Most importantly, however, never forget that it is the relationship you have with your child that will have the greatest influence on how your child responds if and when they do come into contact with drugs, no matter where you live.

Saturday, 25 February 2017

What is GHB and why does it lead to so many overdoses? Sorting fact from fiction

Last weekend 22 people were hospitalized after overdosing at a dance event in Melbourne. According to a spokesperson for Ambulance Victoria, paramedics transported more than 30 people from a number of events across the city in that one evening, stating that it was it was "highest number of overdoses" they had seen "for some time". So what was the drug that caused all this chaos and is it a drug that parents should be overly concerned about?

The drug was believed to be GHB or gamma-hydroxybutyrate. This is certainly not a new drug and has been causing significant problems on the Australian dance/nightclub scene for over 20 years. The media rarely deals with drug stories particularly well, but this one they keep getting wrong and, as a result, there is a great deal of misinformation out there about the substance, what it is, how it is used and its harms.

Some of the statements made in the media last weekend included the following:

  • GHB is a new drug
  • the overdoses were due to a 'bad batch' of GHB
  • the overdoses were caused by a 'derivative' of GHB - GBL
  • GHB is also known as 'fantasy', 'liquid E', 'liquid ecstasy' or 'coma in a bottle'
  • it is a odourless, tasteless and clear liquid that is undetectable
  • GHB is a 'date-rape' drug often used in drink spiking

Some of these statements are just wrong (as already stated, GHB is certainly not a new drug), while others have some basis in truth. As with any drug issue, there is no 'black and white', instead there are lots of 'shades of grey' ... So, let's try and clear things up a little ...

Without a doubt, this drug singlehandedly changed the face of the dance/nightclub scene not only in Australia but around the world. Prior to G (how the drug is often referred to by users) being introduced to the scene, it was rare to ever see ambulances being called to nightclubs or dance events. Drug-related fatalities were extremely rare and although many people became unwell after using drugs at a dance festival or nightclub, for the most part, on-site medical staff could usually look after them without too many problems. That all changed when this liquid drug (the only drug bought and used in that form) started to be used by those on the dance scene. Suddenly people were passing out on dancefloors, their respiratory systems seemingly shutting down. If they were breathing it was only barely and then, to make matters worse, some of them would start to fit and convulse. We had no idea what was happening and some paramedics who arrived on the scene administered Narcan, believing they were seeing a heroin overdose. I remember working at one event in the late 90s where the medical team called almost 30 ambulances across a 3-hour period, often with the ambulance transporting 2 patients at a time!

GHB is a naturally-occurring neurotransmitter, as well as an illegal drug. GHB molecules exist in all of us and they are involved in the everyday functioning of the brain. One of the great problems with identifying if someone has died as a result of GHB is that the coroner has a difficult time in determining whether the GHB they find in the body was there to begin with or the person used the drug. It was first synthesized in the early 1960s and has been used in the treatment of schizophrenia, as an anaesthetic and even an aid to childbirth. For many years it could be bought over-the-counter in some parts of Europe and by prescription in others. 

When the drug first came onto the Australian scene back in the 90s (the first 'mass overdose' was outside a Gold Coast nightclub in 1996), users were actually using true GHB. This usually came in the form of a salty clear liquid but after the Gold Coast incident, governments across the country quickly made the drug illegal and we started to see another substance substituted - GBL or gamma butyrolactone. In fact, from what information we do have on the G available on the street, much of it is GBL and has been for some time.

Gamma butyrolactone (GBL), often used in products such as paint thinner, varnish and woodstripping products is mixed with other more easily obtainable substances to make GHB.  However, if GBL is taken into the body on its own, it metabolises into GHB, creating the same effects as GHB (although it can take a little longer to take effect, often leading to users thinking they haven't taken enough and then taking more and subsequently overdosing). It is an important solvent used in industry and, although it carries the same legal consequences as GHB if caught with it, it is easier to obtain (usually by contract burglaries or diversion from particular industries) and is also far more likely to be imported into the country illegally (there were 33 GHB detections by Customs in 2014-15, 133 GBL in the same time period). Although GHB is definitely preferred by users, it is more likely to be GBL they are being sold (why would dealers bother 'converting' the GBL if they don't need to?) ...

GHB/GBL is a powerful depressant and is highly 'dose-dependent', i.e., the difference between a 'pleasurable' effect and finding yourself in hospital on life-support is minimal. Take too much (and we are talking a usual dose for an adult man being around 2-2.5mls) and the user loses consciousness and their respiratory system may start to shut down. Why so many people overdose on it is because the 'high' they get from this drug is intense and when that feeling starts to subside (usually after about 40 to 90 mins), not surprisingly, they want to feel like that again. Mistakenly believing that the drug has worn off, they take another dose, not realising that they still have a reasonable amount in their system and subsequently overdose. It is rare (although not impossible) for users to overdose on their first dose (most tend to be young women who know little about the drug, who take a similar dose to the males they are with). Typically you see ambulances called to events when G users start to take their second and third doses (doses are usually spaced at least 2 hours apart) and this explains the 'waves' of overdoses that are usually reported.

When GHB first appeared on the scene, it was thought that using it with alcohol appeared to be the major cause of fatal overdose. When mixed with other drugs that slow the central nervous system, including alcohol and sleeping pills, the depressant effects of GHB are increased. This continues to be an issue and is the greatest concern of paramedics and emergency department workers who have to deal with this issue.

GHB/GBL is usually referred to by users as 'G'. When the Gold Coast incident occurred in the late 90s the term 'fantasy' was used by the media but I have never heard a regular user of the drug use that word. 'Liquid ecstasy' or 'liquid E' were certainly street terms used by dealers in the early 2000s to market the drug, particularly to young people, after GHB started to get negative publicity but it is important to remember that this drug is not related to ecstasy in any way. Goodness knows where the term 'coma in a bottle' comes from (maybe paramedics or law enforcement have referred to it in that way for obvious reasons) and I can guarantee you that no user of the drug would call it that - but it makes a great headline and, no doubt, we'll see it repeated many times.

When GBL (a liquid product) is converted into GHB it forms white crystals (as shown) that are then diluted into a liquid. This product is then sold to users by the millilitre. Most regular users purchase the drug in larger quantities (10, 20 or 50ml lots, some even by the litre!) and then take measured doses to events in small vials or bottles. Soy-fish containers (shown below) are particularly popular due to their size and the plastic they are made from, making them difficult to detect if users are searched or patted-down by security or law enforcement.

The term 'bad batch' was used by a number of media outlets, once again implying that there are 'good batches'. We see the media, as well as police, often use this to describe ecstasy when we see a cluster of overdoses or a death - it is not helpful and it is often based on no hard data. If we keep warning people about potential 'bad batches' when we actually don't know what really happened and we run the risk of being seen as the 'boy who cried wolf'. G is always a potentially risky drug and although it is true that due to the dilution process described above when converting GBL to GHB, some 'batches' may be considerably more concentrated than others, the overdoses are more likely to be due to a na├»ve group of users than anything else. GHB overdoses occur every weekend, in almost every city across the country, they are not unusual. Yes, the number was highly unusual but it's important not to throw around terms like 'bad batches' without any toxicological information ...  

Neither GHB or GBL (or any of the other substances such as that can be substituted for G) are odourless and tasteless and undetectable. Certainly GHB was originally available as a clear liquid but due to be it mistaken for water in a few well-publicised cases, manufacturers and dealers usually add food colouring to the mix. The colour was also used as a marketing tool. True GHB is often coloured blue and for a time was sold as 'blue nitro'. GBL used in industry is also usually coloured - most often a green or brown colour. None of these products are odourless and tasteless. Any user will tell you that at the very least G has a salty taste and, at worst, a particularly nasty chemical taste. It is certainly not undetectable, with users usually putting it into a sugary drink to avoid the unpleasant taste. It would appear that the taste is the easiest way to work out whether you have true GHB or GBL. GHB is usually a salt and will have a salty taste and smell (often described as similar to diluted sea water), whereas the solvent GBL is just that, a solvent. It has a very distinctive chemical taste and smell and is certainly not undetectable.

When GHB overdoses occur, the 'date-rape' death of an Australian woman on a cruise in 2002 and the drug's apparent use in drink spiking is also usually raised by the media in their reports. That was once again the case last weekend. Drink spiking is an area that people have very strong opinions on, particularly if they or someone they know believes they have been a victim of this crime. Although research shows that alcohol is most likely to be used in drink spiking crimes, many victims and their families, for a variety of reasons, refuse to accept that this is their case in their instance.

A number of drugs (including Rohypnol) are put forward as possible drugs that could be used but research has shown over and over again that, although routinely checked for, these drugs are rarely identified when someone is tested after an alleged spiking. The reason why GHB is often put forward as a likely drug to be used by perpetrators of this crime is due to the difficulty in identifying the drug in the system, i.e., if nothing else is found, it must be GHB.

There are, however, a number of issues with GHB being used in drink spiking. Firstly, it is a particularly dangerous drug to drop into someone's alcoholic drink or if the potential victim has been drinking. As appears to have been the case with the woman on the cruise, the mix can be lethal. Remember, this drug is highly dose-dependent. The spiker would have to be extremely careful with the dose they used and also have a general awareness of how much alcohol has already been consumed. But more importantly, as already discussed, anyone who has ever taken G knows that it is hardly tasteless and odourless – at the very least it is salty, at worst, extremely chemical tasting. This is hardly a drug you would not notice, unless you were pretty intoxicated. Could it be used in drink spiking? Absolutely! Is it likely to be used by perpetrators of this crime? Highly doubtful ...

We are going to continue to see issues with GHB/GBL - it has been around for over 20 years and won't be going anywhere, anytime soon. It is a particularly risky drug due to it being so dose-dependent and will continue to cause great problems for nightclub owners and promoters of dance events (who I can tell you, absolutely hate the drug!). The strain it puts on the ambulance service and emergency departments can be frightening. It does seem to have a bit of a resurgence in recent times however and that could be due to a number of factors:
  • it is relatively cheap - nowhere as cheap as it once was (it was once $1 per ml!), but certainly in terms of 'bang for the buck', users see the cost as well worth it
  • the quality is consistent - G really came into its own during a period when the quality of ecstasy was at an all time low. MDMA was difficult to find and people started to call ecstasy 'pills' - you didn't know what you were getting. G would always provide the required effect
  • users believe that it is not one of the drugs that can be detected by drug detection dogs - little information is publicly available on what substances the dogs are trained to detect but ecstasy/MDMA and amphetamines are regularly found

As far as I am concerned, it is the drug dog issue, combined, of course, with the fact that users enjoy the effects of the drug, that have ensured its growing popularity amongst a particular subset of partygoers. There is absolutely no evidence that drug detection dogs have had any impact on reducing illicit drug use but we do know that this law enforcement strategy has changed how some people take their drugs. I believe that they have also contributed to some users changing the drugs they use, causing them to start using potentially more risky drugs such as GHB.