How is club drugs taken

The consequences can be catastrophic. During one rave-like music festival in California in , 49 people were taken to emergency rooms.

Some had simple heat exhaustion. But plenty of these concertgoers were experiencing problems due to drug use. Some people who are introduced to club drugs at raves get hooked on them. Cocaine, for example, can cause dramatic brain changes after just one dose. People who use the drug at a party may take several hits to keep the high going, and they may keep on taking the substance when the action is over.

But in general, researchers consider club drugs substances that boost energy, offer hallucinogenic properties, enhance a sense of connection, or all three. This is a dissociative drug that can make you feel disconnected from reality.

It takes just minutes to work, and people who take it can feel unusual for up to 24 hours, says the Center for Substance Abuse Research. The Food and Drug Administration prohibits both the sale and manufacture of this drug. But it is sold online from overseas dealers. At high doses, GHB can put users in a coma, experts say.

Other side effects include high blood pressure, vertigo, aggression, and vomiting. Those problems usually start within about 15 minutes, and some people need treatment to get better. This drug is better known by its nickname: ecstasy. The National Institute on Drug Abuse says more than 18 million people have tried the drug at least once, making it one of the most popular club drugs available. A hit can produce serious side effects, including body temperature increases, high blood pressure, and kidney damage.

Ecstasy can also alter the brain and cause long-term cognitive decline. This drug is a depressant, and it can be used to treat people with depression or insomnia. In a club scene, it can be used to incapacitate a rape victim. The person becomes pliant and easy to overpower, and they may be unable to remember what happened. People who are interested in sedating drugs can, and do, become addicted to Rohypnol.

Hallucinations and sensory distortions are part of the club scene, and DMT can deliver both. Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation.

The most widely used club drugs are 3,4-methylenedioxymetham-phetamine MDMA , also known as ecstasy; gamma-hydroxybutyrate GHB ; flunitrazepam Rohypnol ; and ketamine Ketalar.

These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician.

Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression.

There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug overdose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Table 1 1 lists the various street names for these agents. Club drugs are favored over other recreational drugs, such as marijuana, lysergic acid diethylamide LSD , methamphetamine, and opiates, because they are believed to enhance social interaction.

MDMA is structurally similar to amphetamine and mescaline, which is a hallucinogen. However, it is not as stimulating or addictive as amphetamine, and is considered much less likely to cause psychosis than LSD and other potent hallucinogens.

Ketamine is a dissociative anesthetic that produces a dreamy tranquility and disinhibition in small doses. Unlike opiates, these sedatives encourage sociability and seldom cause nausea.

Mexican valium, circles, roofies, la rocha, roche, rophies, R2, rope, forget-me pill. Information from Gahlinger PM. Illegal drugs: a complete guide to their history, chemistry, use and abuse. New York: Plume, — The popularity of these club drugs is due to their low cost and convenient distribution as small pills, powders, or liquids that can be taken orally.

Consequently, these drugs are popular among young persons who have been educated about the hazards of drug injection and the dangers of heroin, cocaine, and methamphetamine. However, most users are unaware that MDMA is a type of methamphetamine, and incorrectly assume that substances that appear as pharmaceuticals are safe to use.

Club drugs often are taken together, with alcohol, or with other drugs to enhance their effect. Often, they are misrepresented, adulterated, or entirely substituted for another substance without the users' knowledge. These actions result in an extraordinarily high risk of unanticipated effects and overdose. One Australian study 7 showed that only 8 percent of club-goers had not consumed any psychoactive substance.

MDMA was developed in as an appetite suppressant, but animal tests were unimpressive, and it was never tested in humans. MDMA has become the most common stimulant found in dance clubs and is available at 70 percent of raves. MDMA ingestion increases the release of serotonin, dopamine, and norepinephrine from presynaptic neurons and prevents their metabolism by inhibiting monoamine oxidase. Effects of an oral dose appear within 30 to 60 minutes and last up to eight hours.

Users of MDMA describe initial feelings of agitation, a distorted sense of time, and diminished hunger and thirst, followed by euphoria with a sense of profound insight, intimacy, and well-being. Unpleasant side effects of MDMA include trismus and bruxism, which can be reduced by sucking on a pacifier or lollipop. Adverse effects of MDMA ingestion result from sympathetic overload and include tachycardia, mydriasis, diaphoresis, tremor, hypertension, 15 arrhythmias, 16 parkinsonism, 17 esophoria tendency for eyes to turn inward , and urinary retention.

MDMA ingestion directly causes a rise in antidiuretic hormone. Two days after ingestion of MDMA, users typically experience depression consistent with serotonin depletion, 24 which may be severe. Repeated use of MDMA has been associated with cognitive deficits in animals and humans, with potentially permanent memory impairment.

GHB was first synthesized in France in as an anesthetic. It later achieved popularity as a recreational drug and a nutritional supplement marketed to bodybuilders. Recently, sodium oxybate has been studied as a treatment for alcohol withdrawal. GHB is easily manufactured from industrial chemicals. Internet Web sites offer instructions for home production and sell kits with the requisite materials.

GHB is chemically related to gamma butyrolactone and 1,4-butanediol, which are metabolized in the body to GHB. Overdose is common because the strength of the solution is often unknown. The unpleasant salty or soapy taste may be masked in flavored or alcoholic beverages.

Toxicity is increased if taken with alcohol or other CNS depressants. GHB produces euphoria, progressing with higher doses to dizziness, hypersalivation, hypotonia, and amnesia. Coma may be interrupted by agitation, with flailing activity described similar to a drowning swimmer fighting for air.

Flunitrazepam, marketed as Rohypnol, is a potent benzodiazepine with a rapid onset. Manufactured by Roche Laboratories, it is available in more than 60 countries in Europe and Latin America for preoperative anesthesia, sedation, and treatment of insomnia. In a single 1- or 2-mg dose, Rohypnol reduces anxiety, inhibition, and muscular tension with a potency that is approximately 10 times that of diazepam Valium.

Higher doses produce anterograde amnesia, lack of muscular control, and loss of consciousness. Effects occur about 30 minutes after ingestion, peak at two hours, and may last up to eight to 12 hours. The effects are much greater with the concurrent ingestion of alcohol or other sedating drugs. Some users experience hypotension, dizziness, confusion, visual disturbances, urinary retention, or aggressive behavior.

Like other benzodiazepines, chronic use of Rohypnol can produce dependence. The withdrawal syndrome includes headache, tension, anxiety, restlessness, muscle pain, photosensitivity, numbness and tingling of the extremities, and increased seizure potential. Ketamine was derived from phencyclidine PCP in the s for use as a dissociative anesthetic. Ketamine is difficult to manufacture; therefore, most of the illicit supply is diverted from human and veterinary anesthesia products.

As a pharmaceutical, ketamine is distributed in a liquid form that can be ingested or injected. In clubs, it usually has been dried to a powder and is smoked in a mixture of marijuana or tobacco, or is taken intranasally. Effects of ketamine ingestion appear rapidly and last about 30 to 45 minutes, with sensations of floating outside the body, visual hallucinations, and a dream-like state.

They also may experience tachycardia, palpitations, hypertension, and respiratory depression with apnea. Because club drugs are illicitly obtained and often are adulterated or substituted, they must be considered as unknown substances. In the ever-changing world of illegal drug distribution, Internet Web sites can be helpful in identifying the rapidly changing appearances of these substances Table 2.

The immediate concern with the use of club drugs is cardiorespiratory maintenance. Users often present with multiple drug ingestions, which may include stimulant and depressant drugs e. When the predominant symptoms are controlled, the symptoms of a second underlying drug may surface. Most hallucinogens are CNS stimulants; in overdose, patients may exhibit hyperthermia, hypertension, tachycardia, anxiety, and agitation.

The risk of escape or self-injury also should be considered. No standard treatment regimen has been identified for club drug overdose. Basic management should include cardiac monitoring, pulse oximetry, urinalysis, and performance of a comprehensive chemistry panel to check for electrolyte imbalance, renal toxicity, and possible underlying disorders Figure 1.

Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil.

Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome.