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Raves & Party Drugs: Is It All Ecstasy? Pierre-Paul Tellier, MD Associate Professor Family Medicine Director Student Health McGill University Marie-Elaine Delvin, BSc N Nursing Coordinator Student Health McGill University Table of Contents Section 1: Description of Party Drugs. 1) Ecstasty – MDMA 2) GHB 3) Ketamine 4) Cocaine 5) Methamphetamines 6) Stimulants 7) Designer Drugs 8) Hallucinogens 9) Marijuana 10) Depressants/Tranquilizers 11) Inhalants 12) Others Section 2: Annotated Bibliography Section 3: Useful Websites Section 4: Educational Resources Section 1: Description of Party Drugs Party Drugs – Major Drugs of Use Ecstasy – MDMA – 3,4 methylene-dioxy-N-methylamphetamine Names: X, E, XTC, Adam Desired effect: “strengthens” the ego, softens defensiveness and gently removes obstacles to communications (1) History/Pharmacology: amphetamine analog first synthesized in Germany by Merck in 1912. Human experimentation has only been traced back to early 1970s (4 ). It was criminalized in the USA 1985 (4.) Most of what is sold as ecstasy is not MDMA. It may be MDA, MDEA, LSD, amphetamines, caffeine, heroin, “China White”, lactose. Therefore a trip may last from six to 24 hours. May be taken in combination with amphetamines or LSD (candyflipping) as well as cocaine and for coming down, cannabis or alcohol and sometimes Ketamine or GHB. The stimulant effects of MDMA may mask the sedative effects of alcohol or opiates thus leading to overdose of the latter. Alcohol by increasing diuresis may increase the risk of dehydration. Presentation: a white crystalline powder which maybe buffered and pressed into pills (1) Dose/absorption/metabolism: The average dose is between 125mg to 180mg depending on weight of the person. It may be taken orally, placed under the tongue or in juice or carbonated liquid, may be taken nasally. It causes the release of serotonin and dopamine in the brain. Serotonin is released normally to create the mood for situations such as being in love, and dopamine is released to suppress pain in situation where we are hurt but have to carry on. Some of the neurotransmitters released by MDMA help control the regulation of body temperatures and thus allow us to overheat without discomfort. (5) MDMA is metabolized in the liver in large part into MDA which in turn is excreted in the urine. The half life of MDMA is six hours. Response is idiosyncratic, different individuals will respond differently some being very sensitive others less so. The intensity of the responds may be due to variations in metabolism or to psychological factors. Booster dose often taken at about an hour to prolong the experience Stages of a typical session: Coming on: the transition to a peak of an MDMA experience happens very rapidly – about 30 to 45 seconds after the substance is taken on an empty stomach. The duration of the “rush” is between 15 to 30 minutes, followed by a gradual descent back to normal consciousness. There dawns a sudden clarity and intensification of experiencing. Outwardly, everything seems brighter and crisper. Inwardly, there is a feeling of ecstasy and utter happiness. Everything is perfect just as it is; everybody is lovable just as they are. This is when the booster dose is usually taken. Booster doses increase the negative effects of coming down and this seems to worsen with increase use. “Bubble Bursting” occurs when there is a build up of psychic tension, trepidation, stomach tightness, panic and/or mild nausea instead of the described rush. Plateau: one half hour to 3 hours after the initial effect, leveling off of experience after the initial rush, less intense feelings than during coming on period, coordination or movements are not impaired. During this time some young people find various forms of movements extremely pleasurable which lead to long-lasting ecstatic states achieved through “trance dancing”. Coming down: 3 to 6 hours after initial effect, psychological effects shuts, can take up to 6 to 7 hours to fall asleep and there can be disappointment and other negative emotions at this time. (1) There are some residual effects for one to two days after, usually sluggishness. Psychological effects: It produces empathy, openness, peace and caring. It caused altered time perception (speeded up or slowed down), increased ability to interact with or be open with others, decreased defensiveness, decreased fear, (5) It does not cause hallucinations in normal doses and does not disrupt “ego-integrity”, coordination remains intact and no disorganization of the thought process occurs. (1) Ecstasy makes sexual experiences more sensual, affect capacity to obtain an erection and to reach orgasm for both men and women. Other effects can include confusion, depression, sleep problems, drug craving, severe anxiety, paranoia, psychotic episodes. Judgment is impaired, problems with arithmetic and there are conflicting reports of memory loss. (5) Long term it may lead to depletion or decrease in serotonin production in the brain which may be linked to depression and memory impairment. (29) The use of MDMA is usually followed by a state of depression a few days later, “Tuesday Blues”. This is accompanied by impaired attentional function. (44) Physical effects: mild rise in blood pressure and heart rate for up to 11/2 hours, talkativeness, jaw-clenching, nystagmus, muscle tension, nausea, decrease appetite. Occasionally, also reported, difficulty in walking, chills, sweating, biting the inside of the cheek, headache, fainting, and vomiting. (1). There is also decrease appetite, more long term, weight loss and in women irregular periods and amenorhea. Ecstasy may inhibit orgasm and prevent erection in some men. Intoxication with MDMA may lead to hyperthermia, malignant hyperthermia, rhabdomyelisis, disseminated intravascular coagulopathy, acute renal failure, seizures, arrhythmias, intracranial hemorrhage, brain infarction and death (3) (35). In cases of intoxication intubation may be difficult because of trismus thus resulting in the need for tracheostomy. (35) Many of these side effects are described as part of the Serotonin syndrome.(55) Some cases of jaundice and hepatomegaly have been linked to the use of MDMA. ( 53) Dehydration may be indicated by failure to sweat, heat cramps in the legs, arms and back, giddyness, headache, fatigue, vomiting, fainting, suddenly feeling tired and irritable, urinating small amounts but having urgency, concentrated urine. (51) Long term impact: difficult to determine. Known to cause destruction of some neurons but the significance of this is unknown. Saunders in his book published in 1995 reviewed the literature and concluded that there is no indication that this neurotoxicity leads to behavioral changes or functional changes (5.) However more recent studies indicate some impairment of memory secondary to chronic MDMA use. (88,89,95) Contraindications: heart disease, hypertension, epilepsy, MAO inhibitors (including harmaline and ayahuasca hallucinogenic plants which are MAOIs (73)), pregnancy, hyperthyroidism, diabetes mellitus, hypoglycemia, glaucoma, diminished liver functions. (1) Interactions between ritonavir and MDMA may lead to a two to three fold increase in amphetamine levels because enzymes that metabolize amphetamines are inhibited by ritonavir. Theoretically there is the same effect with other protease inhibitors such as indinavir, saquinavir and nelfinavir. (65) Other drugs that inhibit these same enzymes include codeine and dextrometorphan. Synergies: synergistics with most psychedelics, e.g. LSD and 2 – CB, may be dangerous when taken with cocaine. Effects are diminished by alcohol or marijuana (1). MDA 3,4-methylenedioxyamphetamine (29) Name: Love pill, love drug, speed for lovers Psychological/Physical effects: Similar to above but more toxic and stimulating Has greater hallucinogenic effects. May cause cardiac arrhythmias. (56) Destroys serotonin-producing neurons, which play a direct role in regulating aggression, mood, sexual activity, sleep and sensitivity to pain. It is probably this action on the serotonin system which gives MDA its purported properties of heightened sexual experience, tranquility, and conviviality. (4) GHB – Gamma Hydroxybutyrate (10) Names: Liquid Ecstasy, Easy lay, grievous bodily harm, cherry meth, gook, gamma 10, liquid X, liquid G, liquid E. Desired effects: Used to produce euphoria, disinhibition, sexual enhancing effects without an appreciable hangover (57) History/pharmacology: Developed as an adjunct to anaesthesia, however, there were problems in that patient’s reaction were unpredictable. A given dose in one patient could completely anaesthetize him whereas the same dose may have very little effect on another. GHB mediates sleep cycles, temperature regulation, cerebral glucose metabolism and blood flow, memory and emotional control. (59) Made a Schedule 1 drug in 2000. Presentation: orally as a capsule or as a powder which may be dissolved in liquid. Usually sold as a salty, clear liquid in small bottles and taken by the capful. The concentration may vary and the amount taken at one time also, therefore reaction is unpredictable. Absorption and metabolism: When taken orally the onset of action is within 15 minutes to an hour and lasts from one to three hours. The elimination half-life is 27 minutes and the primary route of elimination is expired breath as carbon dioxide. (59) While the patient is intoxicated with GHB and apneic he or she may have episodes of violent agitation so physical stimulation must be kept at minimum. ( 58) As the patient recovers they have an emergence phenomenon which is characterized by myoclonic jerking, transient confusion, and combativeness. Emergence and recovery of consciousness usually occur rapidly. (57) The effect is potentiated by alcohol. Used as a intoxicating agent or to come down from ephedrine, ecstasy, speed or cocaine. Psychological/physical effects: delusions, depression, altered mental status.(57) Physical effects include mydriasis, or miosis, inconsistent pupil response, visual disturbances, myoclonus, agitation, bradycardia, hypotension, nausea, vomiting, vertigo, respiratory distress, transient metabolic acidosis, loss of airway reflexes, loss of consciousness, amnesia, coma (3). Mentally altered mental status (57) Contraindications: Severe illness of any kind, seizures, heart problems, bradycardia, hypertension, hyperprolactinemia, cushing’s syndrome Potentiation: by alcohol, ketamine, benzodiazepines, major tranquilizers, opiates and derivatives, anticonvulsants and over-the-counter cold medicine and sleep medication. All these can potentiate the effects and lead to further respiratory depression. Methamphetamines can increase chance of seizures. GBL Gamma butyrolactone Names: Blue nitro, Gamma-G, renewtrient, reviverent, GHR History/pharmacology: Like for GHB thought to help build muscle mass (3) an organic solvent used for cleaning circuit boards, stripping paint and flavoring soy products. May be made into GHB with home kits by mixing with sodium hydroxide or is metabolized in the liver to GHB (3) Psychological/Physical effects: As per GHB but slower in onset and longer in duration. Side effects: respiratory depression and cardiac dysrythmia (3) Similar products to GBL are 1,4 butanediol found in Thunder Nectar, Revitalize Plus, Serenity, Enliven, GHRE, SomatoPro, NRG3 and Weight Belt Clearner. Other precursors to GHB also include tetramethylene glycol, 2(3H)furanone di-hydro Ketamine (10)(22)(23) Names: Special K, Vitamin K, New Ecstasy, Psychedelic Heroin, Ketalar, ketaject, super K Desired effects: relaxed feeling with hallucinations and visual distortions History/pharmacology: An anaesthetic agent used primarily in veterinary medicine and pediatrics. May be mixed with several other drugs including:: heroin, cocaine and ecstasy The mode of use is orally or intravenously as a liquid, white powder that is snorted, taken orally or smoked with marijuana or tobacco. This powder can be made from the liquid by gentle boiling on a stove or in the microwave. Ketamine can also be injected intramuscularly and intravenously. The effects may be wide ranging and variable with the same amount. Intramuscularly the effect is felt within two minutes, orally in 15-20 minutes and less if on an empty stomach, nasally 5-10 minutes. When taken intranasally the dose will be repeated every 5 minutes until desired effect. If the person enters a “k-hole” they may be semi-conscious for up to an hour, after that the effect will continue for 2-3 hours with some residual symptoms for up to 24 hours. “CK” is a combination of Ketamine and cocaine. Dangerous interactions can occur with alcohol, barbiturates, valium because they are all respiratory depressant. Psychological/physical effects: hallucinations and visual distortions ( K-land) Low dose produce a floppy relaxed feeling, higher doses produces dissociation, near death experience and insights (K-Hole), loss of sense of time, and identity, depression, recurrent flashbacks, delirium, amnesia, impaired motor function, high blood pressure, increased heart rate and cardiac output, respiratory problems, bronchodilation, pupillary dilation, nausea. The user may become cold from inactivity. It stops the user from feeling pain leading to the user to cause unwitting injuries to him or herself (50) Neuroleptic drugs are ineffective in controlling unpleasant mental side effects once they have started. (54) Long term effects: not determined but may cause some brain damage all studies indicating this until now have been done on animals. These effects may be compounded by yohimbine, major tranquilizers and anticholinergics. Other authors claim that ketamine is protective against brain damage (85) The risk of seizures may be compounded when other substances including some antibiotcs, e.g. ofloxacin, anticholinergics, antipsychotics, bupropion (wellbutrin and Zyban), caffeine, GHB. (84) Contraindications: Cardiovascular accidents, hypertension, cardiac problems Potentiation: other depressants such as alcohol, barbiturates, valium, GHB, opiates Methamphetamines (5) (9) (16) Names: Ice, crystal meth, speed, tweak, crank, glass Desired effect: Acts to release high levels of the neurotransmitter dopamine which stimulates brain cells, enhancing mood and body movement. History/Pharmacology: Dose/absorption/metabolism White powder which when heated gives off a vapor which is inhaled, can also be taken orally, intranasally rectally or intravenously. After smoking or using intravenously the users experience a “rush” which is an intense, extremely pleasurable sensation lasting a few minutes. Intransal and oral use does not produce this “rush” but produces a “high”. Snorting produces effects withing 3 to 5 minutes, oral ingestion within 15- 20 minutes. (48) Lasts up to 24 hours. Psychological/physical effects: wakefulness, increased physical activity, decreased appetite, euphoria, irritability, insomnia, confusion, hallucinations, anxiety, paranoia, psychosis which may be long lasting, aggressiveness. Physical effects include headaches, pallor, mydriasis, sensation of piloerection in the head, coldness of the upper and lower extremities due to vasoconstriction, increased viscosity of saliva, a dry mouth, hyperreflexia, tremors, increased heart rate and blood pressure, chest pain, palpitations, atrial and ventricular arrhythmias, cardiomyopathy, irreversible damage to blood vessels in the brain producing strokes, increased respirations, respiratory problems such as dyspnea and wheezing, irregular heartbeat, extreme anorexia, hypethermia, convulsions, and death. (16)(47) (56) A rebound phenomenon develops accompanied by weakness, fatigue and depression. (56) Increases and decreases in sexual desire and activity have been reported. (68) Is addictive. Methamphetamine has been shown by Chicago researchers to cause degeneration of neurons containing the neurotransmitter dopamine. Damage of these neurons is the underlying cause of the motor disturbances seen in Parkinson’s disease. Strong relationship between use of methamphetamines and HIV in gay males. (47) Contraindications: As per MDMA, heart disease, hypertension, epilepsy, MAO inhibitors (including harmaline and ayahuasca hallucinogenic plants which are MAOIs (73)), pregnancy, hyperthyroidism, diabetes mellitus, hypoglycemia, glaucoma, diminished liver functions. (1) Interactions between ritonavir and methamphetamines leading to a two to three fold increase in amphetamine levels because enzymes that metabolize amphetamines are inhibited by ritonavir. Theoretically there is the same effect with other protease inhibitors such as indinavir, saquinavir and nelfinavir. (65) Agitation should be controlled using haloperidol, diazepam can be used to control behavioural and seizures Hypertension is best managed using IV labetolol and esmolol (68) Amphetamines (5) Names: Speed, whizz, billy Desired effects: emotional disinhibition, increased self-worth, reduction of communication barriers, feeling of greater energy, euphoria, History/Pharmacology: Method of ingestion snorted, dabbed with a finger onto the gums, added to a drink or injected. Duration is 8 hours Psysical/psychological effects: emotional disinhibition, increased self-worth, reduction of communication barriers, feeling of greater energy, euphoria, psychosis, paranoia, lack of appetite. Overdose results in feeling irritable and violent. Physical effects include: dry mouth, nausea, vomiting, difficult micturition, sweating, reduced need to sleep, visual and auditory hallucinations, formication, restlessness, irritability, nervousness, clouding of consciousness, increase blood pressure, heart rate and body temperature, chest pain, dysrythmia, seizures, stroke and death ( 64) . Pulmonary edema can result from smoking of amphetamines. Cause the release of neurotransmitters which cause the body to overheat without discomfort (5) Dependence is an issue. Long term use: neurotoxicity, paranoid psychoses, cardiac and circulatory failure, cerebral hemorrhage, stroke Contraindications: Interactions between ritonavir and amphetamines leading to a two to three fold increase in amphetamine levels because enzymes that metabolize amphetamines are inhibited by ritonavir. Theoretically there is the same effect with other protease inhibitors such as indinavir, saquinavir and nelfinavir. (65) Physical dangers as per MDMA and is addictive Cocaine (5) (7) (8) (20) Names: Coke, charlie, snow Desired effect: Induces state of intense euphoria and alertness, increased confidence and strength, heightened sexual feelings, indifference to concerns and cares. This rapidly changes to despondency, dejection and despair, which is obviously less desirable. History/Pharmacology: A stimulant as well as a local anesthetic with potent vasoconstrictor properties. Can be taken orally, intranasally, intravenously, smoking or inhalation of coca paste, cocaine freebase or “crack” cocaine (freebase prepared with sodium bicarbonate). When injected in combination with heroin it is called a “speedball.” Onset is very rapid when smoking or when taken intravenously longer when intranasaly. When snorted up a nostril duration of effect is half an hour. Cocaine is metabolized by plasma and hepatic esterases, hepatic damage may lead to higher plasma concentration. The metabolites are excreted in the urine. Cocaine exerts its effect predominately through CNS excitation, producing a hyperandrenergic state. It inhibits the re-uptake of nerepinephrine and dopamine from both central and peripheral neurons, and it interacts with the serotonergic system. (38) It is of ten combined with many other drugs. When combined with alcohol a metabolite is produced called cocaethylene. This can lengthen the cocaine-induced euphoria and reduce the unpleasant symptoms of withdrawal, but increases the possibility of sudden death from cardiovascular, complications, hepatotoxicity, and behaviors leading to injury. Psychological/Physical effects: Psychological: euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviors, impaired judgment, impaired social or occupational functioning, insomnia, labile affect, hallucinations, psychosis. Physical: tachycardia or bradycardia, pupillary dilatation, nose bleeds, constricted peripheral blood vessels, elevated or lowered blood pressure, increased temperature, nausea or vomiting, evidence of weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrythmias, myocardial infarction, (43) confusion, dyskinesia, dystonia, coma. In diabetics there is a higher incidence of diabetic ketoacidosis. Seizure can occur depending on the reports in 1% to 29% of users. Seizures may be more frequent in people who smoke and inject cocaine. (38) Myocardial infarcts have been reported in cocaine users. The majority of case reports suggest that the person will present with chest pain. This pain occurs shortly after intake of cocaine. The pathophysiology of MIs in this population is not entirely clear but may include vasospasm, enhanced thrombogenicity and platelets aggregation, accelerated atherogenesis in chronic users, increased oxygen demands and direct myocardial toxicity. Smoking appears to compound these problems. Some cocaine users with MIs may not demonstrate ECG changes. Management of chest pains in cocaine users should therefore be very conservative and should include appropriate laboratory analysis, a patient should not be discharged based on the absent of ECG changes. The patient with an MI should have intravenous access, O2, Apirin, nitroglycerin, thrombolytic agents when indicated, beta-adrenergics blockade should be avoided since it may compound the vasoconstrictive effects of cocaine so use calcium channel blockers, and “ caines” for arrythmias should be used judiciously since they may also compound the cocaine effects. (43) Pneumothorax has also been described and is believed to be due to direct traumatic effect of the powder. (45) Other vascular problems may include mesenteric ischemia, renal infarction. Dependence is a problem. There are also effects which are the result of long term use. Contraindications: Drug interactions: mono-amine oxidase, tricyclic antidepressants, alpha-methyldopa, reserpine. The effects of these drugs are potentiated and can cause an adrenergic crisis. Serotonin syndrome when cocaine is taken with SSRIs (69) Crack cocaine(5) Names: Rocks, freebase Smoked high lasts 10 minutes Crack lung: a syndrome usually occurring 1-48 hours after heavy cocaine smoking, represents a hypersensitivity pneumonitis. It consists of the constellation of chest pain, cough with hemoptysis, Marijuana (17) Names: pot, herb, weed, boom, mary jane, gangster, Desired effects: euphoria, laughter, relaxation, time distortion, auditory and visual enhancement History/pharmacology: Mode of use: smoking, cigarettes, pipe or cigar, eaten or brewed in a tea. May be mixed with several other drugs purposely or not including crack cocaine, PCP May be combined with PCP in embalming fluid-soaked marijuana see PCP Psychological/physical effects: Phsychological: Low doses: euphoria, laughter, relaxation, time distortion, auditory and visual enhancement, problems with memory and learning, distorted perception, difficulty thinking and problem-solving, loss of coordination, High dose: mood fluctuations, depersonalization, hallucinations, toxic doses: anxiety and panic attacks, delusions, paranoia, psychosis. Physical: increased appetite, dry mouth, decreased nausea, injected conjunctiva, normal to dilated pupils. Cardiovascular reaction include increase heart rate. The increase in heart rate and blood pressure and the potential for heart attack is greatly enhance when combined with cocaine. The effects of these drugs combine on the circulatory system is greater than when each is used alone. Neurologic findings include normal to increased reflexes, drowsiness, impaired coordination, tracking and reaction times. Long term use may have effects on learning, respiratory system, decrease sperm count, gynecomastia and cause amotivational syndrome. (86) Designer drugs (5), (9) Originally used to mean compounds that were designed to have the same effect as illicit drugs without being illicit themselves. However, the term is often used to mean new drugs which have been designed to have particular effects. (5) They can be derivatives of amphetamines, phencyclidine, tryptamines, meperidine and fentanyl Neurotoxins may be formed if the drugs are not manufactured properly leading to problems such as parkinsonism “designer drug disaster” Usually they are very strong thus precise dosing is difficult and overdosage can be easy and fatal Amphetamine derivatives: Methamphetamine Dexedrine (dexamphetamine sulfate (5) Dexys Tablets with similar effects to amphetamines Physical effects: high blood pressure Contraindications: MAO inhibitors, heart disease, hypertension MDMA See Ectstasy MDA 3,4-methylenedioxyamphetamine (29) Love pill, love drug, speed for lovers Similar to MDMA but more toxic and stimulating Has greater hallucinogenic effects. May cause cardiac arrhythmias. (56) Destroys serotonin-producing neurons, which play a direct role in regulating aggression, mood, sexual activity, sleep and sensitivity to pain. It is probably this action on the serotonin system which gives MDA its purported properties of heightened sexual experience, tranquility, and conviviality. (4) MDE N-ethyl-methylendioxyamphetamine (29) Eve Similar to MDMA, different effect, turns subject inwards. 2 – CB (24) (27) Name: Nexus, N, 4-bromo-2, 5-dimethoxyphenethylamine, phenethylamine analog of DOB (2,5-dimethoxy-4bromoamphetamine, Mode of use: taken orally the onset is in 45-75 minutes, duration 4-8 hours. May be taken in combination with MDMA to enhance effects. Effects: visual hallucination, dissociation, increase body awareness, including skin sensitivity, heightened smell, taste and sexual stimulation. Increased production of mucus at bottom of trachea leading to coughing. Taking large doses can lead to panic attacks, nausea, muscle clenching, claustrophobia, trembling, cramps, shallow breathing. DOB (2,5-dimethoxy-4-bromoamphetamine) (24) Mode of use: a liquid usually sold in impregnated blotter paper (56) Duration of effect 18-30 hours Effects: hallucinations, dissociation 2 – CD 2,5-dimethoxy-4-methylphenethylamine (24) Duration : 4-6 hours Effects: Hallucinations DOM 2,5-dimethoxy-4-methylamphetamine (24) Duration 14-20 hours Effect: hallucination, muscle tremors, facial flushing, minor sensory amplification Tryptamine Derivatives(9) DMT, DET, DPT Names: happy pill, love pill Mode of use: capsules orally Effects: euphoria, dysphoria, hallucinations, visual distortions, everestimation of one’s own capacities, aggression, disorientation, motor activity, restlessness, hypersensitivity, fall in blood pressure Meperidine Derivatives(9) MPPP, PEPTP Effects as for morphine and heroin Fentanyl Derivatives(9) (25) Short acting analgesic used in induction during anaesthesia. Derivatives of this compound are called designer drugs. They are extremely potent and have a quick onset. Onset 1-4 minutes, duration 30 to 90 minutes Effects: respiratory depression, sudden death. Names : China white, persian white Mode of use: snorting or IV Stimulants This category of drugs are used to give more energy and will allow the partygoer to dance all night. The side effect profile is similar. Many create dependence. Amphetamine Derivatives: These include amphetamine, methamphetamine, dexedrine, MDMA ( Ecstasy), MDA (Love Drug), MDE (Eve), 2CB, DOM, DOB, 2CD. All of these are previously described in Ecstasy and Designer Drugs. Methcathinone Cat, Khat, dqat A herb (Catha Edulis) that is chewed Effects: amphetamine like high Cocaine: See Cocaine Ephedrine compounds: Herbal ecstasy (10) Ma Hwang of Ephedra or pseudo ephedrine and caffeine (kola nut) Found in Chinese herbal medication, nutritional supplements, including “Metabolife 356” (3) 300 mg of Ephedra equals 30mg of ephedrine (3) The amount of caffeine and ephedrine vary widely in the pills Side effects; Hypertension or hypertensive emergencies (3), seizures, heart attacks, stroke, death Medication to use: Benzodiazipines for hypertension, nitroprusside for hypertensive crises Ephedrine Found in sudafed (pseudoephedrine) and other over the counter medication Taken orally and effects last 3-4 hours 3 tablets has a similar effect to caffeine or speed Overdose may cause restlessness, muscle spasms, racing heart, dry throat, cold extremeties Contraindication for people with cardiac problems Ritalin (methylphenidate) (14) Stimulant with effects similar but less potent than amphetamines and more potent than caffeine. It is most potent when snorted or injected. May be mixed with heroin or with both cocaine and heroin Mode of use: pills taken orally or crushed and inhaled or disolved in water for intravenous use. Effects: nervousness, insomnia, loss of appetite, nausea, vomiting, dizziness, palpitations, headaches, changes in heart rate and blood pressure ( usually elevation), skin rashes, itching, abdominal pain, weight loss, digestive problems, toxic psychosis, psychotic episodes, dependence, depression on withdrawal. High doses will cause loss of appetite, tremors, muscle twitching, fevers, convulsions, headache (severe), irregular heartbeat and respiration, anxiety, restlessness, paranoia, hallucinations, delusions, excessive repetition of movements and meaningless tasks, and formication. Death is also possible. Problems can also result from fillers used in the manufacture of pills when injected or snorted. (63) Caffeine Drank as a liquid, pills Effects: Increased heart rate and blood pressure, and temperature, nervousness, insomnia, decrease appetite, increased secretion of stomach acid, hand tremor, impaired fine motor movement, headaches, delirium. This compound is also a diuretic. Stay awake pills is used by about 20% of the high school seniors and college-age young adults. Smart Alternatives ( 83) Comes in bottles, cans, powders or capsules, they contain natural substances, mostly herbal, and vitamins They generally boost energy levels, increase stamina, refresh, quench thirst, and aid concentration. If isotonic help replaced fluid lost by sweating and the sugar content helps as well. Most products will contain stimulants. If taken in too large quantities can result in nausea, loss of appetite, insomnia, increased heart rate, visual and sensory impairment and discomfort in the bladder and urinary tract. Most are contraindicated in people who have heart or kidney problems, high/low blood pressure, asthma and diabetes. Should not be mixed with alcohol. Common ingredients may include: caffeine, guarana, stimulant similar to caffeine, Ma-Huang, contains epedrine, ginseng, amino acids, taurine, sugars, tryptophan, vitamins usually high doses of C and Bs Examples include: Stackers which contains ephedra and caffeine Go-go drinks: which contain ginseng, yohimbine, guarana ( being marketed as Viagra for women) Hallucinogens These compounds are used to produce hallucinations. The dose is often difficult to titrate and the effects unreliable. MDMA, MDA, MDE, etc See Designer Drugs and Ecstasy Ketamine: See Ketamine Dextromethorphan DXM Names: DMX, Robo, X, DM, DXM Desired effects: can cause euphoria and mild hallucinations. History/Pharmacology: Doses ranging from 300 to 18,000mg can cause euphoria and mild hallucinations. Therapeutic doses 60mg/day in adults and 10-20mg/day in 12 year old. Doses of 20-30 mg/kg can cause seizures (3) Physical side effects: lethargy, dizziness, drowsiness, ataxia, lateral nystagmus, mydriasis, palpitations, nausea, seizures (3) Medication to use: Naloxone LSD (9) (10) (18) Names: Acid, A, microdots, strawberry, trips, 25+, pink Jesus, morning glory, pink dots, the chief, purple wedges Desired effects: Visual and auditory hallucinations History/Pharmacology: Liquid taken on blotters, sugar cubes, gelatin sheets Begin to feel effects in 30 to 90 minutes of ingestion and the “high” may last up to 12 hours. The high can be widely unpredictable depending on the individual, the environment, etc. The strength is unpredictable and the amount difficult to titrate since the LSD may be very potent so the duration and intensity of the effects is difficult to predict. (52) Physical/psychological effects: Causes visual and auditory hallucinations, distortions Low doses enhance sound and lights Higher doses strong emotional and visual effects Euphoria, depression, acute panic reactions, visuospatial disorientation Dilated pupils, increased body temperature, increased heart rate and blood pressure rates, loss of appetite, sleeplessness, dry mouth, tremors, increased perspiration. Phencyclidine (9) (15) Names: PCP, PeaCe pill, rocket fuel, magic dust, DOA, elephant tranquilizer, angel dust, ozone, wack, Desired effect: euphoria and hallucinations. History/Pharmacology: Originally an intravenous anesthetic. Hallucinogenic, anesthetic, stimulant Mode of use: capsules or tablets orally, occasionally injection as a liquid, powder sniffed or smoked. Onset of effects is within 2 to 5 minutes with a peak at 15 minutes. The duration of the effects may last from 3 to 18 hours. PCP is primarily metabolized in the liver. Predominantly affects the central nervous system and the proposed mechanisms of action include reuptake inhibition of dopamine, norepinephrine, serotonin and GABA. It also acts directly on blood vessels leading to vasospam (66) Psychological/Physical effects: Small doses: disinhibition, euphoria, dysphoria and depression, miosis with nystagmus, slight increase in breathing rate, rise in blood pressure and pulse rate, shallow respiration, flushing, profuse sweating, generalized numbness of the extremities and incoordination. Larger doses adverse effects on concentration, psychosis, agitation, hallucinations, paranoia, catatonia, drop in blood pressure, pulse rate, and respiration, nausea, vomiting, blurred vision, vertical nistagmus, drooling, loss of balance, dizziness, hyperthermia, seizure, coma and death often resulting from seizures and apnea. Death is a result of accidental overdose or suicide attempts. Speech is sparse and garbled. Depending on the dose some of the above may last for days In adolescents may interfere with hormones related to normal growth and development as well as learning process. Inability to feel pain which may lead to bodily harm Hypoglycemia occurs in twenty percent. Embalming fluid-soaked marijuana (happy sticks, sherm, wet, sheba, takow, illie, dank, therm, clickums, clickers, hydro, fry, whack, loveboat, boat) believed to contain PCP. Psychosis has been reported with the use of this combination. (37) Serum glucose should be determined and treated if present Chemical and physical restraints may be needed, IV benzodiazepines may be used of IM lorazepam or midazolam. Hydration is important (67) Psilocybin (6) (9) Magic mushrooms, liberty caps, mushies, shrooms Eaten, stewed and strained then drunk as tea. May be PCP or LSD Effects: mild euphoria, strong visual and auditory hallucinations affecting user’s sense of time and space, dysphoria, paranoia Hallucinogenic plants: (6) Peyote cactus: contains mescaline, cacti are cut up and simmered and the juice is drank may last up to 12 hours San Pedro cactus: contain mescaline, as per peyote but more is needed, can cause nausea and retching Salvia: available in California, hallucinogenic, smoked in a water pipe cause mild hallucinogenic episodes lasting up to 30 minutes, longer and milder if leaves are chewed and held against the cheek. Ayahuasca: also known as caapi, natema, yage. Mixture derived from two plants, the climbing jagube vine which contains the drug harmaline and leaves from pychotria viridis which contains dimethyl tryptamine (DMT) a powerful psychedelic. Causes nausea and retching. Morning glory: seed of some stains contain a close variant of LSD, stomach cramps and nausea likely. Other side effects include convulsion and gangrene. Commercially available seeds from nursery doused with pesticide. “Gordo juice” combination of morning glory seeds and fruit juice. (62) Hawaii Baby Woodrose: seeds contain LSD relatives. Jimson weed, Angel’s trumpet: a wild poisonous weed can cause death (62) Tryptamines (9) See designer drugs. Nutmeg Hallucigenic 10-20 grams of fresh nutmeg (2 to 9 whole netmegs). Mode of use: orally, onset of symptoms withing 3-6 hrs and these resolve within 24 hours. Effects: nausea, vomiting, dry mouth, abdominal pain, cold extremities, palpitations, weak pulse, shallow respirations. Agitation, feeling of impending doom, visual hallucinations, Depressants/Tranquilizers These are varied, most can cause dependence. They include alcohol which is the most widely used drug by young people. Benzodiazepines are also commonly used to come down from stimulants. They are not described here except for Rohypnol. Others include opiods and their derivatives. GHB/GBL Previously described Ketamine Previously described Temazepam Jellies, wobbly eggs Capsules or tablets normally swallowed, but may be melted and injected and cause thrombophlebitis when it solidifies. Muscle relaxant, sleeping pill Propoxyphene (9) A weak narcotic analgesic Mode of use: orally Effects: mild euphoria, drowsiness, abdominal pain, delusions, numbness, coma, spasms, pulmonary edema, heart problems Methadone (9) Heroin substitute Mode of use: Oral, subcutaneous, intramuscular, rectal Effects: sedation, mood swings, miosis, changes in cognitive and sensory functional ability, central respiratory depression, nausea, vomiting, headaches, dizziness. Heroin (9) Modes of use: intravenously, intramuscularly, subcutaneously (skin-popping), with cocaine IV mixed together “speed balling”, cocaine in one arm heroin in the other (stereo shooting) , smoking heroin-treated cigarettes, inhaling the fumes (chasing the dragon), sniffing Effects: euphoria followed by sedation, slowed comprehension, impaired mentation, decreased reflexes, decreased temperature, miosis, nausea, vomiting, muscle pain, lacrimation, rhinorrhea, yawning, fever, insomnia, respiratory paralysis, pulmonary edema, decreased blood pressure, arrythmias, circulatory collapse. Cases of status asthmaticus have been reported in asthmatics who snorted or smoked heroin. (49)(86) Complications from IV administration including endocarditis, cellulitis, track marks, phlebitis, pulmonary emboli, hepatitis, HIV. Morphine Codeine Meperidines (9) MPPP, PEPTP Effects as for morphine and heroin Fentanyls (9) (25) Short acting analgesic used in induction during anaesthesia. Derivatives of this compound are called designer drugs. They are extremely potent and have a quick onset. Onset 1-4 minutes, duration 30 to 90 minutes Effects: respiratory depression, sudden death. Names : China white, persian white Mode of use: snorting or IV Rohypnol (flunitrazepam) (10) Names: roach, Roche, roofies, Run-Trip-and-Fall, R-2, Mexican Valium, Ropynol, Rib, Rope A benzodiazepine ten times stronger than Valium. A white tablet taken orally effects may last up to eight hours. The reaction to this substance varies from individual to individual. In some states clonazepam is sold as Roofies (13) Effects: sleepy, slurred speech, impaired judgment, difficulty walking, deep sedation, respiratory distress, blackouts lasting up to 24 hours. It may have paradoxical effects and cause aggressiveness Combination with alcohol may be lethal. Inhalants Long lists of substances Mode of use: inhaled through nose or mouth Effects: Most are CNS depressants. Much like alcohol initially stimulated, less inhibited, confusion, perceptual distortion and hallucinations often leading to aggressive behavior, ataxia, dysarthria, convulsions, cardiac arrythmias, (in the presence of hypoxia volatile substances are believed to sensitize the myocardium to the action of adrenaline) (42) unconsciousness, heart failure and death. Suffocation can occur by displacing oxygen in the lungs and then in the CNS. Specific problems from various products such toluene, benzenes, nitrous oxide. Long term effects can include lung tissue damage, brain cell destruction leading to neurological impairments such as mood swings, hostility, confusion, depression, memory loss, paranoia. Damage to brain cells can also lead to loss of coordination, balance and muscle control. Inhalants can also damage vital organs such as the liver damage leading to cirrhosis and chronic hepatitis, kidneys, blood and bone marrow. (60) Poppers Sniffed or breathed in open mouth Often used with ecstasy Iso-butyl nitrate Strong rushes of euphoria Side effects: black outs, (hypotensive episodes) headache, nausea, heart attacks Contraindications: heart problems, viagra Amyl nitrates Similar to above More widely uses in gay population for sex to relax anus while maintaining an erection Others Various substances used by partygoers that may affect the individuals reactions to other drugs. Anabolic Steroids (11) Many partiers may be on anabolic steroids the effects of which is unknown when used in combination with other drugs. Different anabolic steroids may have different side effect profiles. The reaction to each may also be idiosyncratic Mode of use: orally, injection Effects: increases lean muscle mass, strength, ability to train longer, liver tumors, jaundice, fluid retention, high blood pressure, acne and trembling. Hemoconcentration has been described in some users with potential resulting strokes and transient ischemic attacks. Other effects may include: shrinking of testicles, reduced sperm count, infertility, baldness, gynecomastia, low HDL (41) . In adolescents may halt growth through premature skeletal maturation and accelerated pubertal changes. In women: growth of facial hair, changes or cessation of menstrual cycle, enlargment of clitoris, deepened voice. Aggression and other psychiatric side effects, wild mood swings, delusions, irritability, mania, hypomania, depression , psychosis. (41) Long term use can lead to cardiomegally, hypertension, atherosclerosis, elevated cholesterol levels, prostatic enlargement, sexual dysfunction, sterility, baldness, gynecomastia, testicular atrophy, liver damage, kidney damage and kidney stones. In women long term effects may include menstrual irregularities, deepening of the voice, fetal damage, baldness, hair growth on other parts of the body, sexual dysfunction, sterility, reduction of breasts, and genital swelling. (61) Interactions: one animal study has reported potentiation of the effect on blood pressure when anabolic steroids and cocaine is used. Since some individual may suffer from hemoconcentration then the use of ecstasy, methamphetamine and other stimulants which lead to hyperthermia and risk of dehydration may increase the risk for clotting problems. (36) Creatine Amino acid compound used by body builders with hopes of improving muscle mass, strength, and recovery time. Anecdotal adverse effects include dehydration, heat-related illnesses, reduced blood volume, and electrolyte imbalance. Some party goers may take creatine and question arise as to whether adverse effects of some drugs, amphetamine derivatives, can be compounded in these individuals. Sildenafil citrate (Viagra) (66) Oral therapy for erectile dysfunction taken at times by party goers who have done MDMA or other drugs Mode of use: Usually this is taken orally but it has been reported that some party goer will ground the pills and snort it with cocaine and ketamine. When taken orally it is absorbed rapidly and has a half life of four hours. It is metabolized in the liver to an other active metabolite. Effects: erection after stimulation, decreased blood pressure, color vision problems due to inhibition of enzymes in the retina. Other adverse effects include flushing, headaches, dyspepsia, nasal congestion, diarrhea, dizziness, rash. Contraindication: the use of poppers in combination with viagra will cause a hypotensive crisis and possible myocardial infarction. Smart Alternatives ( 83) Comes in bottles, cans, powders or capsules, they contain natural substances, mostly herbal, and vitamins They generally boost energy levels, increase stamina, refresh, quench thirst, and aid concentration. If isotonic help replaced fluid lost by sweating and the sugar content helps as well. Most products will contain stimulants. If taken in too large quantities can result in nausea, loss of appetite, insomnia, increased heart rate, visual and sensory impairment and discomfort in the bladder and urinary tract. Most are contraindicated in people who have heart or kidney problems, high/low blood pressure, asthma and diabetes. Should not be mixed with alcohol. Common ingredients may include: caffeine, guarana, stimulant similar to caffeine, Ma-Huang, contains epedrine, ginseng, amino acids, taurine, sugars, tryptophan, vitamins usually high doses of C and Bs Examples include: Stackers which contains ephedra and caffeine Go-go drinks: which contain ginseng, yohimbine, guarana ( being marketed as Viagra for women) Section 2: Annotated Bibliography Annotated Bibliography/Reference List Raves, Party Drugs and Related Articles 1 - Eisner Bruce. Ecstasy – The MDMA Story, Ronin Publishing, Berkeley, CA, 1989 Book on MDMA 2 - Strathdee, S.A. et al. HIV Infection and Risk Behaviours Among Young Gay and Bisexual Men in Vancouver. Can. Med. Assoc. Journ., Vol. 162, 2000, pp 21-25 Prospective cohort study involving gay and bisexual men aged 18-30 3 - McFee, R.B. et al. Ecstasy – A Drug on the Rise. SAM Newsletter, Vol. 10, No. 2, 1999. P. 6 Brief summary of various forms of substances which come under the name of ecstasy. Report of a small clinic studies on usage. 4 – Beck, J, Rosenbaum, M. Pursuit of Ecstasy – The MDMA Experience, State University of New York Press, Albany 1994 Book on Ecstasy, somewhat useful. 5 – Saunders, Nicholas. Ecstasy and the Dance Culture. Nicholas Saunders, London, 1995 Good book on ecstasy, raves with a results of various studies done in England. 6 – Castaneda, R., Time Out, Time Out Magazine Ltd, London, Oct 21-28, 1998 Good summary of plants with hallucigenic properties. 7 – Diagnostic and Statistical Manual on Mental Disorders, 4 th Ed.: DSM-IV, Washington, DC: American Psychiatric Association, 1994. 8 – Mendelson, J.H., Mello, N.K. Management of Cocaine Abuse and Dependence. NEJM, vol. 334, 1996, pp. 965972. Good summary article on cocaine. 9 – Drugs of Abuse: Boehringer-Mannheim 1998. http://www.boehringer-mannheim.com/rapids/drugsabuse Site has moved to Roche search in diagnostics. Good information. 10 – Club Drugs: Just the Facts Texas Commission on Alcohol and Drug Abuse, Jan 7, 1999. http://www.tcada.state.tx.us/research/facts/clubdrugs.html 11 – Steroids (Anabolic) NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/steroids.html 12 – High School and Youth Trends – Monitoring the Future Study (MTF) NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/HSYouthtrends.html 13 – Rohypnol and GHB NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, August 13, 1999. http://www.nida.nih.gov/infofax/rohypnolghb.html 14 – Ritalin NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/ritalin.html 15 – PCP (Phencyclidine) NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/pcp.html 16 – Methamphetamine ) NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/methamphetamine.html 17 – Marijuana NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/marijuana.html 18 – LSD NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/lsd.html 19 – Inhalants: NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/inhalants.html 20 – Crack and Cocaine : NIDA Infofax, National Institute on Drug Abuse, US Department of Health and Human Services, NIH, March 4, 1999. http://www.nida.nih.gov/infofax/cocaine.html 21 – Release Drugs and Dance Survey – An Insight Into the Culture. Release, London 1997 Report on work done by this organization, good summary on raves. 22 – Ketamine Hydrochloride FAQ Hyperreal Organization, 1994. http://www.hyperreal.org/drugs/psychedelics/dissociative/faq.ketamine 23 – Ketamine FAQ The Vaults of Erowid, 1999. http://www.erowid.org/chemicals/ketamine/ketamine_faq 24 – 2C-B FAQ The Vaults of Erowid, 1999. http://www.erowid.org/chemicals/2cb/2cb_faq 25 – Designer Drugs Drug Abuse USA 1997 http://www.drug-abuse.com/information/designerdrugs/designerdrugs1.html 26 – The Official alt.rave FAQ Hyperreak.org, 1994. http://.hyperreal.or/raves/altravefaq.html 27 – Frequently Asked Questions About Raves and Techno Music version 3.0 Brown, M, Behlendorf, B. 1995, http://www.hyperreal.org/~mike/pub/altravefaq.html 28 – Future Synthetic Drugs of Abuse. Cooper, D. A. Hyperreal.org http://hyperreal.org/drugs/misc/future.html 29 – MDMA Frequently Asked Questions Document. Behlendorf, B., Hyperreal.org, 1994 http://www.hyperreal.org/drugs/mdma/faq-mdma 30 – Woody, G.E. et al. Non-injection Substance Use Correlates with Risky Sex Among Men Having Sex with Men: data from HIVNET. Drug and Alcohol Dependence, Vol. 53, 1999, pp 197-205 Reports on a relatively large survey done in major US cities. Links risky sex with inhalants, stimulants, hallucinogens and alcohol use. 31 – Strathdee, S.A. et al. Determinants of Sexual Risk-Taking Among Young HIV-Negative Gay and Bisexual Men. Journal of Acquired Immuno Deficiency Syndromes and Human Retrovirology, Bol 19, 1998, pp 61-66 32 – Warner, E.A. et al. Diabetic Ketoacidocis Associated With Cocaine Use. Arch Internal Medicine, Vol 158, 1998, pp 1799-1802 Report of a series of cases of DKA in diabetic cocaine user compared to non users 33 – Aarons G.A. Adolescent Alcohol and Drug Abuse and Health. Journal of Adolescent Health Care, Vol 24, 1999, pp 412-421. Study on the prevalence of health problems in adolescent using drugs as compared to non-users. 34 – Adlaf, E.M., Smart, R.G. Party Subculture or Dens of Doom? An Epidemiological Study of Rave Attendance and Drug Use Patterns Among Adolescent Students. Journal of Psychoactive Drugs, Vol 29, 1997, pp. 193-197 Study perform in Ontario on high school students looking at the prevalence of party attendance and characteristics of party goers. 35 – Arimany, J., et al. Intentional Overdose and Death With 3,4-Methylenedioxyethamphetamine (MDEA; “Eve”) The American Journal of Forensic Medicine and Pathology, Vol 19, 1998, pp 148-151 A case report on a patient who possibly committed suicide using EVE 36 – Rockhold, R.W. Cardiovascular Toxicity of Anabolic Steroids. Annual Review Pharmacology and Toxicology, Vol. 33, 1993, pp 497-520. Review article on the above subject 37 – Holland, J.A, et al. Embalming Fluid-Soaked Marijuana: New High or New Guise for PCP? Journal of Psychoactive Drugs, Vol. 30, 1998, pp215-219. Case report and review of literature on this topic. 38 – Winbery, S. et al. Multiple Cocaine-Induced Seizures and Corresponding Cocaine and Metabolite Concentration. American Journal of Emergency Medicine, Vol 16, 1998, pp. 529-533. 39 – Schuster, P., et al. Is the Use of Ecstasy and Hallucinogens Increasing? Results from a Community Study. European Addiction Research, Vol. 4, 1998, pp. 15-82. 40 – Alter, M.J. et al. The Prevalence of Hepatitis C Virus Infection in the United States, 1988 through 1994. NEJM, Vol 341, 1999, pp. 556-562. 41 – Pope, H. G., Katz, D.L. Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use – A Controlled Study of 160 Athletes. Arch Gen Psychiatry, Vol 51, 1994, pp. 375-382. 42 – Chalmers, E.M. Volatile Substance Abuse. The Medical Journal of Australia. Vol. 154, 1991, 269-274 Good review article on the subject. 43 – Hollander, J.E., Hoffman, R., S.. Cocaine-Induced Myocardial Infarction: An Analysis and Review of the Literature. The Journal of Emergency Medicine, Vol 10, 1992, pp. 169-177. Good review article on the subject. 44 – Curran, H.V., Ross, R.A.. Mood and Cognitive Effects of ± 3,4-methylenedioxymenthamphetamine (MDMA, ‘ecstasy’): week-end ‘high’ Followed by Mid-week Low. Addiction, Vol 92, 1997, pp 821-831. 45 – Torre, M, Barberis, M.. Spontaneous Pneumothorax in Cocaine Sniffers. American Journal of Emergency Medicine, Vol. 16, 1998, pp. 546-549. 46 – Perkonigg, A. et al. Prevalence of Use, Abuse, and Dependence of Illicit Drugs Among Adolescents and Young Adults in a Community Sample. European Addiction and Research, Vol. 4, 1998, pp. 58-66. 47 – Gorman, M. Speed Use and HIV Transmission. 1996. http://www.tweaker.org/science.html 48 – Methamphetamine: Abuse and Addiction – How is methamphetamine used? National Institute on Drug Abuse, 1996. http://www.nida.nih.gov/researchreports/methamph/methamph3.html 49 – Cygan, J. et al. Inhaled Heroin-Induced Status Asthmaticus – Five Cases and a Review of the Literature. Chest, Vol 117, pp. 272-275. 50 – Bell, V. Ketamine. Drugs, Solvents and Intoxicants – Ketamine. 1995 http://area51.upsu.plym.ac.uk/~harl/ketamine.html 51 - Bell, V. Ecstasy . Drugs, Solvents and Intoxicants – Ecstasy. 1995 http://area51.upsu.plym.ac.uk/~harl/ecstasy.html 52 - Bell, V. LSD. Drugs, Solvents and Intoxicants – LSD. 1995 http://area51.upsu.plym.ac.uk/~harl/lsd.html 53 – Henry, J.A., Jeffreys, K.J., Dawling, S. Toxicity and Deaths from 3,4-methylenedioxymethamphetamine (“ecstasy). Lancet, Vol. 340, 1992, pp. 384-387. 54 – Øye, I. Ketamine Analgesia, NMDA Receptors and the Gates of Perception. Acta Anaesthesiologica Scandinavia, Vol. 42, 1998, pp. 747-749. 55 – Mueller, P.D., Korey, W.S. Death by “Ecstasy”: The Serotoning Syndrome? Annals of Emergency Medicine Vol. 32, 1998, pp. 377-380 56 – Cho, A. K., Segal D. S. Amphetamines and Its Analogs. Academic Press, London, 1994. Pharmacologically oriented book on amphetamines. 57 – Chin, R.L. et al. Clinical Course of Gamma-Hydroxybutyrate Overdose. Annals of Emergency Medicine, Vol. 31, 1998, pp 716-722. 58 – Li, J. et al. A Tale of Novel Intoxication: Seven Cases of Gamma-Hydroxybutyric Acid Overdose. Anna.ls of Emergency Medicine, Vol. 31, 1998, pp. 723-728. 59 – Li, J., et al. A Tale of Novel Intoxication: A Review of the Effects of Gamma-Hydroxybutyric Acid With Recommendations for Management. Annals of Emergency Medicine, Vol. 31, 1998, pp. 729-736. 60 – Inhalants: Just the Facts Texas Commission on Alcohol and Drug Abuse, Aug 30, 1999. http://www.tcada.state.tx.us/research/facts/inhalants.html 61 - Steroids: Just the Facts Texas Commission on Alcohol and Drug Abuse, Aug, 30, 1999. http://www.tcada.state.tx.us/research/facts/steroids.html 62 - Hallucinogens: Just the Facts Texas Commission on Alcohol and Drug Abuse, Aug 30, 1999. http://www.tcada.state.tx.us/research/facts/hallufacts.html 63 – Bailey, W.J. FactLine on Non-Medicinal Use of Ritalin (methyphenidate) Indiana Prevention Resource Center, 1995. http://www.drugs.indiana.edu/publications/iprc/factline/ritalin.html 64 – Handly, N., Toxicity, Amphetamine. Emedicine, 1998, http://www.emedicine.com/emerg/topic23.htm 65 – King, E. Recreational Dangers – Understanding Possible Interactions Between Prescribed and Illegal Drugs. AIDS Treatment Update, Issue 51, 1997 http://www.aegis.com/hivinfoweb/library/misc/atu051a.html 66 – Viagra (Sildenafil citrate) Product monograph, Pfizer, 1998, http://www.viagra.com/hcp/prod_info_temp.html 67 – Graham, S. Toxicity, Phencyclidine. Emedicine, 1999. http://www.emedicine.com/emerg/topic420,htm 68 – Darlet, R. Toxicity, Methamphetamines. Emedicine, 1999, http://www.emedicine.com/emerg/topic859.htm 69 – Bad trips – Dealing With One. Ravesafe Information on dealing with a Bad Trip. http://www.ravesafe.org.za/bad-trip.htm 70 – Adlaf, E. M., Ivis, F.J. Recent Findings from the Ontario Student Drug Use Survey. CMAJ, Vol. 159, 1998, pp. 451-454 71 – High School and Youth Trends – Monitoring the Future Study (MTF) NIDA Infofax 1999, http://165.112.78.61/infofax/HSYouthtrends.html 72 – Ecstasy NIDA Infofax, 1999, http://165.112.78.61/infofax/ecstasy.html 73 – Ecstasy Dancesafe http://www.harmreduction.net/dancesafe/ehealth.html 74 – Monks, G. Axis & Bloomsbury Clinics, Gay Men’s Drug Use Surveys, London (1998) Private communication. 75 – Critchlow Leigh, B. The Relationship of Substance Use During Sex to High-Risk Sexual Behavior Journal of Sex Research, Vol. 27, 1990, pp.199-213 76 - Barrett, D.C., Bolan, G., Douglas, Jr., J.M. Redefining Gay Male Anal Intercourse Behaviors: Implications for HIV Prevention and Research. Journal of Sex Research, Vol. 35, 1998, pp. 381-389 77 – Paul, J. P. et al. Correlates of Sexual Risk-Taking Among Gay Male Substance Abusers. Addiction, Vol. 89, 1994, pp.. 971-983. 78 – de Wit, J.B.F., van Griensven, G.J.P. Time from Safer to Unsafe Sexual Behaviour among Homosexual Men. AIDS, Vol. 8, 1994, 123-126. 79 – Lemp, G.F. et al. Seroprevalence of HIV and Risk Behaviors Among Young Homosexual and Bisexual Men The San Francisco/Berkeley Young Men’s Survey. JAMA, Vol. 272, 1994, pp.449-454. 80 – Ostrow, D.G. et al. Recreational Drug Use and Sexual Behavior Change in a Cohort of Homosexual Men. AIDS, Vol. 4, 1990, pp. 759-765. 81 – Ruiz, J., et al. Risks Factors for Human Immunodeficiency Virus Infection and Unprotected Anal Intercourse Among Young Men Who Have Sex With Men. Sexually Transmitted Diseases, Vol. 25, 1998, pp. 100-107 82 – Siegel, K, et al. Factors Distinguishing Homosexual Males Practicing Risky and Safer Sex. Soc. Sci. Med. Vol. 28, 1989, pp. 561-569. 83 – “Smart” alternatives. RaveSafe Infornation on “Smart” Alternatives http://www.pcb.co.za/users/ravesafe/smart.htm 84 – White, W. E. This is Your Brain on Dissociatives: The Bad News is Finally In. 1998, http://www.frognet.net/~dxm/olney.html 85 – Jansen, K.L.R. Using Ketamine to Induce the Near-Death Experience:Mechanism of Action and Therapeutic Potential. 86 – Schwartz, B, Alderman, E.M. Substance of A buse. Pediatrics in Review, Vol. 18, 1997, pp. 204-215 Tables on each commonly used substance, effects, management of problems. Ecstasy, Ketamine, GHB not included P-P Tellier, MD, March 2000 Section 3: Useful Websites Useful Web Sites 1 – Addiction Research Foundation: Information on drug and alcohol with information on adolescent drug use including statistics. http://www.arf.com/ 2 – The Vaults of Erowid: Good source of information on most drugs used and plants. http://www.erowid.org/index.shtml 3 – Ravesafe Drug: Information on raves and drugs. http://www.pcb.co.za/users/ravesafe/home.htm 4 – The Lycaeum: Information on drugs http://www.lycaeum.org/ 5 – The Realm of Techno: Site devoted to raves and techno music http://www.whizzbomb.com/techno.html 6 – Boehringer-Mannheim: German pharmaceutical company now own by Roche. Provides information on drugs and drug testing http://www.boehringer-mannheim.com/rapid/drugsabuse/DrugsAbuse_EN.html 7 – Center for Addiction Research and Mental Health: Canadian organization provides good information on addiction. http://www.camh.net/ 8 – Dancesafe: Rave and party drug information, based on the West Coast http://www.dancesafe.org/index.html 9 – Do It Now Foundation Online: Drug information http://wwwdoitnow.org/ 10 – Drug Abuse USA Information: Information on drugs, follow just say no philosophy. http://www.drug-abuse.com/information/ 11 – Drugs, Solvants and Intoxicants: Information source from United Kingdom http://www.area51.upsu.plym.ac.uk/~harl/index.html 12 – eMedicine On Line: Medical page on emergency medicine, excellent articles on emergency management of drug overdoses. http://www.emedicine.com/emerg 13 – NIDA – Club Drugs Home Page: Home page for club drug initiative, may be interesting for Americans wanting to get funding for research. http://165.112.78.57/ 14 – NIDA – National Institute on Drug Abuse: Information on all aspects of substance use including reference material and studies. http://www.nida.nih.com/NIDAHome2.html 15 – Indiana Prevention Resource Center: Another source of information http://www.drugs.indiana.edu/ 16 – The CRISSY Campaign Analysis: Gay site providing information on methamphetamines http://www.tweaker.org/index2.html 17 – Texas Commission on Alcohol and Drug Abuse: Information on drugs http://www.tcada.state.tx.us/research/facts 18 – Hearing Education and Awareness for Rockers http://www.hearnet.com P-P Tellier, MD, March 2000 Section 4: Educational Resources Educational Resources: 1. Bad Boys Montreal “Please, Party & play safely!” Gives detail on the drugs GHB, Special K, Crystal, Ecstasy, and Cocaine. This includes a description of what the drug are, the effects, and dangers involved. There are also helpful notes on what to do before and after certain drugs, the effects when coming down, and specific instructions if you are HIV positive. Includes reference numbers for Drug and AIDS helplines in Montreal. Web Site: www.bbcm.org E-mail: [email protected] Address: P.O. Box 1253 Station V Montreal, Quebec H3B 3K9 2. Camden and Islington Community Health Services NHS Trust “Positive about Drugs 2: The Essential Information Guide for HIV + Gay Men Who Use Drugs” A colourful booklet divided into four sections: Section 1 includes Drug Profiles, containing general drug information. If you’re looking for something on how drugs affect you, the law or safer drug use, you’ll find it there. Section 2 looks at Drugs and the Immune system, looking at the effects of drugs on the immune system – whether you’re HIV or not. Section 3 examines the issue of how illicit drugs interact with HIV treatment medicines and the notion of maintaining “compliance” to HIV drug regimes. Section 4 provides a further list of services for more information. Primarily English. “Clued Up: A Handbook of drugs and services for gay men”. The handbook is divided into a Ten-point plan for safer drug use, an A-Z of drugs, Safer injecting, Drugs and the Law, Drugs and Holidays, Drugs and Sex, Further information and support, and other drug resources for gay men to look out for. “In Gear: A Guide to Safer Steroid Use for Men” This Guide is divided into understanding how steroids work, the diet and work-out, how steroids are taken, oral vs. injectables, the truth about side effects: physical problems, mental health problems, steroids and other drugs, injecting advice, other fitness drugs, steroids and HIV, Steroids and Sex, Steroids and the Law, and where to get further help. “Sexual Chemistry: Sex, drugs, and Gay men”. This booklet explores the social context of drugs and sex, drugs and sexual health, drugs and sexual behavior, how to keep safe, and information on further support. Includes sections on Viagra, and HIV. Postcards available: “Control Freak” Briefly describes how drugs can make you lose control. Additional support numbers listed. “ Time Gentlemen, please!” Briefly explores the effects of heavy drinking for gay men, and provides suggestions on how to limit your intake. Additional support numbers listed. “Brian drain” Brief alert on drugs and mental health problems. Additional support numbers listed. “Shaken or Stirred” Briefly describes the dangers of mixing different drugs, and drugs with alcohol. Additional support numbers listed. Websites: www.candihps.com/pinkpages www.cluedup.demon.co.uk www.isdd.co.uk E-mail: [email protected] Address: St.Pancras Hospital, 4 St. Pancras Way London, UK NW1 0PE 3. ETR Associates “Designer Drugs” Short Synopsis of Designer Drugs, includes where Designer Drugs come from, how to identify a Designer Drug, and the risks of Designer Drugs. Specific Drugs included: MDMA (Ecstasy), “China White”, and Rohypnol. Web Site: www.etr.org Address: P.O. Box 1830 Santa Cruz, CA 95061-1830 4. Harmony “ GHB” An informative description of what is GHB, the Effects of GHB, and smart facts to know if you Use GHB (i.e. mixing GHB with other substances). E-mail: [email protected] 5. Santa Monica-UCLA Medical Center: Rape Treatment Center “Rapists are using a new weapon to overpower their victims” A concise pamphlet discussing the silent and invisible drugs Rohypnol and GHB. Topics include how rapist use the drugs, what exactly are Rohypnol and GHB, the effects of these drugs and special sections on what to do if it happens to you, and prevention efforts. Address: 1250 Sixteenth Street Santa Monica, CA 90404 #(310) 319-4000 6. Youth Support “Youth support Guide to Drugs” Not another boring pamphlet telling you don’t do drugs. It is designed to give you a clear understanding of a variety of illegal and legal drugs, their effects both short and long term and their potential dangers, targeted for adolescents. Address: 13 Crescent Road London, UK BR3 2NF # 01816506296 Fax: 01816593309 McGill University: March, 2000.