Club drugs are a pharmacologically heterogeneous group of psychoactive drugs
that tend to be abused by teens and young adults at bars, nightclubs, concerts,
and parties. Gamma hydroxybutyrate (GHB),
Rohypnol, ketamine, as well as
MDMA
(ecstasy) and methamphetamine are some of the drugs included in this group.
- GHB (Xyrem) is a central nervous system (CNS) depressant that was
approved by the Food and Drug Administration (FDA) in 2002 for use in the
treatment of narcolepsy (a sleep disorder). This approval came with severe
restrictions, including its use only for the treatment of narcolepsy, and
the requirement for a patient registry monitored by the FDA. GHB is also a
metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid
(GABA). It exists naturally in the brain, but at much lower concentrations
than those found when GHB is abused. - Rohypnol (flunitrazepam) use began gaining popularity in the United
States in the early 1990s. It is a
benzodiazepine (chemically similar to
sedative-hypnotic drugs such as
Valium or
Xanax), but it is not approved for
medical use in this country, and its importation is banned. - Ketamine is a dissociative anesthetic, mostly used in veterinary
practice.
How Are Club Drugs Abused?
- GHB and Rohypnol are available in odorless, colorless, and tasteless forms
that are frequently combined with alcohol and other beverages. Both drugs have
been used to commit sexual assaults (also known as “date rape,” “drug rape,”
“acquaintance rape,” or “drug-assisted” assault) due to their ability to sedate
and incapacitate unsuspecting victims, preventing them from resisting sexual
assault. - GHB is usually ingested orally, either in liquid or powder form, while
Rohypnol is typically taken orally in pill form. Recent reports, however, have
shown that Rohypnol is being ground up and snorted. - Both GHB and Rohypnol are also abused for their intoxicating effects, similar
to other CNS depressants. - GHB also has anabolic effects (it stimulates protein synthesis) and has been
used by bodybuilders to aid in fat reduction and muscle building. - Ketamine is usually snorted or injected intramuscularly.
How Do Club Drugs Affect the Brain?
- GHB acts on at least two sites in the brain: the GABAB
receptor and a specific GHB binding site. At high doses, GHB’s sedative effects
may result in sleep, coma, or death. - Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can
produce anterograde amnesia, in which individuals may not remember events they
experienced while under the influence of the drug. - Ketamine is a dissociative anesthetic, so called because it distorts
perceptions of sight and sound and produces feelings of detachment from the
environment and self. Ketamine acts on a type of glutamate receptor (NMDA
receptor) to produce its effects, which are similar to those of the drug PCP.
Low-dose intoxication results in impaired attention, learning ability, and
memory. At higher doses, ketamine can cause dreamlike states and hallucinations;
and at higher doses still, ketamine can cause delirium and amnesia.
Rohypnol, a Popular Club Drug
What is Rohypnol?
Rohypnol, a trade name for the drug flunitrazepam, is a central nervous
system depressant. The drug is legally manufactured and available outside the
United States but is neither manufactured nor approved for sale within the
United States. Since the 1990s individuals in the United States have used
Rohypnol illegally, often as a means of mitigating the depression that results
from using stimulants such as cocaine and methamphetamine. Rohypnol also has
been used in the commission of sexual assaults.
What does Rohypnol look like?
Rohypnol is manufactured as a caplet. In 1997 the manufacturer responded to
concerns about the drug’s role in sexual assaults by reformulating the white,
2-milligram tablets. (The original tablets dissolved clear in liquid, making it
nearly impossible for a victim to detect their presence in a beverage.) The new
smaller dosage (0.5 mg and 1.0 mg) caplets are dull green with a blue core that,
when dissolved in light-colored drinks, will dye the liquid blue. However, the
dye may be disguised in blue or dark-colored liquids, and generic versions of
the drug may not contain the blue dye.
How is Rohypnol abused?
Individuals who abuse Rohypnol may swallow the caplets whole, crush and then
snort the powdered caplets, or dissolve the caplets in liquid and then inject
the solution. Sexual predators who administer Rohypnol to their victims
typically slip the drug into a drink, often at a bar or party. The blue color
that results from mixing Rohypnol with a beverage often is masked by serving
blue tropical drinks or by serving the drink in dark or opaque containers.
The effects of the drug typically are felt within 15 to 20 minutes of
administration and may persist for more than 12 hours.
SOURCE: National Drug Intelligence Center
Addictive Potential
- Repeated use of GHB may lead to withdrawal effects, including insomnia,
anxiety, tremors, and sweating. Severe withdrawal reactions have been reported
among patients presenting from an overdose of GHB or related compounds,
especially if other drugs or
alcohol are involved. - Like other benzodiazepines, chronic use of Rohypnol can produce tolerance,
physical dependence, and addiction. - There have been reports of people binging on ketamine, a behavior that is
similar to that seen in some cocaine– or
amphetamine-dependent individuals.
Ketamine users can develop signs of tolerance and cravings for the drug.
What Other Adverse Effects Do Club Drugs Have on Health?
Uncertainties about
the sources, chemicals, and possible contaminants used to manufacture many club
drugs make it extremely difficult to determine toxicity and associated medical
consequences. Nonetheless, we do know that:
- Coma and seizures can occur following use of GHB. Combined use with other
drugs such as alcohol can result in nausea and breathing difficulties. GHB and
two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD), have
been involved in poisonings, overdoses, date rapes, and deaths. - Rohypnol may be lethal when mixed with alcohol and/or other CNS depressants.
- Ketamine, in high doses, can cause impaired motor function,
high blood
pressure, and potentially fatal respiratory problems.
What Treatment Options Exist?
There is very little information available in the scientific literature
about treatment for persons who abuse or are dependent upon club drugs.
- There are no GHB detection tests for use in emergency rooms, and as many
clinicians are unfamiliar with the drug, many GHB incidents likely go
undetected. According to case reports, however, patients who abuse GHB
appear to present both a mixed picture of severe problems upon admission and
a good response to treatment, which often involves residential services. - Treatment for Rohypnol follows accepted protocols for any
benzodiazepine, which may consist of a 3- to 5-day inpatient detoxification
program with 24-hour intensive medical monitoring and management of
withdrawal symptoms, since withdrawal from benzodiazepines can be
life-threatening. - Patients with a ketamine overdose are managed through supportive care for
acute symptoms, with special attention to cardiac and respiratory functions.
How Widespread Is Club Drug Abuse?
Monitoring the Future (MTF) Survey*
MTF has reported consistently low levels of abuse of these club drugs since
they were added to the survey. For GHB and ketamine, this occurred in 2000; for
Rohypnol, 1996. According to results of the 2009 MTF survey, 0.7 percent of
8th-grade and 1.1 percent of 12th-grade students reported past-year** use of
GHB, a statistically significant decrease from peak-year use of 1.2 percent in
2000 for 8th-graders and 2.0 percent for 12th-graders in 2004. GHB use among
10th-grade students was reported at 1.0 percent, an increase from 2008 (0.5
percent), and statistically unchanged from peak use of 1.4 percent in 2002 and
2003.
Past-year use of ketamine was reported by 1.0 percent of 8th-graders, 1.3
percent of 10th-graders, and 1.7 percent of 12th-graders in 2009. These
percentages also represent significant decreases from peak years: 2000 for
8th-graders (at 1.6 percent) and 2002 for 10th- and 12th-graders (at 2.2 and 2.6
percent, respectively).
For Rohypnol, 0.4 percent of 8th- and 10th-graders, and 1.0 percent of
12th-graders reported past-year use, also down from peak use in 1996 for
8th-graders (1.0 percent), 1997 for 10th-graders (1.3 percent), and 2002 and
2004 for 12th-graders (1.6 percent).
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Other Information Sources
For more information about club drugs, visit www.clubdrugs.gov,
www.teens.drugabuse.gov, and www.backtoschool.drugabuse.gov; or call NIDA at
877-643-2644. For street terms searchable by drug name, street term, cost and
quantities, drug trade, and drug use, visit http://www.whitehousedrugpolicy.gov/streetterms/default.asp.
