A Comprehensive Review of MDMA and GHB: Two Common Club Drugs

Christian J. Teter, PharmD, and Sally K. Guthrie, PharmD, FCCP, from the College of Pharmacy, the University of Michigan, Ann Arbor, Michigan. 

Pharmacotherapy. 2001;21(12) 

In This Article

Abstract and Introduction

Abstract

"Club drugs" have become alarmingly popular. The use of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) and -hydroxybutyrate (GHB), in particular, has increased dramatically from 1997-1999. The pharmacokinetics of MDMA and GHB appear to be nonlinear, making it difficult to estimate a dose-response relationship. The drug MDMA is an amphetamine analog with sympathomimetic properties, whereas GHB is a -aminobutyric acid analog with sedative properties. Symptoms of an MDMA toxic reaction include tachycardia, sweating, and hyperthermia. Occasional severe sequelae include disseminated intravascular coagulation, rhabdomyolysis, and acute renal failure. Treatment includes lowering the body temperature and maintaining adequate hydration. Symptoms of GHB intoxication include coma, respiratory depression, unusual movements, confusion, amnesia, and vomiting. Treatment includes cardiac and respiratory support. Because of the popularity of these agents and their potentially dangerous effects, health care professionals must be familiar with these substances and the treatment options for patients who present with symptoms of a toxic reaction.

Introduction

The increase in the popularity of a socially designated class of drugs known as "club drugs" has been alarming. These drugs acquired this label because they are used most often at all-night dance parties known as "raves" or in dance clubs and bars. Drugs commonly included in this group are 3,4-methylenedioxymetham-phetamine (MDMA, "Ecstasy"), -hydroxybutyrate (GHB), flunitrazepam ("Roofies"), ketamine, methamphetamine, and lysergic acid diethyl-amide (LSD). Many of these drugs are colorless, tasteless, and odorless and can be placed covertly into beverages. Therefore, some of these drugs, in particular GHB and flunitrazepam, have been used to intoxicate or sedate unsuspecting individuals to facilitate sexual assault and have been given the name "date rape" drugs.[1]

Epidemiologic studies have shown that use of club drugs is on the rise.[2,3] According to the Monitoring the Future Study,[2] the use of MDMA has risen sharply over the last couple of years. In 2000, 8.2% of 12th graders reported taking MDMA in the prior 12 months, an increase from 5.6% in 1999. Use also increased markedly among American college students, from 0.5% in 1994 to 5.5% in 1999. According to the principal investigator for the Monitoring the Future Study, two reasons explain why MDMA use may still be on the rise despite a great deal of attention in the media. First, young people may not yet see MDMA as a dangerous drug. Second, the perceived availability of MDMA has increased dramatically. By 2000, 51% of 12th graders stated that they could buy MDMA fairly or very easily. The same study reported that the prevalence rates of GHB and ketamine use are 1-2.5% in grades 8, 10, and 12. Ketamine and GHB were added to the ongoing Monitoring the Future Study in 2000, so it is not possible to obtain usage trends for these drugs. The use of flunitrazepam, crystal methamphetamine, and LSD has actually declined from peak levels in the mid-1990s through 2000.

The increase in the use of club drugs has been observed by medical care providers. According to the Drug Abuse Warning Network (DAWN) report,[3] emergency department episodes significantly increased for MDMA (p<0.01), GHB (p<0.01), and ketamine (p<0.05) from 1994-1999. These increases were especially dramatic from 1997-1999 for MDMA and GHB (Figures 1 and 2). Apparent increases in the use of flunitrazepam over the same time period were not statistically significant. Methamphetamine and LSD account for the largest number of emergency department "mentions" in this report overall; however, mentions of methamphetamine dropped significantly from 1994-1999, whereas mentions of LSD remained stable over these 6 years. (A mention refers to a specific substance that was mentioned in a drug abuse episode.)

Figure 1.

Drug Abuse Warning Network (DAWN) statistics of the number of emergency department mentions of 3,4-methylenedioxymethamphetamine (MDMA) from 1994-1999. (From reference 3.)

Figure 2.

Drug Abuse Warning Network (DAWN) statistics of the number of emergency department mentions of -hydroxybutyrate (GHB) from 1994-1999. (From reference 3.)

The use of these drugs poses a serious public health problem, and health care professionals need to be familiar with these substances.

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