Club Drugs (GHB, Ketamine, and Rohypnol)

Club drugs are a pharmacologically medical use in this country, and its heterogeneous group of psychoactive drugs importation is banned. that tend to be abused by teens and young • Ketamine is a dissociative anesthetic, adults at bars, nightclubs, concerts, and mostly used in veterinary practice. parties. Gamma hydroxybutyrate (GHB), Rohypnol, ketamine, as well as MDMA How Are Club Drugs Abused? (ecstasy) and methamphetamine (which are featured in separate DrugFacts) are some of • GHB and Rohypnol are available in the drugs included in this group. odorless, colorless, and tasteless forms that are frequently combined • GHB (Xyrem) is a central nervous with alcohol and other beverages. system (CNS) depressant that was Both drugs have been used to commit approved by the Food and Drug sexual assaults (also known as “date Administration (FDA) in 2002 for use in rape,” “drug rape,” “acquaintance the treatment of narcolepsy (a sleep rape,” or “drug-assisted” assault) due disorder). This approval came with to their ability to sedate and severe restrictions, including its use incapacitate unsuspecting victims, only for the treatment of narcolepsy, preventing them from resisting sexual and the requirement for a patient assault. registry monitored by the FDA. GHB is • GHB is usually ingested orally, either also a metabolite of the inhibitory in liquid or powder form, while neurotransmitter gamma-aminobutyric Rohypnol is typically taken orally in acid (GABA). It exists naturally in the pill form. Recent reports, however, brain, but at much lower concentrations have shown that Rohypnol is being than those found when GHB is abused. ground up and snorted. • Rohypnol (flunitrazepam) use began • Both GHB and Rohypnol are also gaining popularity in the United States abused for their intoxicating effects, in the early 1990s. It is a similar to other CNS depressants. benzodiazepine (chemically similar to • GHB also has anabolic effects (it sedative-hypnotic drugs such as Valium stimulates protein synthesis) and has or Xanax), but it is not approved for been used by bodybuilders to aid in fat reduction and muscle building.

Club Drugs • December 2014 • Page 1 • Ketamine is usually snorted or Ketamine users can develop signs of injected intramuscularly. tolerance and cravings for the drug.4

How Do Club Drugs Affect the Brain? What Other Adverse Effects Do Club Drugs Have on Health? • GHB acts on at least two sites in the brain: the GABAB receptor and a Uncertainties about the sources, chemicals, specific GHB binding site. At high and possible contaminants used to doses, GHB’s sedative effects may manufacture many club drugs make it result in sleep, coma, or death. extremely difficult to determine toxicity • Rohypnol, like other benzodiazepines, and associated medical consequences. acts at the GABAA receptor. It can Nonetheless, we do know that: produce anterograde amnesia, in • Coma and seizures can occur following which individuals may not remember use of GHB. Combined use with other events they experienced while under drugs such as alcohol can result in the influence of the drug. nausea and breathing difficulties. GHB • Ketamine is a dissociative anesthetic, and two of its precursors, gamma so called because it distorts butyrolactone (GBL) and 1,4 perceptions of sight and sound and butanediol (BD), have been involved produces feelings of detachment from in poisonings, overdoses, date rapes, the environment and self. Ketamine and deaths. acts on a type of glutamate receptor • Rohypnol may be lethal when mixed (NMDA receptor) to produce its with alcohol and/or other CNS effects, which are similar to those of depressants. the drug PCP.1,2 Low-dose intoxication • Ketamine, in high doses, can cause results in impaired attention, learning impaired motor function, high blood ability, and memory. At higher doses, pressure, and potentially fatal ketamine can cause dreamlike states respiratory problems. and hallucinations; and at higher doses still, ketamine can cause What Treatment Options Exist? delirium and amnesia. There is very little information available in the scientific literature about treatment for Addictive Potential persons who abuse or are dependent upon • Repeated use of GHB may lead to club drugs. withdrawal effects, including • There are no GHB detection tests for insomnia, anxiety, tremors, and use in emergency rooms, and as many sweating. Severe withdrawal reactions clinicians are unfamiliar with the drug, have been reported among patients many GHB incidents likely go presenting from an overdose of GHB undetected. According to case reports, or related compounds, especially if however, patients who abuse GHB other drugs or alcohol are involved.3 appear to present both a mixed • Like other benzodiazepines, chronic use picture of severe problems upon of Rohypnol can produce tolerance, admission and a good response to physical dependence, and addiction. treatment, which often involves • There have been reports of people residential services.3 binging on ketamine, a behavior that is • Treatment for Rohypnol follows similar to that seen in some cocaine- or accepted protocols for any amphetamine-dependent individuals. benzodiazepine, which may consist of a 3- to 5-day inpatient detoxification

Club Drugs • December 2014 • Page 2 program with 24-hour intensive the peak year of 2002, in which 2.6 percent medical monitoring and management reported past-year use. of withdrawal symptoms, since withdrawal from benzodiazepines can For Rohypnol, 0.3 percent of 8th-graders, be life-threatening.3 0.5 percent of 10th-graders, and 0.7 percent • Patients with a ketamine overdose are of 12th-graders reported past-year use, also managed through supportive care for down from peak use in 1996 for 8th- acute symptoms, with special graders (1.0 percent), 1997 for 10th- attention to cardiac and respiratory graders (1.3 percent), and 2002 and 2004 functions.5 for 12th-graders (1.6 percent).

How Widespread Is Club Drug Abuse? Learn More For additional information about club Monitoring the Future (MTF) Survey* drugs, visit www.drugabuse.gov/drugs- MTF has reported consistently low levels of abuse/club-drugs. abuse of these club drugs since they were added to the survey. For GHB and ketamine, Data Sources this occurred in 2000; for Rohypnol, 1996. * These data are from the 2014 Monitoring According to results of the 2014 MTF the Future survey, funded by the National survey, 1.0 percent of 12th-grade students Institute on Drug Abuse, National Institutes reported past-year use of GHB, a of Health, U.S. Department of Health and statistically significant decrease from peak- Human Services, and conducted annually by year use of 2.0 percent in 2004. GHB use the University of Michigan’s Institute for among 8th- and 10th-grade students was Social Research. The survey has tracked not reported. 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and Past-year use of ketamine was reported by 10th-graders were added to the study. 1.4 percent of 12th-graders in 2014. This also represents a significant decrease from

1 Anis NA, Berry SC, Burton NR, Lodge D. The dissociative anaesthetics, datamine and phencyclidine, selectively reduce excitation of central mammalian neurons by N-methyl-aspartate. Br J Pharmacol. 1983;79(2):565-575. 2 Kapur S, Seeman P. NMDA receptor antagonists ketamine and PCP have direct effects on dopamine D2 and serotonin 5-HT2 receptors – Implications for models of schizophrenia. Molecular Psychiatry. 2002;7:837-844. 3 Maxwell JC, Spence RT. Profiles of club drug users in treatment. Subst Use Misuse. 2005;40(9–10):1409- 1426. 4 Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and dependence. J Psychoactive Drugs. 2001;33(2):151-158. 5 Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine –hydroxybutyrate. Am J Health-Syst Pharm. 2002;59(11):1067-1076.

hydrochloride, and γ

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