What Are Club Drugs?


The term club drugs has been used to designate a somewhat diverse group of substances commonly used by teenagers or young adults in bars, nightclubs, or other party settings.1,3 It is a conceptually loose category, as many of the substances labeled as club drugs have quite distinct pharmacologic mechanisms and effects. Some of the so-called club drugs are Schedule I, illicit substances, but all of them are associated with adverse effects, some of which may be made worse by the setting they are frequently used in (e.g., situations that might be more likely to lead to high body temperature and dehydration; or conducive to repeated dosing over the course of the evening; or, potentially, unsafe sexual encounters or victimization).1

As a somewhat indistinct category, those substances designated as club drugs might change over time. However, according to the FBI website, examples of substances that are considered to be club drugs include:2

GHB

GHB is an abbreviation for gamma-hydroxybutyrate. Reported street names for the illicit form of the substance include liquid ecstasy, grievous bodily harm and, simply, G.4,5 A pharmaceutical formulation of GHB—known as sodium oxybate, and marketed as Xyrem—is used to manage cataplexy, or the daytime sleepiness associated with narcolepsy.6 It is most commonly used orally, and may be found in liquid or white powder form (which is often dissolved into liquid solution for drinking).7

The pharmacologic effects of GHB are similar to those of other central nervous system (CNS) depressants—at high doses it can slow heart rate and result in overdose deaths from respiratory arrest. After oral ingestion, GHB rapidly enters the circulation; its relaxing, sedating, and euphoric effects can begin to be felt as soon as 15 minutes after use. 4 However, these somewhat desirable effects may also be accompanied by several negative effects, including:4,5

  • Headache.
  • Dizziness.
  • Profound drowsiness.
  • Confusion.
  • Memory loss.
  • Hallucinations.
  • Seizures.
  • Nausea and vomiting.
  • Incontinence.
  • Decreased heart rate.
  • Low body temperature.
  • Respiratory depression.
  • Seizures.
  • Loss of consciousness.
  • Coma.

Overdose is fairly common, according to the American Academy of Family Physicians, as the strength of the illicitly manufactured substance is often unknown. Also, as it is frequently used in combination with alcohol or other drugs, the risk of overdose increases.8

As the taste of GHB may be obscured by mixing it with flavored or alcoholic beverages, it may in some cases be ingested unwittingly. Due to this as well as the fact that its use is associated with significant sedation and amnestic effects (memory loss), it has received much notoriety as a potential “date rape” drug.7,8 A good form of prevention is for individuals to refuse drinks that they did not obtain themselves and also not to leave drinks unattended—if a drink is left unattended, it should be discarded.

Ketamine

This drug—with street names such as special K, vitamin K, and cat valium—is intended for use as an anesthetic in both human and veterinary medicine. Though a more recent, nasal spray formulation exists, much of the abused ketamine is diverted from pharmaceutical sources of an injectable solution. On the illicit market, ketamine is also sometimes found as a whitish powder. Nonmedical misuse of ketamine may involve either snorting or smoking, as well as ingestion of the powder after mixing into drinks.7

Like PCP, ketamine is a dissociative anesthetic drug with some hallucinogenic properties; its use may lead to perceptual disturbances, derealization, and a sense of disconnection from one’s body and environment. Effects may appear quite rapidly after use and last for about 30 to 45 minutes.8,9

Other effects individuals may experience with ketamine include:5,8

  • Sedation.
  • Confusion.
  • Amnesia (memory loss).
  • Delirium.
  • Flashbacks or visual disturbances days to weeks after use.
  • Hallucinations.
  • Hypertension.
  • Increased heart rate.
  • Palpitations.
  • Slow breathing with apneic episodes.
  • Loss of consciousness.

Addiction to ketamine is also a legitimate risk after a period of consistent use, as well as the development of significant physical dependence and a potentially dangerous, medical detox-requiring withdrawal syndrome. Injecting ketamine will put individuals at a higher risk for infectious blood-borne diseases such as HIV/AIDS and hepatitis. As with some other club drugs on the page, ketamine has also been scrutinized for its potential role as a date rape drug.5,7,8

LSD

Lysergic acid diethylamide (LSD) is a classical hallucinogen thought to exert its psychedelic effects through its interaction with certain serotine receptors in the brain.4Historically, it has been referred to as several names including acid, blotter, fry, and microdot.5,7 It is a Schedule I controlled substance, meaning that it has no acceptable medical use and a high potential for abuse.10

LSD’s subjective effects (which may begin within 20 to 90 minutes and last as long as 12 hours) may be highly variable from one person to the next and may be influenced not only by the dose taken but the setting in which it is taken, as well as the mood of the individual.11 In addition to the characteristic hallucinations and perceptual distortions associated with LSD use, several physiological effects may also occur with use. Such effects include:7

  • Dilated pupils.
  • Fast heart rate.
  • Increased blood pressure.
  • Increased body temperature and sweating.
  • Diminished appetite.
  • Dry mouth.
  • Insomnia.

Some individuals experience what is known as a bad trip, meaning they experience frightening hallucinations as well as terrifying thoughts.11

LSD overdose deaths are rare and, rather than resulting from direct drug toxicity, are more likely to arise as a result of accidents or injury in relation to altered judgment and dangerous behavior. Treatment may include monitoring the individual in a safe, comfortable, and low stimulus environment and, when necessary, symptomatic relief for relatively severe effects such as agitation.7,11

That National Institue on Drug Abuse (NIDA) states that LSD is not considered to be addictive, due to the lack of drug-seeking behaviors that accompany use. People can, however, develop significant tolerance (and cross-tolerance to other classical hallucinogens), and the ramping up of use to overcome such tolerance can be dangerous, given the unpredicted and potentially problematic effects of such a drug.11

MDMA

MDMA, an abbreviation for 3,4-methylenedioxymethamphetamine, might be more commonly known as molly, ecstasy, X, or E. MDMA is a substituted amphetamine with both stimulant and psychedelic properties. The drug is most commonly taken in tablet form, but it is sometimes ingested as powder.12

When taken orally, the effects of ecstasy may develop within 30 minutes to an hour and can last for several hours (some estimates vary anywhere from 3 hours to 8).7,8,13 Some individuals who use ecstasy may “piggyback,” meaning that they will take a second dose of ecstasy as they begin to feel the effects from the first dose wearing off. Other users might combine ecstasy with other drugs, such as cocaine.7

Effects of ecstasy include:5,7,13

  • Disinhibition.
  • Impulsivity.
  • Euphoria.
  • Distorted sensory perception.
  • Increased heart rate.
  • Increased blood pressure.
  • Anxiety.
  • Insomnia.
  • Depression.
  • Confusion.
  • Paranoia.
  • Dizziness.
  • Nausea and vomiting.
  • Chills or sweating.
  • Blurred vision.
  • Muscle cramps and tension (e.g., teeth grinding, jaw clenching).

MDMA/ecstasy use can lead to dangerous hyperthermia, which may be associated with liver, kidney, and heart failure, and in rare cases, death.13

The DEA warns that ecstasy use may increase the risk of long-term, persistent problems with learning and memory.7,14 While some effects—including anxiety, depression, paranoia, insomnia, and cravings—may last for hours after use for most people, some may continue to experience these issues for weeks.7 MDMA’s interaction with the serotonin system is thought to play a potential role in certain individuals experiencing depression in the wake of ecstasy use.7,8,14

Is MDMA addictive in the same way that drugs like heroin or cocaine are? There is some debate, and research evidence to support an addictive potential is somewhat varying. Animal studies have demonstrated some self-administration of MDMA, yet they do less than they do with exquisitely addictive drugs like cocaine.13 Physical dependence and withdrawal do seem to be factors with frequent MDMA use, and there is no question that use of this “party drug” can be problematic enough to warrant professional treatment.

Methamphetamine

Alternatively referred to as speed, crystal meth, or crank, methamphetamine is a stimulant most commonly encountered in crystalline or powder form (though a Schedule II pharmacotherapeutic known as Desoxyn is also available as an oral tablet).5,12Methamphetamine misuse can take place via several routes—it can be swallowed, smoked, snorted, or injected.15,16

The onset of effects and duration of them may differ somewhat with each route of administration. For example, injecting or smoking the drug results in more immediate onset of effects, often reported as an intense initial rush. Oral or nasal use may result in some delay in effects onset, but ones that stick around relatively longer after use.15

Some potential acute, or short-term effects of meth include:5,15,16

  • Euphoric rush.
  • Increased wakefulness.
  • Increased activity.
  • Appetite suppression.
  • Hypertension.
  • Rapid and/or irregular heart rate.
  • Rapid breathing.
  • Hyperthermia.
  • Increased stroke risk.
  • Increased heart attack risk.
  • Increased seizure risk.

Injecting methamphetamine with non-sterile needles can also place individuals at a higher risk for infectious blood-borne diseases, such as HIV/AIDS and hepatitis.5,16

Long-term or chronic methamphetamine use is also associated with addiction and other detrimental health effects including unhealthy weight loss, deteriorating dental health, and certain psychotic features such as hallucinations and paranoia.16 Crystal meth use is known to cause rapid physical deterioration and drastically alter users’ appearance with long-term use.12

Treatment for methamphetamine usually involves one or more types of behavioral therapeutic interventions, such as cognitive-behavioral counseling, motivational incentives, and Matrix Model.15,16 Mutual help groups such as those offered by various 12-steps programs have also helped many struggling with meth abuse.15 Presently, however, there are no medications specifically approved to manage methamphetamine use disorders.12

Rohypnol

Rohypnol, which is a trade name for the drug flunitrazepam, is the drug most synonymous with date rape. Though similar to other benzodiazepine medications such as Xanax, Rohypnol and its generic equivalents are not approved for use in the United States.5,7 The drug—which, may make its way into the U.S. from other countries—is sometimes referred to as roofies and most commonly ingested orally, either in pill form or, infamously, dissolved in a drink.7

With a potency roughly 10 times that of Valium, Rohypnol’s effects may develop within 30 minutes of oral ingestion, peak at 2 hours, and resolve within 12 hours.1

Potential effects of Rohypnol include:1,4,5

  • Dizziness.
  • Drowsiness.
  • Sedation.
  • Disinhibition.
  • Amnesia.
  • Confusion,
  • Muscle relaxation.
  • Impaired reaction time.
  • Slowed heart rate.
  • Lowered blood pressure.
  • Respiratory depression.
  • Loss of consciousness.

Rohypnol is associated with significant physiological dependence and withdrawal. Those who have become dependent on the drug may experience headaches, muscle pain, anxiety, and hallucinations when attempts are made to quit or cut back on use. Seizures are also a risk with abrupt discontinuation.5

When Rohypnol is combined with alcohol, its sedative effects may be significantly increased, and could more easily result in loss of consciousness or even death from severely slowed breathing.

Treatment for Club Drug Abuse

As with all substances of abuse, club drugs are associated with serious negative health effects and, in many cases, have the potential to lead to compulsive use and addiction. When club drug use becomes problematic, professional substance abuse can help people begin their recovery. Care that often begins with a period of medical detoxification, progresses to structured rehabilitation with ongoing counseling and therapy, and continues beyond treatment with relapse prevention and other aftercare efforts can be invaluable in helping individuals maintain long-term sobriety and achieve healthy lives.

References

  1. American Academy of Family Physicians [website]. (2018). Information From Your Family Doctor—Club Drugs: What You Should Know. Am Fam Physician. 2018 Jul 15; 98(2):online.
  2. Federal Bureau of Investigation [website]. (n.d.). Scams and Safety—About Protecting Your Kids.
  3. National Institute on Drug Abuse. (n.d.). Club Drugs.
  4. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  5. National Institute on Drug Abuse. (2019). Commonly Abused Drugs Charts.
  6. United States Department of Health and Human Services—Food & Drug Administration. (2002). Labeling-Medication Guide—Xyrem.
  7. United States Drug Enforcement Administration. (2017). Drugs of Abuse—A DEA Resource Guide.
  8. Gahlinger, PM. (2004). Club Drugs: MDMA, Gamma-Hydroxybutyrate (GHB), Rohypnol, and Ketamine. Am Fam Physician. 2004 Jun 1;69(11): 2619-2627.
  9. Volkow, ND. (2015). National Institute on Drug Abuse. Hallucinogens and Dissociative Drugs.
  10. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
  11. National Institute on Drug Abuse. (2019). Hallucinogens.
  12. Klega, AE, Keehbauch, JT. (2018). Stimulant and Designer Drug Use: Primary Care Management. Am Fam Physician. 2018 Jul 15;98(2):85-92.
  13. National Institute on Drug Abuse. (2018). MDMA (Ecstasy/Molly).
  14. National Institute on Drug Abuse. (2017). MDMA (Ecstasy) Abuse.
  15. American Academy of Family Physicians [website]. (2018). Information From Your Family Doctor—Meth: What You Should Know. Am Fam Physician. 2018 Jul 15; 98(2):online
  16. National Institute on Drug Abuse. (2019). Methamphetamine.


About The Contributor

Scot Thomas, M.D.
Scot Thomas, M.D.

Senior Medical Editor, American Addiction Centers

Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More


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