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March 01, 2000
NIDA Director Dr. Alan I. Leshner
NIDA Director, Alan I. Leshner

For several years, NIDA monitoring systems have registered a nationwide pattern of drug use centered on all-night party and "rave" dance clubs and bars. The drugs reported in these scenes are extremely diverse and vary among locales. Overall, they include drugs that have long been abused, such as marijuana and cocaine, and drugs whose abuse is a more recent development, such as methamphetamine, ecstasy, gamma-hydroxybutyrate (GHB), flunitrazepam (Rohypnol), and ketamine. Some are stimulants, some depressants, and some hallucinogens. Some are prescription drugs that are made in licensed factories using strict quality control, but illegally diverted for abuse. Others have no legitimate medical uses and are produced clandestinely.

Because of this diversity, "club drugs" is an ambiguous and flexible term. However, it clearly applies to methamphetamine, ecstasy, GHB, and Rohypnol, which have become widespread in the 1990s in tandem with contemporary club culture.

The novelty of many club drugs is undoubtedly one reason for the recent surge in their use. Because these drugs are relatively new, some vulnerable individuals may imagine that taking them is safe-that their reported adverse effects are rare or exaggerated, and that such reactions could never affect them personally. In contrast, few can harbor such misperceptions about older drugs. Cocaine, for example, was widely used in dance clubs and elsewhere in the 1980s, but its use has receded as its health and social costs have become well known.

Because these drugs are relatively new, some vulnerable individuals may imagine that taking them is safe.

Scientists still have much to learn about club drugs. However, they have already shown that these substances can cause serious and perhaps permanent impairments and sometimes death.

Methamphetamine (also known as "speed" and "crank") is a more powerful variation of a stimulant found in some diet medications. The well-documented effects of long-term methamphetamine exposure include anxiety, confusion, paranoia, hallucinations, and cardiovascular problems. This drug is highly addictive. Last year in San Diego and Seattle, more people came to publicly funded treatment programs for help getting off methamphetamine than for help getting off any other drug.

NIDA-supported researchers using new brain imaging techniques have produced vivid and worrisome evidence of methamphetamine's ill effects. The pictures show that the drug damages brain cells that produce the neurotransmitters dopamine and serotonin. These neurotransmitters contribute to pleasure, motivation, cognition, and memory. Their loss may underlie a syndrome of slowed thinking, depressed mood, and motor impairment that has occurred in some heavy users of methamphetamine. Meth-amphetamine abuse also facilitates the spread of HIV/AIDS through unsafe sex and shared injection equipment.

Ecstasy (also called "X," "Adam," and "MDMA") is both a stimulant and a hallucinogen. Rave-goers use it for energy to keep on dancing and for mood enhancement. Ecstasy increases the heart rate and temperature and has occasionally contributed to heart and kidney failure. The drug also appears to mask the sense of thirst-a potentially hazardous effect if one is dancing for hours on end in a crowded, sweltering club. Ecstasy users have died from acute dehydration.

Ecstasy also appears to have long-term effects. In a recent study, long-term ecstasy users had residual problems of verbal and visual memory 2 weeks after stopping the drug. Brain imaging studies have shown that the drug damages brain cells that produce serotonin. We still do not know if these cells regenerate, so the memory loss-and perhaps additional still-to-be-discovered serotonin-related impairments-may be long-lasting or permanent. In addition, a study in Great Britain documented an elevated incidence of congenital abnormalities in the children of women who took ecstasy during pregnancy.

GHB (sometimes called "G" or "liquid ecstasy") and Rohypnol (known as "roofie" or "Roche") have become notorious for their use in crimes, particularly rape. Colorless, odorless, and tasteless, they can be slipped into drinks and ingested without the victim having any clue. They cause sedation, often rendering the victim helpless. They also produce amnesia, making it very difficult to arrest and convict a perpetrator.

GHB is also dangerous when taken knowingly for its relaxing effects. Because GHB is illegal and made by amateurs, samples vary many-fold in their strength and purity. Users simply cannot know how much they are getting. Overdoses are common, with consequences of coma and sometimes death from respiratory arrest. As of mid-1998, GHB has been implicated in at least 26 deaths.

Because widespread use of ecstasy, GHB, and Rohypnol is relatively recent, the worst effects of these drugs may be the ones that are not yet known. For example, the full addictive potential of these substances has not yet been determined. There are indications, however, that the potential may be significant. GHB users have reported that they need higher and higher doses to get the effects that they want, and that when they try to quit, they can't.

An additional challenge to scientists-and peril to users-is the fact that club drugs are often taken in combination or with other intoxicants. GBH, for example, is frequently consumed with alcohol, which is also a depressant. A significant percentage of those who have died with GHB have also had alcohol in their blood. In Seattle and Miami, ecstasy is sometimes taken mixed with LSD, psilocybin, or heroin. It is very likely that such combinations will affect the and brain in ways that are more deleterious than either drug alone.

In December, NIDA launched a major initiative to warn the Nation not to underestimate the harm that club drugs do (see "NIDA Launches Initiative to Combat Club Drugs," p.1). What is at stake is the potential for a new national drug tragedy just when we seem to be emerging from the worst devastation of the crack cocaine epidemic.

For more information on club drugs, see Club Drugs Summary Page