Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB

•Pleasures associated with GHB relate to both sensation and interpersonal intimacy, GHB used to enhance sex across entire sexuality and gender spectrum.•New users vulnerable to overdose due to deficits in harm reduction knowledge, most long-term users report occasional overdose.•Variable accounts of differences between GHB, GBL and 1,4-BD, the safety of consuming alcohol prior to GHB use and overdose severity highlight priority areas for future GHB education interventions.•Experiences around GHB enhanced sexual violence warrants further attention in research and intervention responses. GHB is used among some sexuality and gender diverse populations at elevated rates, however little qualitative research has explored GHB use among these populations with regards to diverse contexts, settings, practices, and experiences of use. Internationally, harms relating to GHB overdose appear to be increasing. Research outlining consumers’ experiences of GHB-related pleasures and their strategies to reduce harms may inform GHB education and intervention responses. N = 31 participants reporting three or more occasions of GHB use within the previous 12 months were recruited via digital advertising and snowball methods. Semi-structured interviews were conducted, data were transcribed and analysed in NVivo using a thematic framework analysis. Emergent themes were charted, and divergences and convergences were considered with regards to the sexuality and gender identities of participants. Pleasures associated with GHB were described in relation to the sensation of the GHB high and experiences of intimacy, and connection. GHB was used to enhance socialising and sex in domestic, private, and commercial venues. Participants prioritised terminology of ‘control’ when describing their practices associated with GHB dosing, measuring, timing and peer moderation. Most participants reported personal experience of GHB overdose with loss of consciousness. Participants’ near-ubiquitous experience of GHB overdose highlights ongoing education needs around overdose prevention. Efforts must target people new to GHB use who appeared particularly susceptible to overdose. Inconsistencies in understandings around GHB overdose, the perceived severity of overdose and the differences between GHB and its precursors GBL and 1,4-BD, highlight potential focus areas of future education responses. Further research is required to better understand consumers’ experiences of sexual violence in the context of