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Article Excerpt
As global club and rave cultures continue to mutate and fragment, so too do the patterns and cultures of drug use so often associated with them. New drugs emerge and gain popularity just as older substances ebb and recede only to reappear in unfamiliar and often unexpected contexts. Illicit drug cultures are in this way ever changing, transforming both the ways in which these drugs are used and the manner in which users experience related risks and harms. This would appear particularly true in club and rave settings (St. John 2005). While much is known about the rise and continuing popularity of ecstasy, cocaine, and amphetamines within these settings, the emergence of a number of newer substances including gamma hydroxybutyrate (GHB), ketamine, and 2CI/B is less clear (see Hammersley et al. 2002; Dillon & Degenhardt 2001). The growing popularity of GHB within club settings has been especially controversial given the drug's significant overdose "liability" amid a range of related risks and harms (Caldicott et al. 2004, Mangan 2004:3). Little is known however, about how GHB first gained popularity as a recreational drug within club and rave settings, or about the prevalence and extent of the harms attending its use. Similarly, little is known about the cultures and contexts associated with GHB: how the drug is used, in what quantities, circumstances and settings.
Nonetheless, recent increases in the use of GHB have been associated with a series of acute problems in many parts of the world (Maxwell 2005, Caldicott et al. 2004). In Australia there have been a number of well publicized GHB overdoses at major dance events in recent years, while individual overdose presentations have become a regular weekend phenomenon at many inner-city hospitals (Caldicott & Kuhn 2001, Mangan 2004, Johnston et al. 2004). Presentation of overdose cases typically involves convulsions, depressed breathing, and passing in and out of consciousness (Caldicott & Kuhn 2001). It is this acute harm, with users requiring emergency first aid, that has attracted so much media attention and community concern (Beaumont et al. 2004). Meanwhile, the long term effects of GHB use are uncertain, with some researchers suggesting the drug may well be associated with both physical and/or psychological dependency, while others have identified evidence of a discrete withdrawal syndrome (Craig et al. 2000). Anecdotally, regular users have described a number of other problems associated with the drug including difficulties in judging an appropriate dose, difficulties in determining the strength of the drug, and difficulty in determining appropriate intervals between doses (Degenhardt et al. 2002; Nicholson & Balster 2001).
Reports of this nature underscore the urgent need for more comprehensive research on the subject of GHB use, associated risks, and harms both in Australia and elsewhere. Only one GHB specific study has been conducted in Australia (Degenhardt et al. 2002), and while this study was of a high standard, the relative paucity of the existing evidence base has made the planning of effective prevention and harm reduction strategies very difficult. It is for this reason that the present study is so timely, in that it is the first comprehensive account of the culture and context, risks and harms of GHB use in Australia. This focus on the cultures and contexts of GHB use is especially important given the range of research evidence from around the world highlighting the ways in which these cultural contexts frame both the specific manner in which illicit drugs are used and the distribution of risks and harms subsequent to this use Fendrich et al. 2003, Moore 2004, Rhodes 2002, Slavin 2004). Such approaches suggest that drug use ought to be conceived of as a complex cultural practice, grounded in users' lived experience of specific drug use contexts and "scenes" in which the meaning and significance of this drug use is constantly negotiated and renegotiated (Moore 2004:200-203).
Of key relevance here is the claim that the risks and harms associated with illicit drug use are themselves subject to a good deal of cultural mediation in ways that impact on both the manner in which these risks are defined and interpreted, and the ways they are subsequently managed (Duff 2003, Rhodes 2002, Le Breton 2004). This is apparent in club and rave settings where multifaceted and often poorly understood cultural norms, rituals and "scenes" structure, mediate the cultural experience of drug use, and the experience of drug related risks and harms (Malbon 1999, Duff 2005). It is only in carefully delineating such norms, rituals, and scenes, and the manner in which they are constituted and culturally transformed, that one might come to develop more culturally sensitive responses to the risks and harms associated with illicit drug use in diverse cultural settings.
The present study aimed to tease out some specific features of these club and rave "scenes" in further illuminating existing cultures of GHB use in Melbourne, Australia. The study also examined the manner in which GHB related risks and harms are mediated and structured in and through these same scenes. Such research is vital in the on-going development of more effective prevention and harm reduction responses to the problems associated with GHB misuse, particularly overdose. To this end, the study utilized both quantitative and qualitative research methods; a survey tool was designed to assess the incidence and prevalence of GHB use across diverse settings while follow-up in-depth interviews were completed in order to further explore specific features of these cultures and settings and the experience of GHB related risks and harms. Before turning to outline the findings of this study however, a brief review of the relevant research literature is provided.
Research background
Gamma-hydroxybutyrate (GHB), also known as GBH (Grievous Bodily Harm), liquid ecstasy, "G", or fantasy, is a central nervous system depressant originally used in clinical settings as a sedating anesthetic and to treat sleep disorders (Galloway et al. 1997). It is categorized in Australia as a Schedule 9 substance so its sale, supply, possession, and use are prohibited. Nonetheless, GHB has been used as a recreational drug among a number of cultures in Australia for over 20 years, though its use appears to be increasing more recently (Johnston et al. 2004).
Recreational use of GHB
While GHB has been available on the market in various licit and illicit forms since the mid-1980s in the U.S. and the early 1990s in Australia, it has only gained significant public attention in Australia in more recent times with the emergence of recreational forms of GHB use (Dillon & Degenhardt 2001). Dillon & Degenhardt (2001) report that the recreational use of GHB first emerged in Australia in Sydney's gay and lesbian community, before spreading to other recreational settings associated with the dance scene. An ever-burgeoning literature now exists on the use of illicit drugs in club and dance "scenes", although such a literature has typically focused on the far more widespread use of ecstasy and amphetamines than on GHB (Degenhardt et al. 2005, Duff 2005, Maxwell 2005). Despite this lacuna, the extant literature suggests that GHB has gained popularity in club and party settings due to its euphoric and aphrodisiac properties, and for the way it increases relaxation, sociability, and disinhibition (Johnston et al. 2004, Degenhardt et al. 2002). Conversely, many users report using GHB to abate symptoms of the "comedown" associated with the use of stimulants such as ecstasy or amphetamines (Winstock et al. 2001).
Procuring more specific and reliable data on GHB use in Australia remains fraught. GHB is not specifically mentioned in either the Victorian Youth Alcohol and Drug Survey (Department of Human Services 2005) or the National Health Survey (Australian Bureau of Statistics 2001). Historically, GHB use has not been tracked in the National Drug Strategy Household Survey either, though this changed in the most recent survey round completed in 2004 (Australian Institute of Health and Welfare (AIHW) 2005). First reported results from the 2004 survey indicate that approximately 0.5% of Australians over age 14 have tried GHB with the average age of first use 23.7 years (AIHW 2005:4-5). More specific results for young Australians (14-29 years) were not available at the time of writing.
Results reported by Degenhardt et al. (2002) provide further insights into the prevalence and patterns of GHB use in Australia. Drawing from a sample of 76 active users in inner suburban Sydney, the authors found that GHB use was relatively widespread among certain subcultural communities in these areas. Degenhardt and colleagues report that GHB is typically used by stable, educated, and well-functioning individuals, and often in conjunction with other drugs (Degenhardt et al. 2002:90-93). The Party Drugs Initiative (PDI) also attempts to track GHB use within youth populations in Australia (Johnston et al. 2004:10). Drawing data from a convenience sample of 100 regular ecstasy users in each Australian capital city, the most recent PDI report indicates that around 23% of participants have "ever" tried GHB, while approximately 10% reported using the drug in the six months prior to the interview (Stafford et al. 2005:102). It is not clear however, how generalizable these findings are given that the PDI has thus far failed to generate consistent data on GHB use in Victoria.
Moreover, these studies say relatively little about the cultures and contexts of GHB use in Australia, or about how these patterns of use may be changing. One must turn to the broader youth studies and subcultures literature to glean further insights into these questions. Much of this literature turns on the key insight that contemporary changes in the production and reproduction of youth subcultures may in many instances be traced to emergent trends in youth drug use and popular music (Malbon 1999, Measham et al. 2001). Researchers here argue that changing patterns of recreational drug use, coupled with the commodification of young people's leisure time and the increasing diversification of popular music styles and genres intersect in the creation of new and divergent youth "scenes" and subcultures (Measham et al. 2001, Miles 2000). John Fitzgerald (1998:41) for example, identifies three "axes" of this cultural differentiation in dance music (or "techno") scenes: a race axis, "which plotted the movement of the genre from black ... to white" audiences; the "authenticity axis" involving constant struggles between ostensibly "underground" and more commercial genres and styles; and the "locality axis" in which dance cultures evolved from their putative roots in Detroit and London to more contemporary, globalized iterations. To Fitzgerald's taxonomy one might add illicit drugs themselves as powerful symbolic determinants of sub-cultural affiliation. Distinct preferences for individual drugs (or combinations of drugs) thus emerge in parallel with specific subgenres of popular music in the creation of diverse cultural scenes or subcultures. Ciaran O'Hagan (2004:123-5) has noted how in the UK different illicit drug preferences are manifest in different "dance culture scene formations" such that LSD, "shrooms" and other hallucinogens are popular in "underground psy-trance" scenes, while cocaine and alcohol predominate in "UK garage" and "drum and bass" settings.
The key point here is that while to the outsider these popular genres might appear very alike, these "cultural scenes" are in fact quite distinct, founded in specific venues, specific performers and deejays, and specific drug preferences. Indeed as O'Hagan and others argue, these drug use preferences are often as important as distinctions in the style and genre of music in maintaining discrete "scene formations". It is in this sense that Fitzgerald (1998:53-55), borrowing from Deleuze and Guattari, describes these cultural scenes as "assemblages"; as powerful combinatory nexuses linking different corporeal styles and fashions, musical and drug preferences, desires, pleasures, local economies, practices, spaces and settings in the creation of distinct cultural formations. Importantly these assemblages also work to fashion the manner in which new drugs are introduced and negotiated; how they are used and how attendant risks and harms are managed (Southgate & Hopwood 2001). This process may be observed in the manner in which GHB has been introduced into many of these cultural scenes around the world.
As noted, GHB appears to have first emerged in club and dance cultures in the early 1990s in gay and lesbian party scenes and in the nascent and underground "acid house" parties that were flourishing in this time in the UK and on the west coast of the United States (Malbon 1999, Mattison et al. 2001). GHB at first remained a "niche" drug popular among more "hardcore" party-goers--those who regularly attended a variety of both legal and illegal parties and who regularly consumed a variety of illicit drugs at such events (Lewis & Ross 1995, Ross et al. 2003). Similar to ketamine, amyl nitrate, and methamphetamine, GHB at this time remained a drug that most tried sometime after establishing a regular drug use routine including the use of ecstasy, cannabis, and cocaine (Lewis & Ross 1995). GHB was in other words not a drug that novice or experimental users typically sought out, rather the drug remained less widely available than drugs like ecstasy and cocaine and so remained more "underground". It is arguable that the drug has today retained this particular symbolic valence. Indeed, the cultural and symbolic meanings attached to the use of GHB ostensibly remain very different to those associated with the use of cannabis, amphetamines, and even ecstasy (Reeders 2005, Moore 2004). GHB...
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