Gamma-hydroxybutyrate, also known as "GHB" and "liquid ecstasy" is used for its euphoric and disinhibiting effects at low doses.
But the clear, liquid substance is notorious for the razor-thin margin between the amount required for a positive experience and an overdose.
A study has found the number of GHB-related deaths in Australia has increased tenfold since 2013, while the number of hospitalisations has tripled.
The study, led by the National Drug and Alcohol Research Centre, analysed coronial records, hospital data, treatment services, population surveys and interviews with drug users.
It found there was a statistically significant increase in GHB-related deaths from 0.02 per 100,000 people in 2013 to 0.24 per 100,000 people in 2022.
Researchers found GHB-related hospitalisations increased from 5.3 to 19.1 cases per 100,000 people, while treatment episodes increased tenfold, straining hospital and ambulance resources.
"GHB is a drug that carries quite a high risk of overdose and other harms," senior author of the study, Associate Professor Amy Peacock, told AAP.
"Those harms are rising and they are preventable."
St Vincent's emergency medicine director Dr Jonathan Karro said GHB-related presentations at the Melbourne emergency department had spiked in recent years.
"It's now a daily occurrence," Dr Karro told AAP.
"The spread of patients is much wider now too, with patients of all ages and backgrounds presenting at odd times."
Dr Karro said the substance poses unique challenges to clinicians because there is no antidote and patients are often unconscious.
Users are increasingly purchasing the substance by the litre, given its affordability at about $5 per dose, he added.
Although overall use remains low, national survey data suggests the share of Australians who have used it in the past year tripled over the decade.
Dr Peacock called for urgent improvements in health messaging related to GHB, focusing on the risks posed by repeat dosing and drug mixing.
"Repeated dosing can quickly lead to overdose because GHB builds up in the body faster than people realise," Dr Peacock said.
"And using it with alcohol, ketamine, or other depressants greatly increases the risk of respiratory depression and loss of consciousness."
The study suggested increasing availability was behind the spike in GHB-related hospitalisations, with illegal imports on the rise.
In May, Australian Federal Police (AFP) warned of a "tidal wave" of illegal importation of 1,4-Butanediol, the precursor to GHB.
The AFP seized more than 18.3 tonnes of the substance in the 12 months leading to March, more than any other drug.
"Our message to the community remains clear - there is no safe dose of this drug," Acting Assistant Commissioner Paula Hudson said at the time.
"By importing this substance into Australia, criminal networks are creating a demand and appetite for this illicit drug and the bigger the appetite, the bigger the profits."
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