Club Drugs

What are Club Drugs?

MDMA (Ecstasy), Rohypnol, GHB, and Ketamine are among the drugs used by teens and young adults who are part of a nightclub, bar, rave, or trance scene. Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use drugs, but those who do may be attracted to the generally low cost, seemingly increased stamina, and intoxicating highs that are said to deepen the rave or trance experience.

Current science, however, is showing change to critical parts of the brain from use of these drugs. Also, in high doses most of these drugs can cause a sharp increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure.

MDMA (Ecstasy)

MDMA is a synthetic, psychoactive drug with both stimulant (amphetamine-like) and hallucinogenic (LSD-like) properties. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. Its chemical structure (3-4 methylenedioxymethamphetamine, “MDMA”) is similar to methamphetamine, methylenedioxyamphetamine (MDA), and mescaline – other synthetic drugs known to cause brain damage.

MDMA also is neurotoxic. In addition, in high doses it can cause a sharp increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure.

Health Hazards

Brain imaging research in humans indicates that MDMA causes injury to the brain, affecting neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays a direct role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. Many of the risks users face with MDMA use are similar to those found with the use of cocaine and amphetamines:

Psychological difficulties, including confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia – during and sometimes weeks after taking MDMA.
Physical symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.
Increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease.
Also, there is evidence that people who develop a rash that looks like acne after using MDMA may be risking severe side effects, including liver damage, if they continue to use the drug.
Research links MDMA use to long-term damage to those parts of the brain critical to thought and memory. One study, in primates, showed that exposure to MDMA for 4 days caused brain damage that was evident 6 to 7 years later.
MDA, the parent drug of MDMA, is an amphetamine-like drug that has also been abused and is similar in chemical structure to MDMA. Research shows that MDA also destroys serotonin-producing neurons in the brain.

MDMA also is related in its structure and effects to methamphetamine, which has been shown to cause degeneration of neurons containing the neurotransmitter dopamine. Damage to these neurons is the underlying cause of the motor disturbances seen in Parkinson’s disease. Symptoms of this disease begin with lack of coordination and tremors and can eventually result in a form of paralysis.

Extent of Use

Community Epidemiology Work Group (CEWG)***
In many of the 21 metropolitan areas monitored by CEWG members, MDMA, once used primarily at dance clubs, raves, and college scenes, is now being used in a number of other social settings.

It is the most prominent stimulant used in Chicago; it is sold in many singles bars in Denver; it is used by a wide variety of age groups and in a number of recreational settings in Atlanta; it has become the drug of choice among white middle class young adults in Washington, D.C. In Miami in 1999, there were eight MDMA-related deaths, and five in Minneapolis/St. Paul. In Boston during the first three quarters of 2000, MDMA was the most frequently mentioned drug in telephone calls to the Poison Control Center. MDMA is usually taken orally in pill form, but snorting has been reported in Atlanta and Chicago, as has injecting in Atlanta, and anal suppository use in Chicago.

Ecstasy content varies widely, and it frequently consists of substances entirely different from MDMA, ranging from caffeine to dextromethorphan.

Emergency room data indicate that MDMA is increasingly used by marijuana users, with reports of MDMA in combination with marijuana increasing from 8 in 1990 to 796 in 1999.***

Ecstasy tablets seized by the Drug Enforcement Administration increased from 13,342 in 1996 to 949,257 in 2000.

National Household Survey on Drug Abuse (NHSDA)*****
Each year, NHSDA reports on the nature and extent of drug use among the American household population age 12 and older. The 1998 survey is the latest for data relating to MDMA use. It found that an estimated 1.5 percent (3.4 million) of Americans had used MDMA at least once during their lifetime. By age group, the heaviest use (5 percent or 1.4 million people) was reported for those between 18 and 25 years old.

Monitoring the Future Study (MTF)******
From 1999 to 2000, the use of MDMA increased among all three grade levels measured in this study – 8th, 10th, and 12th. For 10th and 12th graders, this is the second consecutive year MDMA use has increased. Past year use of MDMA increased among 8th graders from 1.7 percent in 1999 to 3.1 percent in 2000; from 4.4 percent to 5.4 percent among 10th graders; and from 5.6 percent to 8.2 percent among 12th graders. Also among 12th graders, the perceived availability of MDMA rose from 40.1 percent in 1999 to 51.4 percent in 2000.

African American students showed considerably lower rates of Ecstasy use than white or Hispanic students in the 2000 MTF. For example, past year use among African American 12th graders was 1.3 percent, compared to 7.6 percent for white 12th graders and 10.6 percent for Hispanic 12th graders.

Ecstasy Use by Students, 2000:
Monitoring the Future Study

8th-Graders

10th-Graders

12th-Graders

Ever Used

4.3%

7.3%

11.0%

Used in Past Year

3.1%

5.4%

8.2%

Used in Past Month

1.4%

2.6%

3.6%

“Ever used” refers to use at least once during a respondent’s lifetime. “Past year” refers to an individual’s drug use at least once during the year preceding their response to the survey. “Past month” refers to an individual’s drug use at least once during the month preceding their response to the survey.

Rohypnol, GHB, and Ketamine

GHB, Rohypnol, and ketamine are predominantly central nervous system depressants. Because they are often colorless, tasteless, and odorless, they can be added to beverages and ingested unknowingly.

These drugs emerged a few years ago as “date rape” drugs. Because of concern about their abuse, Congress passed the “Drug-Induced Rape Prevention and Punishment Act of 1996” in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault.

GHB

Since about 1990, GHB (gamma hydroxybutyrate) has been abused in the U.S. for euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s and until 1992. It was purchased largely by body builders to aid fat reduction and muscle building. Street names include Liquid Ecstasy, Soap, Easy Lay, and Georgia Home Boy. Even though GHB may be difficult to distinguish from water, it has appeared in law enforcement indicators, including seizures of large amounts in Minneapolis/St. Paul and Phoenix.*

Coma and seizures can occur following abuse of GHB and, when combined with methamphetamine, there appears to be an increased risk of seizure. Combining use with other drugs such as alcohol can result in nausea and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating.

GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD) have been involved in poisonings, overdoses, date rapes, and deaths. These products, obtainable over the internet and sometimes still sold in health food stores, are also available at some gyms, raves, nightclubs, gay male parties, college campuses, and the street. They are commonly mixed with alcohol (which may cause unconsciousness), have a short duration of action, and are not easily detectable on routine hospital toxicology screens.*

GHB emergency room mentions increased from 55 in 1994 to 2,973 in 1999.** In 1999, GHB accounted for 32 percent of illicit drug-related poison center calls in Boston. In Chicago and San Francisco, GHB use is reportedly low compared with MDMA, although GHB overdoses seem frequent compared with overdoses related to other club drugs.

Rohypnol

Rohypnol, a trade name for flunitrazepam, has been of particular concern for the last few years because of its abuse in date rape. It belongs to a class of drugs knows as benzodiazepines. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce “anterograde amnesia,” which means individuals may not remember events they experienced while under the effects of the drugs. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants.

Rohypnol is not approved for use in the United States, and its importation is banned. Illicit use of Rohypnol started appearing in the United States in the early 1990s, where it became known as “rophies,” “roofies,” “roach,” and “rope.” Emergency room mentions of Rohypnol were 13 in 1994 and increased to 624 in 1998; they decreased to 540 in 1999.**

Abuse of two other similar drugs appears to be replacing Rohypnol abuse in Miami, Texas, and Boston. These are clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril, and alprazolam (marketed as Xanax). Rohypnol, however, continues to be a problem among treatment admissions in Texas, particularly among young Hispanic males along the Mexican border.

Ketamine

Ketamine is an anesthetic that has been approved for both human and animal use in medical settings since 1970; about 90 percent of the ketamine legally sold is intended for veterinary use. It can be injected or snorted. Ketamine is also known as “Special K” or “vitamin K”.

Certain doses of ketamine can cause dream-like states and hallucinations, and it has become common in club and rave scenes and has been used as a date rape drug.

At high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems.

Emergency room mentions of ketamine rose from 19 in 1994 to 396 in 1999.** Recent use has been reported more frequently among white youth in many cities, including Atlanta, Baltimore, Boston, Chicago, Minneapolis/St. Paul, Newark, New York City, Phoenix, San Diego, Texas, and Washington, DC.*

Other Sources of Information

NIDA’s Community Alert Bulletin on Club Drugs
www.clubdrugs.org

National Clearinghouse for Alcohol and Drug Information (NCADI)
1-800-729-6686.

* The information in this fact sheet is taken primarily from the June 2000 Highlights and Executive Summary, Epidemiologic Trends in Drug Abuse, a summary of the proceedings of the June 2000 meeting of NIDA’s Community Epidemiology Work Group (CEWG). CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign countries who meet semiannually to discuss the current epidemiology of drug abuse.

** These data are from The DAWN Report, December 2000, by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report is available online at www.samhsa.gov or by calling 1-800-729-6686.

*** CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign countries who meet semiannually to discuss the current epidemiology of drug abuse. CEWG’s most recent report is Epidemiologic Trends in Drug Abuse, Advance Report, December 2000.

**** The 1999 Drug Abuse Warning Network (DAWN) emergency room (ED) data are from a national probability survey of 21 hospitals nationwide. The survey captures data on ED episodes that are related to the use of illegal drugs or the nonmedical use of legal drugs. The DAWN survey is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686, or at www.samhsa.gov.

***** The National Household Survey on Drug Abuse (NHSDA) is an annual survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Copies of the latest survey (1999) are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686, or at www.samhsa.gov.

****** The Monitoring the Future (MTF) survey is funded by National Institute on Drug Abuse, National Institutes of Health, and is conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th graders’ illicit drug use and related attitudes since 1975; in 1991, 8th and 10th graders were added to the study. For the latest, year 2000 study, 45,173 students were surveyed from a representative sample of 435 public and private schools nationwide; the student response rate was 86%. For the latest survey results, please visit the NIDA website at www.drugabuse.gov

1 U.D. McCann, et al. The Lancet, Vol. 352:1433. October 31, 1998.

2 G. Hatzidimitriou, et al. J. Neuroscience. 1999 19:5096-5107.