Rave Culture and Illicit Drug Use in the Young
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REVIEW ELLEN S. ROME, MD, MPH Head, Section of Adolescent Medicine, Cleveland Clinic It’s a rave new world: Rave culture and illicit drug use in the young ■ ABSTRACT EW AND POTENTIALLY dangerous illicit N drugs are popular among young people Illicit drug use by young people has changed in the last today. Relatively little is known about the decade, with the increasing use of “designer” or “club” short-term and long-term adverse effects of drugs such as ecstasy. Keeping abreast of current trends in these drugs or how to test for them. illicit drug use prepares the primary care clinician to A major trend since the early 1990s has recognize the clinical effects of drug use, to manage drug been the use of “designer” or “club” drugs such as “ecstasy” at raves—all-night dance parties emergencies, and to detect addictive behavior. Today’s with marathon dancing to electronic “techno” widely used drugs, their street names, their effects, and how music. Use of the designer drugs gamma- to manage overdoses are reviewed. hydroxybutyrate (GHB), Rohypnol, and keta- ■ mine, also called “date rape” drugs, is wide- KEY POINTS spread enough to have prompted Congress to adopt the Drug-Induced Rape Prevention and Popular “designer” drugs include ecstasy, gamma- Punishment Act of 1996, which increased hydroxybutyrate (GHB), Rohypnol, ketamine, herbal ecstasy Federal penalties for use of any controlled sub- (ma huang, ephedra), and methamphetamine. stance to aid in sexual assault (see “Date rape drugs: What parents should know,” page Designer drugs are easily obtainable and affordable at 551). raves—all-night dance parties with marathon dancing to Drug abuse leads to short-term and long- electronic “techno” dance music. term health problems. Keeping abreast of trends in illicit drug use enhances the clini- Other substances associated with rave culture include cian’s ability to recognize and manage overdos- “smart drinks” sold for rehydration; these may contain ma es and to pick up clues of addiction in young huang, caffeine, guarana (a caffeine-like stimulant), and patients. This article briefly reviews the scope ginseng. of illicit drug use in young people and the most popular designer drugs. When questioning teens and young adults about drug use, ■ THE SCOPE OF DRUG ABUSE a non-confrontational approach helps. The clinician needs IN THE YOUNG to establish confidentiality and to define the limits of that confidentiality. Illicit drug use continues to be prevalent among young people. Some of the drugs used are familiar (alcohol, marijuana) and some are newer and perhaps unfamiliar to many of us.1 The percentage of 8th graders reporting illicit drug use doubled from 11.3% in 1991 to 21.4% in 1995.2 Then, after 1 or 2 years of PATIENT INFORMATION decline in the late 1990s, the use of marijuana, Date rape drugs: What parents should know, page 551 amphetamines, tranquilizers, heroin, and alco- CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 68 • NUMBER 6 JUNE 2001 541 Downloaded from www.ccjm.org on October 1, 2021. For personal use only. All other uses require permission. ILLICIT DRUG USE ROME The rave scene: A closer look AVES ARE PARTIES with loud, electronic “tech- “Circuit parties” are weekend-long parties or R no-rock” music, laser light shows, and all- raves with a homosexual orientation, involving night dancing. They are held in clandestine loca- 5,000 to 20,000 people. Partygoers travel from tions, including warehouses, nightclubs, and farm event to event, with some of these parties being fields. They first became popular in Great Britain in substantially linked economically to fundraising or the late 1980s. cultural events. Alcohol is not sold at many raves, but designer In Montreal, this circuit has been estimated to and other drugs are obtainable and affordable. In be the second largest money maker for their tourism addition, “power drinks” are usually sold: these are industry. fruit juice mixed with amino acid powders and B vitamins to replenish fluids lost during strenuous ATTEMPTS TO MAKE DRUG USE AT RAVES SAFER marathon dancing. Drug safety check stations. Because the designer drugs sold at raves are not always pure, SPREADING THE WORD many raves now feature stations where users can Two to three days before a rave, information about have the purity of their drugs checked, without the the location is disseminated via the Internet (eg, risk of being arrested for possession. This is an effort links accessible from www.dancesafe.org), fliers, or to increase the safety of illicit drug use by letting word of mouth. Raves are sometimes advertised users know exactly what they are taking. Many under alluring names, such as “Rave New World” or local police departments arrest only those individu- “Save the Rave Forest.”7 Raves attract mainly peo- als caught selling drugs. ple 16 to 21 years old, but younger teens and some Safe spaces. In Montreal, physicians often go adults also frequent these parties. A single rave in to raves to create “safe spaces” for medical triage Ohio attracted young people from a five-state area. and urgent referral to local emergency rooms. This Some rave fans go from city to city in search of the practice is one of damage control rather than pri- next best rave. mary prevention and has been controversial among adolescent medicine professionals. On one OTHER TYPES OF RAVES hand, this practice has prevented deaths from “Bush parties” are outdoor parties often with a overdose and has provided a source of education; sports focus; alcohol use at these events tends to but on the other hand, it does little to decrease exceed drug use. actual drug use. hol among 8th, 10th, and 12th graders stopped counter drugs. One example is a “roboshot”— declining and leveled off from 1998 to 1999, 1 to 2 ounces of Robitussin DM chugged with according to the National Institute on Drug a 12-ounce beer. This allegedly produces a Abuse’s 1999 Monitoring the Future study.3 “buzz” equivalent to a six-pack of beer, with- out any hangover. Alcohol Alcohol is the most widely used drug among Marijuana young people, with four out of every five stu- Marijuana is the second most widely used drug dents having consumed alcohol by the end of among young people: 17% of 8th graders, 32% high school, and 52% by the 8th grade.3 of 10th graders, and 38% of 12th graders Almost two thirds of 12th graders and one reported having used it at least once, and 1.4% fourth of 8th graders reported having been of 8th graders, 3.8% of 10th graders, and 6.0% drunk at least once.3 Binge drinking rates of 12th graders reported daily use.3 have leveled off in the past few years, just as designer drugs started gaining in popularity. Inhalants Alcohol-drug combinations. A popular For the past 5 years, the use of inhalants by trend is to combine alcohol with over-the- students surveyed in the Monitoring the 542 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 68 • NUMBER 6 JUNE 2001 Downloaded from www.ccjm.org on October 1, 2021. For personal use only. All other uses require permission. Future Study has steadily declined, with 10% graders reported using ecstasy in the past year. of 8th graders, 7% of 10th graders, and 6% of The 2000 Monitoring the Future Study 12th graders reporting use at least once during showed that the use of ecstasy by all three 1999. The data for the year 2000 show groups increased.4 inhalant use continues to be more prevalent GHB is a date rape drug either intention- in younger teens.4 ally used or surreptitiously administered to Inhalants are readily accessible. A wide incapacitate a victim, preventing her or him range of common household products are from resisting sexual assault. As with other used, including glue, solvents, butane, gaso- date rape drugs, its use is not confined to date line, and aerosols. rape situations. No data on the prevalence of its use are Anabolic steroids available as of this writing. Nevertheless, Among young people, use of anabolic steroids the problem of GHB, Rohypnol, and keta- is more common in boys than in girls. Steroid mine use received sufficient national atten- use increased in 1999, with 2.5% of 8th tion to prompt Congress to pass a law graders and 2.8% of 10th graders using increasing penalties for using drugs in sexual steroids.3 These rates almost doubled com- assault. pared with 1998 rates of 1.6% and 1.9%, Rohypnol is an anti-seizure drug avail- respectively, and fewer 12th graders consid- able in Europe but not in the United States. ered steroids as risky as they did the previous Rohypnol use showed a small decline in year. The 2000 Monitoring the Future study4 1999, with 0.5% of 8th graders and 1.0% of showed that between 1999 and 2000 the use 10th and 12th graders reporting use.3 of anabolic steroids increased among 10th Rohypnol may be lethal when combined graders. with alcohol.3,7 Ketamine is a rapid-acting general anes- Designer drugs thetic used as an alternative to cocaine and A number of drugs are used by teens and usually snorted. No data on the prevalence young adults who frequent raves, bars, and of ketamine use are available as of this writ- GHB, Rohypnol, nightclubs, where they are relatively easy to ing. and ketamine obtain and affordable. Popular designer drugs currently include: ■ ECSTASY are the date • Ecstasy, the common name for 3-4 meth- rape drugs ylenedioxymethamphetamine (MDMA), Ecstasy (MDMA, XTC, X, E, Adam) is a syn- also called “Adam” and “XTC” thetic, psychoactive, hallucinogenic drug, • The date rape drugs GHB, flunitrazepam first synthesized in Germany by Merck in (known mainly by its brand name, 1914 to facilitate communication during psy- Rohypnol), and ketamine chotherapy.8 It is an amphetamine analogue • Herbal ecstasy, another name for ma and a selective serotonergic neurotoxin.