As you may know, there are many drugs that are considered to be club drugs or designer drugs. Here are a few that have been seen where I practice:

Ecstasy

A. The chemical name is 3,4- methylenedioxymethamphetamine or MDMA, it is also known on the street as Ecstasy, XTC, Clarity, Essence, Doctor, Dove, Love Dove, Pink Cadillac, Fido Dido, Dennis the Menace, New Yorker and Adam. The drug comes in pill form often in bright colors with logos on the pills like the Mitsubishi symbol, Rolex symbol, Pink Panther, Adidas symbol, butterfly, lighting bolt, and four leaf clover. The retail price is $20-30 dollars per hit.

B. It is ingested as a tablet or capsule, and sometimes is mixed in drinks as a powder.

C. Effects

At low doses it causes disinhibition, enhanced pleasure, heightened sexuality, and the sense of touch can be enhanced.

At higher doses it causes more of a stimulant effect including anxiety, panic, nausea, loss of appetite, chills, diaphoresis, distorted thoughts, feelings or awareness, and increased heart rate and blood pressure. There can also be teeth grinding, impaired gait or restless legs.

With abuse or toxic doses there can be dysrhythmias, hyperthermia, rhabdomyolysis, disseminated intravascular coagulation, confusion, drug craving, seizures, hyperventilation, chest pain and even cardiac arrest.

Treatment is supportive therapy. There is no antidote. It is detected on a drug screen as amphetamines.

II. GHB (gamma hydroxy butyrate)

Is a naturally occurring substance found in the body. For this reason was initially sold in health food stores as GBL, which is then converted to GHB in the body. It has been touted as causing muscle growth without exercise. This is not true, but has caused it to be popular among body builders. On the street it is known as Liquid X, Scoop, Georgia Home Boy, Grievous Bodily Harm, Goop, Easy Lay, G-juice and Energy Drink. It is no longer available in health food stores.

B. It is comes in a powder form and is ingested after being dissolved in water or a drink. There is no residue left behind, but if the water is shaken it may cause some foaming on top.

Effects

There are 3 stages of effect.

Initial mild euphoria, and disinhibition

Drowsiness, which could turn into sleep, confusion, tremors, dizziness, nausea and vomiting.

Coma, respiratory depression and even death due to hypoxia, and respiratory arrest. There can also be hypotension or bradycardia.

The above symptoms are all compounded by the simultaneous use of sedatives, i.e., alcohol, benzodiazepines or opiates.

There may also be amnesia, which makes it difficult for date rape victims to remember what happened.

D. Treatment is again supportive and many of these patients require ventilatory support. It is not detected on a standard drug screen but some facilities have a separate test for it.

III. Ketamine

A. Ketamine hydrochloride, used in Emergency Departments, Operating Rooms and in veterinary medicine across the country for anesthesia and sedation. On the street it is known as Special K, Vitamin K, new ecstasy, psychedelic heroine, Ketalar and Super K.

B. It comes as a powder, capsules and liquid form, and is ingested.

Effects

At lower doses it causes numbness, lack of coordination, hallucinations, out of body experiences, amnesia, and other dissociative symptoms.

At higher doses it can cause increased blood pressure, vomiting, delirium, seizures, and even violent behavior. It can also cause a near death state. It alone does not usually cause respiratory arrest, but can and will if combined with other sedatives similar to GHB. This in turn can again lead to respiratory depression, arrest, coma or even death.

D. Treatment is again supportive. It is not detected on a standard drug screen.

IV. Rohypnol

A. Rohypnol is the trade name for Flunitrazepam. It is widely available in Europe as a sedative but is not approved by the FDA in the US. It is a benzodiazepene much like valium. However, its hypnotic effects predominate over its sedative, anxiolytic, muscle relaxant and anticonvulsant effects. Its half-life is about 20 hours but its duration of clinical effect is only 1-3 hours after ingestion. On the street it is known as roofies, ruffies, roach, rope and the forget pill.

B. The drug can be ingested in pill form or inhaled, or it can be dissolved in alcohol facilitating its use as a date-rape drug.

C. Effects

In the short term it may cause memory loss, drowsiness, dizziness, motor incoordination, nausea, slurred speech, headache, low blood pressure, visual disturbances and dry mouth.

higher doses can cause irritability, and outbursts of aggression. Blackouts of memory loss can occur, as well as respiratory depression, coma and death. As with GHB and Ketamine its effects are enhanced by the concomitant use of alcohol.

D. Treatment is again supportive. Small frequent doses titrated to the desired effect are preferred to bolus therapy. If Rohypnol is used chronically and then stopped it can produce withdrawal symptoms similar to other benzodiazepines. It will appear on a drug screen up to 4 days after use as a benzodiazepine.

V. Ephedrine

A. This final drug is widely available in health food stores and vitamin supply houses. It is a stimulant that is typically found in diet or energy pills. It is often mixed with caffeine in doses equivalent to 2-4 cups of coffee. On the street it is known as X, Herbal X, Cloud 9, and Ultimate Xphoria.

B. This has been available in pill or capsule form and is usually ingested. In the past it was used to treat asthma and nasal decongestion, until better drugs with less side effects came along.

Effects

At low doses it can cause loss of appetite, increased heart rate and increased blood pressure.

Higher doses can produce insomnia, headache dizziness, anxiety, increased heart rate and blood pressure. When combined with other stimulants like MDMA or caffeine or if taken alone in high doses it can produce hyperthermia, seizures, dysrhythmias, stroke, hypertensive crisis and even death.

D. Treatment is again supportive. The drug will not show up on a standard drug screen.

As you can see these drugs have serious effects. Compound this by the fact that they are often made in clandestine labs with no quality control and therefore no account of what a patient may actually be taking. Unfortunately, it is a widely held belief by young Americans that are using these drugs that they are safe.

As a staff Emergency Department physician, and as the medical director for our paramedic program encompasing 100 paramedics, I have been on the frontline of this siege.

I can also tell you of countless patients coming to the Emergency department with confusion, feeling like their heart is racing out of there body, and hypertension from the use of ecstasy. Then there are the victims of amnesia from either GHB, Rohypnol or Ketamine whose friends panic when they become unresponsive or confused, and they either drop them at our door and run or the patient simply becomes lost. They later awaken in hour emergency department with no recall of how they got there, who they were with, or what may have happened.

Our community is not alone. There are many others with the same problem we have. I hope my experiences, and those of my colleauges are helpful. As a physician, and parent, I urge you to do whatever you can to help us keep the youth of the world safe from these dangerous, deadly drugs.