Harmen Beurmanjer

27 Review on the GHB using Population 2 median age 25 versus 35 years). The five studies reporting employment status showed unemployment in 48–70% of patients. Four studies reported on level of education, though information was inconsistent and difficult to compare. Psychiatric problems (30–92%) and GUD (77–100%) were reported in five and three studies, respectively. Higher GHB use was significantly associated with treatment drop-out (Cappetta & Murnion, 2019) and re-admission (Dijkstra et al., 2017). Most patients reported concurrent polysubstance use (68%−71%), mostly with alcohol (median 29%), cannabis (33%, 3 studies), cocaine (23%, 3 studies), benzodiazepines (22%, 2 studies), and MDMA (13%, 3 studies). Two studies mentioned the use of ketamine and mephedrone (respectively 3 and 37%; 7 and 48%). Amphetamine (25%), metham- phetamine (25%), and opioids (8%) were mentioned once. Last month percentages were substantially higher. Patients initially used GHB for recreational purposes (56%), like euphoria (54%) and improved sex (18%, 19%). Other reasons were friends use it (40%), sedation (27%), psychological reasons (22%), unsatisfied with other drugs (19%), no hangovers (16%), and cheap (11%) (Brunt, Koeter, Hertoghs, van Noorden, & van den Brink, 2013; Durgahee, Allen, & Williams, 2014). The most common reason why patients entered GHB treatment were because of sleep problems (31%), followed by social problem (23%), psychological problems (20%), physical problems (19%) and passing out (8%) (Brunt et al., 2013). A similar transition in motivation was reported by Dijkstra, de Weert-van Oene, Verbrugge and de Jong (2013), where patients initially used GHB for mainly positive reasons (euphoria, no hangover, enjoying sex more, etc.) followed by mainly negative reasons for using GHB during admittance for detoxification (eg. helping to forget problems, to help fall asleep, to prevent withdrawal, etc.). GHB-related mortality GHB-related mortality was found predominantly in males (69– 100%) with an average age of 29 years (range 25–34 years). Most people accidentally deceased after intoxication (86%), mostly at home or a friend’s place (49–67%), or in hospital (20–33%). Chemsex was mentioned in 25% of the cases (Hockenhull et al., 2017). Corkery, Loi, Claridge, Goodair, & Schifano (2018)) reported that 5% of the deceased people were unemployed. Most cases had co-ingestion with other psycho-active substances, predominantly alcohol (median 30%, five studies), MDMA (median 7%, two studies), amphetamine (median 32%), and cocaine (median 32%). Opioids (30%), ecstacy (29%), benzodiazepines (24%), ketamine (24%), mephedrone (24%), and cannabis (9%) were mentioned by one study. Two studies reported high comorbid substance use, but did not differentiate between different substances (Jones, Holmgren, Kugelberg, & Busardo, 2018; Zvosec, Smith, Porrata, Strobl, & Dyer, 2011). Reasons for GHB use was only reported in one study with 21 participants (Corkery, Loi, Claridge, Goodair, & Schifano, 2018).