Table 3 Reported considerations that discouraged or motivated decisions to call emergency medical services in response to GHB overdose

Discouraging factors

Cost

Making someone else liable to pay an ambulance fee, disputes arising related to ambulance attendance fees

Hospitalisation distress

A concern for experiences of stigma against people who use drugs in hospital settings, distress and confusion associated with waking up in hospital

Legal ramifications

Belief that police will co-attend GHB overdose, fear of onwards legal ramifications

Overdose environment

Not feeling empowered to call an ambulance to another person’s residence, locations where other drugs present, sex occurring

Prior experience of GHB overdose

Prior experience of non-fatal GHB overdose; sense that overdose is transient and not harmful

Dually discouraging and motivating factors

Confidence to manage GHB overdose

Knowledge and prior experience of managing GHB overdose impacted anxiety around overdose response and willingness to call for an ambulance, those less experienced with GHB overdose were more willing to call EMS, by contrast to those with more experience of GHB overdose

Other respondents

Peer pressure not to call an ambulance or group collaboration and support for EMS call

Breathing assessment

Breathing deemed ‘normal’ prevented ambulance call, by contrast faint, shallow or abnormal breathing increased likelihood of EMS call

Responsive assessment

Ability to gain a response via pain or sound stimuli prevented ambulance call, no response increased likelihood of EMS call

Motivators

Accidental GHB ingestion

Rapid loss of responsiveness after accidental ingestion of a large dose of GHB motivated decision to call EMS on all reported occasions