Club Drugs

A wave of new drugs has become increasingly popular with today's adolescents and young adults. These drugs are commonly known as club drugs, a term originating from the rave phenomenon. Many club drugs are also called designer drugs, referring to the fact that many of the drugs are manmade (for example, Ecstasy or ketamine) rather than found in or derived from nature (for example, marijuana or opium derivatives). Raves are all-night dance parties with loud, pounding music and flashing lights stimulating vigorous dancing.

• History: Initially popular in England in the 1980s, raves are now very popular in the United States. They are often held in inconspicuous places such as warehouses and are frequently announced with short notice. Unique to the rave experience, a stimulatory barrage -- frequently augmented by mind-altering drugs -- overloads the senses.
• Trends in drug use: The rave phenomenon in the United States has increased the frequency of use of club drugs. In a study of ecstasy (a popular club drug) use in raves, 89% of rave attendees reported using ecstasy at least once, and nearly 50% reported use within the past month. This study also found that current ecstasy users were more likely than nonusers and past users to have smoked marijuana and snorted powder cocaine within the past 12 months.
• Emerging recreational drug use: Club drugs have reflected changing trends in the recreational use of drugs in teens and young adults. These new types of drugs are often related to parental compounds of "traditional" drugs such as amphetamines and LSD. In other cases, they reflect the availability of cheap products creatively made from common items. As new recreational drugs emerge, potential users must be well informed of their associated risks. Unfortunately, many young people are obtaining this critical information from Internet sites that often provide incorrect and misleading information. In order to provide accurate information about commonly abused club drugs, professionally written summaries should be available to caregivers, adolescents, and young adults.
• Frequency of use: Club drugs are not only popular in raves but are often used in other social settings frequented by adolescents and young adults. In a hearing before the Senate Caucus on International Drug Control, the director of the National Institute of Drug Abuse reported an increase in the use of club drugs, especially ecstasy, among those older than 12 years. This is reflected in statistics like those reporting use of club drugs increasing from 5.1 million in 1999 to 6.5 million in 2000. While the rate of Ecstasy use has decreased somewhat since 2001, its potentially devastating medical complications continue to make its use a significant health risk. Emergency department visits related to the drug gamma-hydroxybutyric acid (GHB), also known as the "date-rape" drug, also increased dramatically from 1994 to 2000 (from 56 cases in 1994 to 4,969 cases in 2000); however, there has been somewhat of a decline in the use of GHB in the past decade.
• Importance of education: As the use of these new drugs increases, it becomes increasingly important to educate young people and their parents and guardians about the risks associated with club drug use.
  • Internet sites can be misleading, and some people are using these sites for information. One site (DanceSafe) tries to educate nonaddicted users to the risks of club drugs. It offers free testing of tablets submitted by mail and sells home testing kits to analyze the content of pills. The site even goes so far as to compare the risks of drugs to other activities. It states, for example, that Ecstasy and GHB are less risky than giving birth, motorsports, or water sports. Sites like this imply that club drugs are non-addicting and not significantly risky. This is simply untrue.
  • The medical literature reports that club drugs can be addictive and put users at risk for long-term consequences, including death.

Methamphetamine, also known as crystal, meth, crystal meth, ice, speed, tina, and crank, is an amphetamine derivative with similar stimulant properties. Ice began as a major drug problem in Japan. It first appeared in Hawaii and California in the mid-1980s and has now become one of the top illicit drugs in the West and Midwest.

• What it looks like: Methamphetamine powder can be inhaled, smoked, injected, or ingested. The inhaled or ingested powder eliminates the use of a needle, is longer lasting, and is often odorless, colorless, and tasteless. Crystal, also known as crank, meth, or crystal meth on the street, is a white or yellow product easily created in amateur laboratories. Many illicit chemists have used lead acetate as a substrate for its production, which can cause severe lead poisoning. Methamphetamine can be injected for an intense high, or it can be snorted.
• What it does: After the initial stimulating rush, a state of high agitation typically ensues, which may lead to violent and dangerous behavior. "Tweaking" is the term used to describe this agitated and often psychotic state. During this time, other short-term effects may include delusions, hallucinations, and paranoia, and users are at the greatest risk of being a danger to themselves and others. Some of the warning signs and symptoms of stimulant addiction include the following:
  • Irritability, nervousness
  • Wide mood swings, depression
  • Unreasonable fear, suspicion
  • Significant weight loss
  • Irregular sleep pattern
  • Clogged, runny nose
  • Neglect of work and studies
  • Withdrawal from family
  • Change in friends
  • Loss of money
• Harmful effects: Methamphetamine highs can last up to 20 hours; heavy users may stay awake for several days. Additional health risks include heart attacks, strokes, weight loss, malnutrition, fluid buildup in the lungs, and death. Methamphetamine is a highly addictive drug. It can damage nerve cells, thus causing mental impairment. Withdrawal results in abdominal cramps, gastroenteritis, headache, lethargy, breathing troubles, increased appetite, and profound depression (occasionally ending in suicide).

Ecstasy is the street name for the hallucinogenic methamphetamine derivative methylenedioxymethamphetamine (MDMA). First used in psychiatric patients, it became a popular recreational drug because of its hallucinogenic effects. Other street names for ecstasy include X, E, XTC, Adam, M&M, bean, roll, clarity, and essence. It gained popularity in the 1980s and can now be purchased on the street alongside other street drugs like cocaine and heroin.

• What it looks like: Ecstasy is usually taken in capsule or tablet form, although it can also be crushed into a powder and injected, snorted, or smoked. The tablets often come imprinted with popular logos such as Mercedes, Gucci, Nike, Versace, Rolls Royce, Golden Arches, and even Teletubbies.
• What it does: Ecstasy is a popular club drug because of its stimulant properties. Stimulants act on the body by constricting blood flow in the veins and arteries, increasing heart rate and blood pressure, eye pupil dilation, and sweating. The effects of the drug begin 15-60 minutes after ingestion and last one to six hours. This enables users to dance vigorously for long periods. Ecstasy also enhances feelings of emotional closeness (leading to the nickname "love drug") combined with a sense that everything will be all right.
• Harmful effects: Ecstasy increases chemicals in the body known as catecholamines. These chemicals cause blood vessel constriction and increase heart rate, which can lead to dehydration, high blood pressure, and severe rises in body temperature. It can result in complications like heart attacks, heart failure, strokes, and kidney failure. Death following chronic ecstasy use has been reported. Early deaths are most often due to dehydration that leads to heart, kidney, and liver failure. Later deaths most commonly result from seizures and a condition that causes abnormal chemistries in the blood.
• Ecstasy also elevates serotonin levels in the brain, thus causing hallucinations, decreasing appetite, and increasing body temperature. Ecstasy has been shown to damage brain cells, specifically neurons releasing serotonin. "Club kids" often chew on pacifiers to counteract bruxism, or teeth grinding, a common side effect of ecstasy. Chronic use may also lead to chronic mood instability, cognitive impairment, increased impulsivity, or psychosis. Withdrawal symptoms have not been reported.

Ephedrine: Ephedrine is a stimulant similar to amphetamine and is found naturally in the Chinese herbal medicine "ma-huang" and in "Mormon's tea." College students and truck drivers use it for its stimulant effect. Incorrectly viewed as a safe alternative to amphetamines, this "herbal ecstasy" has been associated with strokes and deaths in adolescents.

Ritalin: Ritalin (generic name, methylphenidate) is a central nervous system stimulant known on the street as vitamin R, R-ball, and skippy. This drug is used to manage attention-deficit/hyperactivity disorder (ADHD). Stimulants are the primary drugs used in treatment of this disorder and are effective 90% of the time. In the 1990s, the prevalence of methylphenidate use increased by 250% compared to the 1980s, but its use has somewhat declined in the past 10 years.

• What it looks like: Ritalin is a very difficult drug to make on the street, so users get Ritalin by taking prescriptions for medication written for others. Available in 5-, 10-, and 20-mg immediate-release tablets, the effects of Ritalin last up to four hours. Ritalin 20-mg, sustained-release tablets and Concerta (generic name, methylphenidate) 18-, 36-, and 54-mg extended-release tablets are used illegally on the street and sell for about $5. The legitimate wholesale price is about $0.28 to $1.03 per tablet.
• What it does: When used as prescribed, Ritalin reduces hyperactivity, impulsivity, and inattentiveness. On the street, the drug is used by crushing the tablet and snorting the powder through the nose or by crushing the tablets and dissolving the powder in water before injecting it. Both routes produce euphoria similar to that of cocaine. It is usually taken orally to stay awake.
• Harmful effects: These include palpitations, hallucinations, paranoia, fainting, agitation, dizziness, seizures, tremors, fever, sweating, chest pain, and irregular heartbeats, liver dysfunction, and death. Chronic use can result in withdrawal, which produces symptoms such as lethargy, paranoia, apathy, and depression. These symptoms are similar to those of amphetamine (speed) withdrawal.
• Similar drugs: dextroamphetamine/amphetamine (Adderall), methylphenidate (Concerta), dexmethylphenidate (Focalin), etc.

Phencyclidine (PCP): PCP is also known as angel dust, Love Boat, lovely, elephant tranquilizer, crystal, crystal joints (CJs), TAC, hog, and the sheets. It was first used in the 1950s as a general anesthetic with rapid onset but few side effects. It was rapidly discontinued in the mid-1960s because it created problems such as losing contact with reality or depression for people after surgery. By the late 1960s, it was solely used as a veterinary tranquilizer.

PCP abuse started in San Francisco, where the drug was known as the Peace Pill. PCP abuse first became widespread during the 1970s. The drug is easy and inexpensive to make and is often sold as other drugs, such as psilocybin, cocaine, amphetamine, LSD, and synthetic THC (marijuana). This has added to its wide consumption.

• What it looks like: Phencyclidine is available as white powder, liquid, tablets, leaf mixtures, and rock crystal forms. It is readily absorbed in water and alcohol. It can be smoked, inhaled, ingested, and injected. Leaf mixtures are made by sprinkling powder on tobacco, marijuana, mint, or parsley. Menthol cigarettes dipped into liquid PCP are known as supercools. Other names of cigarette PCP mixtures are hydro, dip, dippers, wet, and fry.
• What it does: PCP produces a dissociative state or an "out-of-body" experience. It produces symptoms similar to ketamine. The effects are felt most quickly with intravenous use (within minutes) and usually last for four to six hours. PCP crosses into the brain to produce dissociative symptoms (feeling disconnected), amnesia, delirium, disordered thought processes, frequent loss of ideas, paranoia, apathy, depersonalization (for example, the user feels like they are out of their own body, perhaps watching themselves as if they are on television), illusions, and delusions.
• Harmful effects: In large overdoses, symptoms can last from 24-48 hours. The dissociation can resemble schizophrenia. An overdose can produce high blood pressure, hostility, and alterations of body images. These unintentional actions have resulted in people jumping from heights. Neurologic signs, such as uncontrolled eye movements, inability to maintain balance, and difficulty speaking, may also occur. Users may lose consciousness (pass out) with large doses.

Ketamine: Ketamine, also known as special K, K, vitamin K, and fort dodge, is a derivative of PCP (a powerful psychedelic drug) that has become increasingly popular. Although more difficult to produce than PCP, users can obtain large, inexpensive quantities from some veterinary pharmacies. Ketamine is commonly used in hospitals for sedation and pain relief.

• What it looks like: Ketamine is abused in clubs and other social situations. Most often, ketamine is inhaled, but it may also be injected into muscle or fat just below the skin or placed into the rectum. It has also been used to ease the crash associated with cocaine or amphetamine binges.
• What it does: Ketamine increases blood pressure, heart rate, muscle tone, and salivation. The clinical effects begin within minutes and last up to an hour. Overdose, which is often referred to as falling into a "K hole," is common. Overdose is characterized by severe brain-body dissociation, or inability to sense what the environment is really like, and vomiting, restlessness, and tiredness. Ketamine can also produce an emergence reaction resulting in nightmares, floating sensation, visual and hearing disturbances, out-of-body experiences, agitation, and confusion that last up to a day after drug use. During this time, users are not necessarily asleep and usually remember the event.
• Harmful effects: Although the long-term effects of ketamine abuse have not been well studied, it is suggested that out-of-body experiences may recur even without the additional use of the drug, and psychosis (severe mental instability) from chronic use may occur.

Gamma-hydroxybutyric acid, or GHB, is a hypnotic depressant known on the street by several names: easy lay, Georgia home boy, liquid X, liquid ecstasy, liquid E, grievous body harm, Gib, G-riffic, natural sleep-500, gamma-oh, cherry meth, scoop, soap, salty water, organic Quaalude, fantasy, sodium oxybate, somatomax, and gamma hydrate. GHB is perhaps most commonly known as the date-rape drug.

• What it looks like: GHB usually comes in a liquid form that can be mixed with other liquids. Recipes for home synthesis are available on the Internet. 3-butyrolactone and 1,4 butanediol are derivatives of GHB that are converted to GHB after ingestion. They are often purchased by body builders at health food stores for their purported muscle-building and fat-burning qualities. GHB is less commonly available in the capsule form.
• What it does: GHB is a nervous system depressant similar to gamma-aminobutyric acid. Its effects range from drowsiness, forgetfulness, and loss of muscle tone to seizure-like activity, slowed heartbeat and breathing, and coma. The coma lasts one to two hours, with full recovery usually occurring by eight hours. In the date-rape scenario, it is often slipped into an unwitting victim's drink. By January 2000, the U.S. Drug Enforcement Agency had reported 60 deaths associated with GHB use. High school kids have been reported to use this substance as an alternative to alcohol. It leaves no odor for parents to detect, and the effects are gone by the time users return home from a night out.
• Harmful effects: Effects of the drug begin 15-60 minutes after use and typically last up to six hours. It can be detected in the urine up to 12 hours after ingestion. Tolerance (progressive decreased susceptibility to a drug's effects), dependence (compulsion to take a drug to experience its psychic effects or to avoid the discomfort of its absence), and withdrawal reactions have been reported with GHB use. Respiratory depression can be severe enough to require life support on a ventilator or breathing machine until the drug effects wear off.

Rohypnol (generic name, flunitrazepam) a potent benzodiazepine (a class of tranquilizing agents), is known as Mexican Valium, circles, roofies, la rocha, roche, R2, rope, and forget-me pill. It is available in more than 60 countries in Europe and Latin America, where its legitimate use includes preoperative anesthesia. This drug is not available in North America for sale or prescription. It is usually brought into the United States by mail. Florida, California, and Texas are the states that have had the most confiscations of rohypnol.

• What it looks like: The pills usually include a single score, the Roche imprint, and "1" or "2" to denote the tablet strength. The tablets are usually 1 or 2 mg in strength and are relatively cheap at only $5 per pill. Flunitrazepam is 10 times more potent than diazepam (the generic name for Valium) and is thus considered a cheap high. Rohypnol is odorless and colorless, making it easy to slip into someone's drink. Rohypnol has been associated with date rape.
• What it does: Rohypnol in low doses is a sedative and muscle relaxant. In higher doses, it can cause lack of muscle control, amnesia, loss of inhibitions, and loss of consciousness. The effects are usually worsened with alcohol. Sedation occurs within 30 minutes after ingestion, with peak effects at two hours. As little as 1 mg can impair an individual for eight to 12 hours.
• Harmful effects: Adverse effects include low blood pressure, dizziness, confusion, visual disturbances, inability to urinate fully, and, in some users, aggressive behavior. Dependence on flunitrazepam can occur. Withdrawal produces symptoms such as headache, tension, extreme anxiety, restlessness, muscle pain, light sensitivity, numbness and tingling of arms and legs, and even seizures.
• Detection: Benzodiazepines are easily detectable on most urine drug screens. However, flunitrazepam is used in such small doses and is so rapidly metabolized that it is not detected on standard drug screens, although it can be detected by specialized laboratories.

Inhalant abuse is also increasingly popular in adolescents and young adults. An inhalant is a vapor you breathe in. Of first-time inhalant users in 1998, 62% were 12-17 years of age. Inhalants may be liquid or gases.

• Nitrous oxide: This is an inhalant used in whipped cream chargers and dispensed into balloons. Known as whippets, abusers inhale nitrous air through the balloon. Nitrous oxide has anesthetic effects and may give a high from breathing the low oxygen content in the balloon. Sudden death has been reported from breathing air with low oxygen content. Other dangers include producing air bubbles in the lungs and chest and rupture of the eardrums. Chronic abusers may develop nerve damage.
• Hydrocarbons: Inhalants are often ingredients in household products such as paint cans and air fresheners. Hydrocarbons can be abused by huffing, bagging, or sniffing. Huffing involves inhaling vapors from a cloth soaked in hydrocarbons. Bagging is inhaling a hydrocarbon that was sprayed into a bag. Finally, sniffing is direct inhalation of the hydrocarbon from its source.
  • Hydrocarbons commonly produce euphoria, drunkenness, sedation, and low brain oxygen levels. They can cause brain damage as seen in abuse of toluene, a cheap inhalant that also causes muscle damage and dangerously low potassium levels.
  • Inhalants have also been associated with sudden death. This results from a startle reaction in which the heart becomes excessively sensitive to adrenaline because of hydrocarbon inhalant use.

Chloral hydrate: A sedative, chloral hydrate can be swallowed in the liquid or capsule form or inserted into the rectum. The combination of chloral hydrate and alcohol, known as a Mickey Finn, produces rapid loss of consciousness. This action of placing chloral hydrate into an alcoholic beverage of someone else without their knowledge is referred to as "slipping a Mickey." In addition to sedative brain effects, chloral hydrate also lowers a person's ability to breathe, irritates the gastrointestinal tract, and interrupts the normal beating of the heart. Mild use is similar to alcohol intoxication (drowsiness and unsteadiness). Users often have a pear-like odor on their breath. With increased use, chloral hydrate can cause death, usually from heart disturbances.

Dextromethorphan: An over-the-counter cough suppressant, dextromethorphan has gained popularity as a drug of abuse because of its structural similarity to PCP and morphine derivatives. It is also known as DM, Robo, and Robo shots. Dextromethorphan is a depressant that can produce a high with hallucinations similar to those of PCP at larger doses. Almost two 4-oz bottles of over-the-counter cough suppressant must be ingested to reach these doses. Nausea and vomiting often prevent drinking large amounts. Pure forms are also available over the Internet.

As is true with virtually any other mental health diagnosis, the fact is there is no one test that definitively indicates someone has a club drug use disorder. Screening tools, including online or other tests, may help identify individuals who are at risk for having this problem. Therefore, health care professionals diagnose club drug abuse or dependence by gathering comprehensive medical, family, and mental health information. The practitioner will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental health symptoms.

In asking questions about mental health symptoms, mental health professionals are often exploring if the individual suffers from club drug or other drug abuse or dependence disorders, as well as depression and/or manic symptoms, anxiety, hallucinations or delusions, behavioral disorders like attention deficit hyperactivity disorder (ADHD), or other substance abuse disorders. Practitioners may provide the people they evaluate with a quiz or self-test as a screening tool for substance use disorders.

Club drug addiction is a destructive pattern of the use of one or more substances in that group that includes tolerance to or withdrawal from the substance, using more quantities of the drug or for longer than planned, and trouble reducing its use. Other potential symptoms include spending an inordinate amount of time getting, using or recovering from the use of a club drug, compromised functioning and/or continuing to use of the substances despite an awareness of the detrimental effects it is having on one's life. An addiction to a club drug, like any other substance abuse or dependence, is appropriately considered a disease rather than a weakness of character or chosen pattern of bad behavior.

An unfortunate fact about the treatment of club drug and other street drug addiction is that it remains largely unutilized by most substance dependence sufferers. Less than 10% of people with a substance abuse disorder and less than 40% of those with a substance-dependence disorder seek treatment. Those statistics do not seem to be associated with socioeconomic or other demographic factors but do seem to be associated with the presence of other mental health problems (co-morbidity).

The primary goals for the treatment of addiction symptoms (also called recovery) are abstinence, relapse prevention, and rehabilitation. During the initial stage of abstinence, an individual who suffers from club drug addiction or other chemical dependency may need help avoiding or lessening the effects of withdrawal. That process is called detoxification or detox. That aspect of treatment is usually performed in a hospital or other inpatient setting, where medications used to lessen withdrawal symptoms and frequent medical monitoring can be provided. The medications used for detox are determined by the substance the individual is dependent upon. As with many drugs of abuse, the detox process from stimulants like cocaine, Ritalin, and Ephedrine is the most difficult aspect of coping with the physical symptoms of addiction and tends to last for days. Medications that are sometimes used to help stimulant addicts abstain from drug use include propranolol (Inderal, Inderal LA, InnoPran XL), which decreases some of the physical symptoms associated with withdrawal from stimulants, as well as vigabatrin (Sabril), a medication that treats seizures.

Often, much more challenging and time-consuming than recovery from the physical aspects of addiction to some substances is psychological addiction. For people who may have less severe club drug dependency, the symptoms of psychological addiction may be able to be managed in an outpatient treatment program. However, those who have a more severe addiction, have relapsed after participation in outpatient programs or who also suffer from a severe mental illness might need the higher level of structure, support, and monitoring provided in an inpatient drug-treatment center, sometimes called "rehab." Following such inpatient treatment, many club drug addicts may benefit from living in a sober-living community, that is, a group-home setting where counselors provide continued sobriety support and structure on a daily basis.

Also important in the treatment of club drug addiction is helping the parents, other family members, and friends of the addicted person refrain from supporting addictive behaviors (codependency). Whether providing financial support, making excuses, or failing to acknowledge the addictive behaviors of the addict, discouraging such codependency of loved ones is a key component to the recovery of the affected individual. A focus on the addicted person's role in the family becomes perhaps even more acute when that person is a child or teenager, given that minors come within the context of a family in nearly every instance. Drug dependency treatment for children and adolescents differs further from that in adults by the younger addict's tendency to need help completing their education and achieving higher education or job training compared to adult addicts who may have completed those parts of their lives before developing the addiction.

There are numerous individual treatments for club drug addiction. Relapse prevention uses methods for recognizing and amending problem behaviors. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of the substance altogether. Cognitive therapy techniques, like helping the individual recognize what tends to precede and follow their episodes of drug use, are often used to address this problem. Some treatment programs include drug testing. Twelve-step recovery programs like Narcotics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the person suffering from club drug addiction to increase their desire to participate in therapy. Stimulus control refers to a treatment method that teaches the drug dependent person to stay away from situations that are associated with drug use and to replace those situations with activities that are contrary to using drugs. Urge control is an approach to changing patterns that lead to drug use.

While group therapy can help teens stay sober, groups that include a number of teens who also engage in disordered behaviors can actually tend to increase drug use in this age group. Family interventions for drug dependence that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE). MDFT has been found to be quite effective. Longer-term residential treatment, often called rehab, of three to five months that addresses peer relationships, educational problems, and family issues are often used in treating drug use in teens.

For people in the earlier stages of club drug use (having access, but not having yet used a club drug), preventive measures are used. Therefore, limiting access to any drugs and teaching the individual how to recognize and avoid drugs in nightclubs are important. Also, addressing any risk factors of the potential club drug consumer or family and optimal parental supervision of youth and expression regarding parental expectations are often recommended. The approach to those who have experimented with club drugs should not be minimized by mental health professionals, since infrequent use can progress to the more serious stages of regular drug use if not addressed. Therefore, professionals recommend that the club drug-consuming individual be thoroughly educated about the effects and risks of drugs, that fair but firm limits be set on the use of any drugs, and that the user be referred for brief counseling, a self-help group, and/or family support group. People who have progressed to the more advanced stages of substance abuse and dependence are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.

Drug addiction increases the risk of a number of negative life stressors and conditions. Individuals who are addicted to cocaine are at increased risk for domestic violence. If treated, the prognosis of cocaine dependency improves significantly but is not without challenges. Recovery from substance abuse is usually characterized by episodes of remission (abstinence from drug use) and relapse.

Club drug abuse and dependence can increase the likelihood of engaging in unprotected sex and other unsafe sexual practices. That, in turn, tends to lead to higher rates of the transmission of sexually transmitted disease, including the human immunodeficiency virus (HIV).