How Geelong became an unexpected frontline for GHB harm

You’ve heard of heroin, crystal methamphetamine, and ecstasy, but have you heard of gamma-hydroxybutyrate (GHB)? This lesser-known drug is now causing a surge in ambulance attendances across Victoria, and it’s not happening where you might expect.

New research, led by Monash University, has revealed that the regional local government area (LGA) of Greater Geelong, near Melbourne, has emerged as an unexpected hotspot for GHB-related harms.

The city now accounts for one-third of all GHB ambulance attendances outside metropolitan Melbourne, surpassing inner-city areas traditionally associated with nightlife and club culture.

Dr Rowan Ogeil, the paper's senior author, says GHB first emerged in the 1960s as an anaesthetic and later gained the nickname “liquid ecstasy” due to the euphoric side-effects commonly associated with its use. GHB is a depressant drug that has traditionally been associated with nightclub, dance, chemsex, and festival scenes.

Read more: Sex, drugs and research: Review probes the world of ‘chemsex’

However, the research shows GHB is being increasingly used in private settings, away from the neon lights and crowds of nightclubs, festivals and bars.

A narrow window between desired effect and overdose

GHB-related harms have been increasing in many parts of the world, including Australia, and experts believe that the rise in polydrug (using multiple drugs at once) use involving GHB is partially responsible.

Overdose is common among people who use GHB because the difference in dose between achieving the “high” commonly associated with the drug, and a serious adverse effect, which can include overdose and even death, is very small, Dr Ogeil says.

Previous research has found that 56% of GHB-related ambulance attendances in Victoria between 2018 and 2021 involved overdose, with 45% resulting in loss of consciousness.

The emerging data shows how drug use patterns are evolving beyond traditional settings. When used in private settings, such as the home, overdose events related to GHB-use often require acute emergency care.

Shifting patterns of GHB harm: From urban to regional Australia

The new study, published in Drug and Alcohol Review, used ambulance data from the world-first National Ambulance Surveillance System (NASS) to examine 16,971 GHB-related ambulance attendances between January 2015 and March 2024.

Greater Geelong ranked fourth out of all LGAs in Victoria by total number of GHB-related ambulance attendances, recording a higher number of attendances than metropolitan LGAs Yarra and Stonnington, says lead author Naomi Beard. These areas are typically known for nightlife hubs in South Yarra, Richmond, Fitzroy and Collingwood.

Previous research from the same group found that GHB-related ambulance attendances in regional Victoria were 31% more likely to result in severe outcomes compared to metropolitan areas, a finding that reflects both the drug’s inherent dangers and limited regional healthcare resources.

The data also revealed clear seasonal patterns in Greater Geelong, with attendances peaking during summer months that coincide with the music festival season, presenting opportunities for targeted interventions during high-risk periods.

“These patterns show us where and when people need support most,” Dr Ogeil says. “Rather than waiting for emergency situations, we need accessible harm-reduction services that can engage with people before harms escalate.”

Why regional communities are particularly vulnerable

Increasing harms resulting from GHB use are not equally spread across the population. People under 30 and those who live in regional areas are more likely to have experienced an overdose from GHB.

The concentration of GHB harms in areas such as Geelong highlights how current public health approaches may not be reaching the populations most at risk, says Beard. The shift from traditional club settings to private homes, combined with limited regional healthcare resources, creates a particularly dangerous situation.

"Regional communities often have limited access to specialised alcohol, drug and other health and support services, meaning ambulance responses may be the only help available.”

Dr Ogeil says recent media stories from Geelong’s emergency departments have highlighted significant knowledge gaps within the community about GHB-related risks.

Research has also identified major gaps in understanding the signs of GHB overdose, misconceptions about home remedies for preventing overdose, and confusion about when emergency services should be called.

These knowledge gaps, combined with the seasonal patterns observed in regional areas, underscore the need for targeted harm-reduction responses that reach beyond traditional urban nightlife settings.

The path forward

The Victorian government is undertaking an 18-month implementation trial of drug-checking services, which has included mobile drug checking at five music festivals, including a site at the Beyond the Valley music festival located in the LGA of Greater Geelong over the 2024 New Year period.

Data from the trial shows that for more than 65% of the 1500 festival-goers interviewed by harm-reduction workers, this was the first time they had engaged in an honest and judgement-free conversation about their drug use with a healthcare professional.

This highlights the extent to which drug-checking services offer more than just testing of substances, offering vital opportunities to have conversations around reducing drug-related harm.

Following the successful pilot over the summer period, the Victorian government has announced the opening of a fixed-site service located in Fitzroy (in the LGA of Yarra), due to open by August 2025.

However, the research findings highlight an urgent need to extend these services to regional areas.

The results from our study, alongside results from the state government’s pilot, provide evidence that GHB and other drug-related harms are not geographically isolated to metropolitan Melbourne, and the benefits of drug-checking services should be available to people in regional Victorian locations.

Regional communities deserve equal access to these potentially life-saving services. Mobile drug-checking should continue at regional festivals across the Australian summer, while Greater Geelong must be considered for a permanent fixed-site service.