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Gay Men, Lesbians and Substances of Abuse and the ''Club and Circuit

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Gay Men, Lesbians and Substances of Abuse and the ''Club and Circuit Gay Men, Lesbians and Substances of Abuse and the ‘‘Club and Circuit Party Scene’’: What Clinicians Should Know David McDowell, MD SUMMARY. Many researchers believe that substance use rates are higher among gay men and lesbians than in the general population. In particular, recreational drugs, used as part of weekend and night ‘‘life’’ are particular- ly popular. In recent years these so called ‘‘club drugs’’ have become a regular part of many gay men and women’s social life. MDMA, better known as ‘‘Ecstasy,’’ is a synthetic amphetamine derivative, with some unique physiological properties. MDMA can induce depression and panic attacks in those who use it. A serious concern is the potential that MDMA may cause long lasting, even permanent neuropsychiatric damage, in par- ticular to serotonin neurons. Ketamine, ‘‘Special K,’’ is a dissasociative anesthetic which induces feelings of unreality, and may even cause catato- nia (a ‘‘K hole’’). GHB is a naturally occurring biological substance which has effects similar to alcohol. Modest doses can cause sleep, and coma. There have been a growing number of reports of fatal overdoses associat- ed with GHB. The clinician working with gay and lesbian people is urged to become aware of these particular substances, as well as other recre- ational drugs, as well as their dangers, in order to more effectively work with his or her clients. [Article copies available for a fee from The Haworth Dr. David McDowell is Assistant Professor of Clinical Psychiatry and Director, The Substance Treatment and Research Service (STARS), Columbia University/The New York State Psychiatric Institute, 600 West 168th Street, Second Floor, New York, NY 10032 (E-mail: [email protected]). This article has been adapted, in part, from a chapter from the American Psychiat- ric Association Textbook on Substance Abuse Treatment: Marc Galanter and Herbert Kleber, Editors, APA Press, Washington DC. [Haworth co-indexing entry note]: ‘‘Gay Men, Lesbians and Substances of Abuse and the ‘Club and Circuit Party Scene’: What Clinicians Should Know.’’ McDowell, David. Co-published simultaneously in Journal of Gay & Lesbian Psychotherapy (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 3, No. 3/4, 2000, pp. 37-57; and: Addictions in the Gay and Lesbian Community (ed: Jeffrey R. Guss, and Jack Drescher) The Haworth Medical Press, an imprint of The Haworth Press, Inc., 2000, pp. 37-57. Single or multiple copies of this article are available from The Haworth Document Delivery Service [1-800-342-9678, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]]. E 2000 by The Haworth Press, Inc. All rights reserved. 37 38 ADDICTIONS IN THE GAY AND LESBIAN COMMUNITY Document Delivery Service: 1-800-342-9678. E-mail address: <getinfo@haworth pressinc.com> Website: <http://www.HaworthPress.com>] KEYWORDS. Club drugs, MDMA, Ecstasy, Ketamine, K hole, GHB, raves Much has been written about substance abuse within the gay community. This is an extremely broad topic, and as varied as the individuals who use these drugs. Although there is scant hard evidence, most people who study these issues agree that rates of substance use are higher in gay and lesbian individuals than in the population in general (McDowell, 1999; Lee and McDowell, 1999). There are, however, some illicit substances that are espe- cially popular among gay men and lesbians. A working knowledge of these substances, their history, chemistry, physiological effects, and the treatment options available is important for a clinician that works with this population. Methylenedioxymethamphetamine (MDMA), Ketamine, and Gamma Hy- droxybutyrate (GHB) are unique compounds, differing in terms of their phar- macological properties and their phenomenological effects. They are particu- larly popular within the gay community, and are, for some, an integral part of social life. They are not of course, the sole provinces of gay men and women, and individuals from quite varied backgrounds, and in many different ways use these drugs. They are particularly popular among young people who are part of the ‘‘rave’’ culture. With gays and lesbians, they are most often associated with nightclubs and circuit parties. Hence, these three drugs, which will be discussed extensively, and several others, which will be de- scribed more briefly, are widely known as ‘‘club drugs.’’ In recent years, the popularity of the ‘‘club drugs’’ has been inextricably linked with the rise of the ‘‘rave’’ phenomenon. Anecdotal reports suggest that raves were ‘‘created’’ in Ibiza, an island off the coast of Spain, known as a destination for Europeans and Americans interested in beaches and night- life. Raves first became popular in England during the late 1980s and have since spread to the United States and the rest of the world. In the early 1990s, raves were considered ‘‘the next big thing,’’ a rising trend. Although their popularity has not grown dramatically, it has remained relatively constant. At raves, groups of young people (typically in their teens) dance to rapid electronically synthesized music with no lyrics (techno). These events tradi- tionally take place in unregulated and unlicensed locations such as stadiums, abandoned warehouses, and other surreptitious arenas. There are significant numbers of individuals at these events who identify themselves as gay, lesbian or bisexual (McDowell and Kleber, 1994). Since the early nineties, the venues have become increasingly ‘‘mainstream.’’ These drugs, along with marijuana and LSD, are extremely popular at these events. At some of these events, as Overviews and Empirical Study 39 many as 70% of rave participants are using Ecstasy, Ketamine, or GHB, along with other drugs like marijuana and LSD (McDowell and Kleber, 1994). Circuit parties are large-scale social events, which have become increas- ingly popular among gay men over the last decade. At these events, several thousand people, mostly (but not exclusively) gay men, congregate in a dance club setting. Several of these events have been associated with fundraising events, in particular organizations which fund services and research con- cerned with HIV related disease. These were, initially, small events that took place in private rather than commercial settings. Recently, they have become much larger, and spawned a worldwide industry, including a magazine called Circuit Noize, which is dedicated to issues related to circuit parties. These parties are held in various cities throughout the United States and in several countries including Austra- lia, Canada, and Greece. These events typically take place over several days and involve numerous related events. Alcohol is often readily available at these events. There have been numerous anecdotal and media reports citing rampant and illicit drug use among attendees at circuit parties. One concern about the drug use at these parties is the possible toxicity of the drugs them- selves. In the early morning hours before a New York area circuit party, one man died from a fatal overdose, and many speculate that his drug use was related to the atmosphere of permissiveness towards drugs associated with the circuit party (Bruni, 1998). Another concern is the possible increase in unsafe sex practices associated with intoxication. MDMA Introduction Many groups, including HIV-organizations and gay and lesbian communi- ty groups, have used circuit parties as fund-raising events, raising hundreds of thousands of dollars in a single night. There is increasing controversy over the role of circuit parties as fund raisers. A popular circuit party held on Fire Island in the summer of 1998 raised $450,000 for AIDS research, but resulted in the death of at least one participant. MDMA has unique subjective and biochemical properties (Shulgin, 1986, Hermle, 1993). Recreational use of MDMA has been illegal since it was made a Schedule I drug on July 1, 1985. Prior to that time, because it was not mentioned in the controlled substances act of 1970, its use was unregulated and therefore legal. In spite of its illegal status, its use has skyrocketed in the past several years (Cohen, 1997). This rise in usage has been particularly marked among adolescents, and MDMA has been powerfully linked to raves. It is also sometimes known as a ‘‘gay drug’’ because of its popularity at gay bars and nightclubs. MDMA damages brain serotonin neurons in laboratory animals (McCann, 40 ADDICTIONS IN THE GAY AND LESBIAN COMMUNITY 1993). Although it is not definitively known if MDMA is neurotoxic to humans, the weight of current scientific evidence indicate that this is prob- ably the case (Gold, 1997). A recent article by McCann (1998) compared subjects with extensive use of MDMA to matched controls. The MDMA users had significantly less serotonin activity as measured using Positron Emission Tomography (PET). The indirect implication is that the use of MDMA is indeed neurotoxic. This is particularly germane for individuals with affective illness. Lower serotonin levels correspond with depression and impulsivity. Individuals who are prone to or have a history of depression and anxiety are warned to use MDMA with particular caution. MDMA’s appeal rests primarily on its psychological effect, a dramatic and consistent induction in the user, a profound feeling of attachment and connec- tion. This feeling of connection is not necessarily to another individual, and people who use the drug alone may feel ‘‘connected to’’ the larger world. The compound is perhaps a misnomer; the LA dealer who coined the term Ecsta- sy, wanted to call the drug ‘‘Empathy,’’ but asked, ‘‘who would know what that means?’’ (Eisner, 1986). History MDMA is not a new drug. It was first patented in 1914 by Merck in Darmstadt, Germany (Shulgin, 1990). MDMA was probably patented as so many compounds were at that time, to serve for subsequent research. Except for a minor chemical modification in a patent in 1919, there is no other known historical record of MDMA until the 1950s.
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