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Club Drugs Understanding What They Are, Why People Use Them, and What They Do. Thomas E. Freese, Ph.D. Director, Pacific Southwest Addiction Technology Transfer Center Director of Training, UCLA Integrated Substance Abuse Programs July 7, 2006. The Club Drugs. THE BIG ONES -

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club drugs understanding what they are why people use them and what they do

Club DrugsUnderstanding What They Are, Why People Use Them, and What They Do

Thomas E. Freese, Ph.D.

Director,

Pacific Southwest Addiction Technology Transfer Center

Director of Training,

UCLA Integrated Substance Abuse Programs

July 7, 2006

the club drugs
The Club Drugs
  • THE BIG ONES -
  • 3,4 methylenedioxymethamphetamine (Ecstasy)
  • Gamma Hydroxy Butyrate (GHB)
  • Ketamine
  • Nitrous Oxide
  • SOME NEW ONES
  • 2C-B
  • DXM
ecstasy
Ecstasy
  • MDMA technically 3,4 - Methylenedioxymethamphetamine
  • Hallucinogenic amphetamine
  • Releases serotonin and blocks reuptake
  • Dopamine and adrenergic effects
ecstasy history
Ecstasy History
  • Developed and patented in Germany in 1912 by Merck
  • Stimulant properties were identified in 1933
  • Scientific studies began in the 1970s
  • Used in psychotherapy in 70’s and early 80’s
  • MDMA emerged in mid 1980s on the “Rave Party Scene”
  • DEA Schedule 1 in 1985
patterns of use the picture in the late 90s
Patterns of useThe Picture in the Late ‘90s
  • Third most used illicit drug
  • Used recreationally
  • Youth culture centered on “raves”
  • Trend in increase of injection
percentage of seniors reporting ecstasy as fairly easy or very easy to get
Percentage of Seniors Reporting Ecstasy as ‘Fairly Easy’ or ‘Very Easy’ to get

Source: Monitoring the Future Study, 1999 -- NIDA

ecstasy rates by grade 2003 2005
Ecstasy Rates by Grade 2003-2005

SOURCE: Monitoring the Future Study, 2005.

poison control center calls for major substances of abuse 2000 2005
Poison Control Center Calls for Major Substances of Abuse: 2000-2005

Los Angeles County

SOURCE: California Poison Control System, 2006.

ecstacy tablets
Ecstacy Tablets

Anatomy of a Tab

  • different sizes & shapes
  •  Typical X is 300 mg tab
  • 50-150 mg MDMA (maybe less)
  • coloring
  • binders

 coatings

mdma packaging
MDMA Packaging
  • Tootsie rolls are softened & X hidden inside-- “Doing rolls” or “Rolling”
  • Skittles--X mixed in
  • Pez containers--they fit
talk about creative
Talk About Creative
  • Beaded necklaces for the pacifiers can be homemade; even the “fuzzies” come in kits.
  • Ravers have gone as far as drilling their X pills & stringing them into candy necklaces.
ecstacy
Ecstacy

X

Dosage & Ingestion

  •  50-150 mg MDMA in one 300 mg tab (lots of variability (50-300 mg/tab)
    •  1-3x a night
    •  $25 per tablet
    •  taken primarily orally
    •  can be injected (IM, not IV)
    • Snorted

 Rectally (“Plugging“)

ecstacy1
Ecstacy

Onset & Duration of Effects

Starts: 20 – 40 minutes

Peaks: 2 – 4 hours

Lasts: Physically: up to 8 hours

Mentally: 24 – 48 hours

Street names: Adam, X, XTC, e

Drug class: Empathogen

ecstacy2
Ecstacy

Under the Influence

  •  dilated pupils high temp
  •  elevated pulse  insomnia
  • hyperactive  muscle rigidity
  • grinding teeth  sweating
  • increased sensual perceptions
  • hallucinations rare

CNS STIMULANT

ecstacy3
Ecstacy

X

Dilated Pupils

pharmacological effects
Pharmacological effects
  • Initial enhancement of extracellular seratonin
    • Eventual decrease in seratonin levels
    • Effects are influenced by ambient temperature
  • Elevation of dopamine
    • Mediates effects of cocaine and amphetamine
long term effects
Long-term effects
  • Neurotoxicity
    • Damage to neurons containing seratonin
    • Abnormalities in brain morphology
  • Short-term memory impairment
slide22

BRAIN CHANGES of Ecstasy users as well as people who abstain. Ecstasy users have far less serotonin activity (dark areas). May be permanent.

slide23

Effects of MDMA on Serotonin Transporters

The Johns Hopkins Medical Institutions

subjective effects of mdma
Subjective Effects of MDMA
  • Altered time perception
  • Increased ability to interact with others
  • Decreased libido
  • Decreased defensiveness
  • Changes in visual perceptions
  • Increased awareness of emotions
  • Less impulsive
physical effects
Physical effects
  • Pupil dilation
  • Nystagmus
  • Dry mouth
  • Loss of appetite
  • Bruxism (Jaw tension / teeth grinding)
  • Sweaty palms
  • Hot / cold flushes
  • Tachycardia
  • Motor tics
  • Headaches
  • Lethargy
  • Anorexia
most significant acute adverse effects
Most significant acute adverse effects
  • Hyperthermia
    • Seizures
    • Disseminated intravascular coagulation
    • Renal and liver impairment
    • Rhabdomyolysis
  • Hyponatraemia
    • Confusion
    • Reduced consciousness
    • Seizures or convulsions
other acute adverse effects
Other acute adverse effects
  • Seizures without hyperthermia or hyponatraemia
  • Hemorrhage due to changes in blood pressure
  • Respiratory difficulties
  • Chest pains associated with physical exertion
  • Ophthalmic complications
psychological effects
Psychological effects
  • Euphoria
  • Increased energy
  • Feeling of closeness
  • Depression
  • Increased restlessness
  • Increased anxiety
  • Decreased motivation
  • Anhedonia
psychiatric sequelae
Psychiatric sequelae
  • Depression
  • Panic disorders
  • Flashbacks
  • Delusions

Risk is greatest when used repeatedly and in conjunction with other drugs

slide30
MDMA
  • Heavy MDMA have memory problems for at least 2 weeks after use - functional consequences
  • Reduction in number of serotonin transporters - PET Studies
  • Damage of serotonin nerve endings

(Bolla, McCann & Ricaurte Neurology 51, 1998)

ecstasy users had poorer performance in three general intelligence tests
Ecstasy users had poorer performance in three general intelligence tests

Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725

ecstasy users had poorer short term memory performance than non drug users
Ecstasy users had poorer short-term memory performance than non-drug users

Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725

ecstasy like drug
“Ecstasy-like” Drug
  • Paramethoxyamphetamine (PMA) – a dangerous hallucinogen with stimulant properties
  • Releases serotonin
  • Slow onset - people often take more and they may overdose
  • Not new - deaths were reported in 1970s
street development
Street Development

Gamma Hydroxy Butyrate (GHB)

slide35
GHB
  • Available in health food supplements until 1992.
  • Odorless liquid, frequently clear with a salty taste
  • Precursor, GBL available until recently in health food supplements
slide36
GHB
  • Hypnotic (nonanalgesic) anesthetic
  • Epileptogenic agent in animals
  • Increases growth hormone
  • Promotes slow wave sleep
  • Treatment of narcolepsy
  • Trials for the treatment of opiate and alcohol withdrawal
a dose of ghb
A Dose of GHB
  • 1 teaspoon (approx 2.5 g) - 4 tablespoons (30 g)
  • Dependent users 25 grams/day (357.14 mg/kg for a 70 kg man)
  • 50-70 mg/kg dose - anesthesia

>60 mg/kg coma

  • Sleep studies - 50 - 60 mg/kg/night 2 doses
  • Alcohol studies - 50 - 150 mg/kg day divided doses
ghb users
GHB Users

- Rave/club crowd

- Gay community

- Exotic dancers/ strippers

- Bodybuilders

- Rapists

- Individuals subject to random or mandatory drug testing

slide39

liquid: clear, odorless, colorless

  • salty taste
  •  solid: white powder usually mixed in water
  •  mixed in drinks to mask taste
  •  one dose = 1/2 to 3 teaspoons (1/2 - 1 cap full)

Gamma Hydroxy Butyrate (GHB)

gamma hydroxy butyrate
Gamma hydroxy butyrate

Onset & Duration of Effects

  • Cap concentration varies 500mg-5g
  • Rapidly absorbed, peak concentration 20-60 min
  • Almost completely oxidized to carbon dioxide
  • Readily crosses the blood brain barrier and placenta
slide41
GHB
  • Also known as:

GHB, G, Jib, Scoop, Liquid E, Liquid X, Sodium Oxybate, Woman’s Viagra, Grievous Bodily Harm, Easy Lay, Gamma 10, Salty Water, GH Buddy, Aminos, Blue Nitro, Blue Thunder, Thunder Nectar, Renewtrient, Revivarant, Remforce, Firewater, Invigorate

analogs of ghb
Analogs of GHB

Blue Nitro, Renewtrient, Revivarant, Remforce, Firewater Serenity, FX, Weight Belt Cleaner, Enliven, Biosul

- 1, 4 butanediol (BD or BDO)

- sold legally as a floor stripper

ghb indicators
GHB Indicators
  • Information not collected in standardized measures
  • ER Mentions:
    • 1994 = 55
    • 1999 = 2973
  • 32% of calls to Boston Poison Control involve GHB
slide44
Common Depressant Impairment

 depressed  slow slurred speech

 impaired attention  intoxicated like ETOH

 sleep-ish  difficulty concentrating

 under-active  disoriented

 droopy eyelids  bloodshot /watery eyes

ghb gbl analogs and reported uses
Gamma-Butylactone

2(3H) Furanone di-hydro

1,4 Butanediol

Sodium oxybate

Improve sleep

Insomnia

Dancing

Avoid drug testing

Antidepressant

Antianxiety

Socialize

Weight lifting

GHB/GBL Analogs and Reported Uses
ghb survey
GHB Survey
  • Convenience sample - recruited by a news paper advertisement
  • 120 callers
  • 42 came in for an interview
  • Male 76%
  • Caucasian 73%
  • Heterosexual 70%
  • Employed 69%
ghb use survey study n 42
GHB Use Survey Study N=42
  • How often do you use GHB
    • Every day 21.4%
    • 1-6 days/ week 35.7%
    • 1X/month or less 42.9%
  • How many times per day
    • Once 28.6%
    • 2-3 times 42.9%
    • 4 or more 28.6%
  • How much do you use at a time?
    • < 1 capful 9.5%
    • 1-3 capfuls 73.8%
    • > 3 capfuls 14.3%
    • Other 2.4%
subjective effects of ghb reported by 50 of participants
Euphoria

Increased sexuality

Wellbeing

Relaxation

Talkative

Tranquility

Drowsiness

Optimism

Increased energy

Giddiness

Increased sensitivity to sound

Silliness

Sweaty

Loss of consciousness

Subjective Effects of GHB Reported by > 50% of participants
subjective effects after ghb use
60 - 30 %

Exhaustion

Sluggishness

Amnesia

Confusion

Clumsiness

29 - 15%

Anxiety

Insomnia

Mumbling

Weakness

29 - 15%

Agitation

Stiff muscles

Babbling

Craziness

Depression

Tremor

Overdose

Pessimism

Sadness

Dizziness

Subjective Effects After GHB Use
after ghb withdrawal clinical concerns
After GHB Withdrawal –Clinical Concerns

Severity of “protracted withdrawal” associated with severity acute withdrawal

  • Depression
  • Anhedonia - negative symptoms
  • Panic attacks
  • Tremor
  • Paresthesia
  • Overdose
ghb withdrawal
GHB Withdrawal
  • Tolerance to GHB developed within months of use in this case series
  • Withdrawal was reported by high dose users
    • The onset of withdrawal occurred with in 2-24 hours of last use
  • A spectrum of withdrawal signs and symptoms was seen:
    • Mild: tremor, anxiety, insomnia, mood lability
    • Severe: above plus, delerium, psychosis, autonomic instability, tachycardia, blood pressure elevation, extreme agitation
symptoms of ghb withdrawal
Symptoms of GHB Withdrawal

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Key:Mild = +Moderate = ++ Severe = +++

treatment of adverse ghb effects
Treatment of adverse GHB effects
  • Extended delirium
  • Extreme cognitive dysfunction and amnesia
  • Medical monitoring needed
  • Response to treatment with standard medications is highly variable and potentially dangerous
  • Only treatment is often supportive care
ketamine
Ketamine
  •  Extensive use in Vietnam War
  •  Current use on animals & humans
  •  Behavioral Analog of PCP
  •  1/4th the strength of PCP
  •  Medically in liquid injectable form
ketamine1
Ketamine
  • Can be heated in oven/microwave to make powder
  • Powder looks like cocaine/methamphetamine
ketamine special k
Ketamine – “Special K”
  • Snorted or smoked
  • Dissociative effects called a “K-hole” – your brain is active but your body isn’t, “like you’re in a tunnel, your hear echoes, you’re in a semi-conscious state”
  • Used at rave/dance club scene, not as popular as in past
  • “like living inside a big cotton ball,” “everything is in slow motion”
  • flashbacks
ketamine2
Ketamine
  • Central nervous system depressant
  • Rapid acting-acting dissociative anesthetic
  • Sedative-hypnotic, analgesic and hallucinogenic properties
  • Structurally similar to PCP
  • N-methyl-D-aspartate (NMDA) antagonist
ketamine3
Ketamine

Sources & Distribution

 Diversion

 Theft

 Mexico

ketamine4
Ketamine
  • Administration: injected, intranasal, oral
  • 10 ml vials provide 5 illicit doses
  • Sell for $20 a dosage unit
  • Rapid onset of effects
  • Duration of effects 4-6 hours
ketamine5
Ketamine

Street Names

 K  Vitamin K

 Ket  KitKat

 Special K  Super Acid

 K-Land  K-Hole

 K-Head  Super K

ketamine6
Ketamine

Dose

  • DoseOnsetDuration
  • IM 25-125mg 1-5 min’s 45 min’s-3 hrs
  • Oral 50-450mg 5-20 min’s 1.5 hrs
  • Nasal 25-150mg 5-15 min’s 10-30 min’s
ketamine7
Ketamine
  • Muscle spasm
  • Blurred vision
  • Dizziness
  • Slurred speech
  • Visual “flashbacks”
  • Psychological effects
  • Tolerance
street development1
Street Development

Common Ketamine Impairment

 slow slurred speech

 intoxicated like ETOH

 impaired attention

 difficulty concentrating

 disoriented

 bloodshot /watery eyes

nitrous oxide1
Nitrous Oxide
  • Large canisters stolen from dentist or medical supply house
  • Medium canisters from performance vehicle shops
  • Little canisters from kitchen stores for whipped cream makers
nitrous oxide2
Nitrous Oxide

Whippets, “cracker” & balloon

Regular whipped cream

slide70
s

Onset & Duration of Effects

  • Onset

 Immediate

  • Duration
  •  5 minutes max
nitrous oxide3
Nitrous Oxide

Common Inhalant Impairment

 depressed  slow slurred speech

 impaired attention  intoxicated like ETOH

 sleep-ish  difficulty concentrating

 chemical odor  disoriented

 droopy eyelids  bloodshot /watery eyes

the new ones1
The New Ones

2C-B

4-Bromo-2,5-dimethoxyphenethylamine

  • Originally synthesized in 1974
  • White powder pressed into tablets or gel caps.
  • Enactogen (literally “touching within”)
slide74
2C-B

The Effects

  • Lower doses
    • Feeling in touch with themselves and emotions
    • Erotic feelings
    • Being “in ones body”
slide75
2C-B
  • Higher Doses
    • Visual effects
      • Trails
      • Geometric patterns
      • Breathing objects
      • See the music
    • Nausea, trembling, nervousness
  • Very dose sensitive—a few miligrams can produces significantly more effect.
  • No known deaths—but safety not known

The Effects

the new ones2
The New Ones

Dextromethorphan

DXM

Robo

Skittles

CCC

Tripple Cs

DexTussin

Vitamin D

dextromethorphan
Dextromethorphan

Poison Control Center Calls

  • According to Partnership for a Drug-Free America, 10 percent of teens (2.4 million) have intentionally abused cough medication to get high.
dextromethorphan1
Dextromethorphan
  • Clinical Dose
    • 15-30 mg every 6-8 hours
    • 60 mg every 12 hours for extended release
  • Abuse Doses
    • Often as high as 240-360 mg per administration
dextromethorphan2
Dextromethorphan
  • Effects at high doses
    • LSD-like high
    • Out of body experience
    • Hallucinations
    • Vivid dreams with visions
dextromethorphan3
Dextromethorphan

Consequences of Abuse

  • Sweating
  • Delusions
  • Hallucinations
  • High body temperature
  • Loss of consciousness
  • Tachycardia
  • Blurred vision
  • Confusion
  • Seizures
  • Vomiting
best friends til the trip ends
Best friends ‘til the trip ends
  • Raves create an instant community
  • Offers everything a teenager wants

- acceptance

- attention

- popularity

  • Fosters sexual or intimate behavior
slide84
Thomas E. Freese, Ph.D.

[email protected]

www.psattc.org

www.clubdrugs.org

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