Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths

Abstract

Background

The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16–23 (N = 19,084).

Methods

Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs.

Results

Approximately 20% of youths aged 16–23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18–21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16–19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence.

Conclusions

Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.

Introduction

In the United States, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA or Ecstasy), LSD (d-lysergic acid diethylamide), GHB (gamma-hydroxybutyrate), ketamine, and flunitrazepam (Rohypnol) have been labeled “club drugs” by the National Institute on Drug Abuse (NIDA, 2005). These drugs are typically used by teenagers and young adults at bars, clubs, concerts, and parties, and the use of these drugs is reported to help maintain energy levels for dancing or to enhance an altered state of consciousness (Koesters et al., 2002). As stressed by the Director of the NIDA, several national monitoring mechanisms have suggested an emerging use of these club drugs (Volkow, 2004). In an attempt to combat the increasing use of club drugs in the community, NIDA has established a website to provide scientific information about them—http://www.clubdrugs.org (Volkow, 2004). Similarly, many investigators in other countries have suggested that the use of such drugs has increased (Gross et al., 2002, Joe Laidler, 2005, Lua et al., 2003, Schuster et al., 1998), and that party attendees typically use multiple drugs (Barrett et al., 2005, Boys et al., 1997). To better gauge the extent of this drug use, we examine the prevalence rates, patterns, and correlates of club drug use among youths aged 16–23 in the United States. Our study is based on a national household survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Methamphetamine (“speed”, “ice”, “crystal”, “crank”, and “glass”) is a powerful addictive stimulant that has high potential for widespread abuse because it is inexpensive, available in many different forms, and can be easily made in clandestine laboratories from relatively inexpensive, over-the-counter ingredients (NIDA, 1999). MDMA, an hallucinogenic stimulant, is a synthetic, psychoactive drug with a chemical structure similar to methamphetamine and mescaline (Freese et al., 2002). LSD is the most potent mood- and perception-altering drug known, and it is the most widely used hallucinogen among adolescents (Golub et al., 2001, NIDA, 2001). Ketamine and GHB are anesthetic agents. Ketamine produces effects similar to those of phencyclidine but with a much shorter duration of effect (Jansen, 1993). GHB (liquid X, liquid ecstasy) has been used as a sleep aid, an intoxicant (producing a pleasurable intoxication or enhancing social activity), and a growth promoter (Nicholson and Balster, 2001, Zacny and Galinkin, 1999). Flunitrazepam is a benzodiazepine sedative/hypnotic (NIDA, 2000). GHB and flunitrazepam have been reported to be associated with drug-facilitated sexual assaults, such as “date rape” (NIDA, 2000, Nicholson and Balster, 2001).

Of these drugs, illicit use of methamphetamine and MDMA has been suggested to become a new epidemic worldwide (Koesters et al., 2002, United Nations, 2003). There has been a substantial global increase in the supply and use of methamphetamine and MDMA (United Nations, 2003). Data from emergency department (ED) visits in the United States suggest that the prevalence of the NIDA-defined set of club drugs rose dramatically among patients receiving care at EDs during the mid-to-late 1990s (OAS, 2002). Globally, methamphetamine is the most widely available and used club drug (United Nations, 2003). Investigators in many different countries also have reported an increase in MDMA use, as well as MDMA-related deaths, particularly among young people (Cregg and Tracey, 1993, Landry, 2002, Raikos et al., 2002, Schifano et al., 2003, Schuster et al., 1998, Wilkins et al., 2003). In the United States, Patel et al. (2004) reported a 400% relative increase in MDMA-related fatalities between 1999 and 2001.

To date, most studies of club drug use in the United States and elsewhere have focused on adults and specific population subgroups (e.g., drug users, gay/bisexual people, college students, and party or club participants), and the patterns and correlates of specific club drug use among youths in the community have been understudied. For instance, LSD is the hallucinogen most commonly used by adolescents (Golub et al., 2001), and its use is significantly associated with frequent risky sexual behaviors and frequent heavy drinking (Rickert et al., 2003). However, LSD has received relatively little recent research attention (Nichols, 2004), and therefore scarce data are available on the correlates of LSD use.

Research data on the use of GHB, ketamine, and flunitrazepam among the general population are especially scant (Maxwell, 2004, Nicholson and Balster, 2001). Current knowledge of the use of these drugs is based primarily on studies of gay or bisexual people as well as party or club participants, which tend to report a very high prevalence of GHB use (25–29%) and ketamine use (47–66%) and a significant association of using these drugs with risky sexual behaviors (Colfax et al., 2001, Lua et al., 2003, Mansergh et al., 2001, Mattison et al., 2001, Romanelli et al., 2003, Rusch et al., 2004).

The recent rise in the prevalence of the use of these drugs is of particular concern. Regardless of the sample characteristics, studies have consistently suggested that some club drug users typically use multiple drugs, engage in risky sexual behaviors, and are at high risk for substance addiction and HIV transmission (Boyd et al., 2003, Frosch et al., 1996, Klitzman et al., 2002, Molitor et al., 1998, Rickert et al., 2003, Romanelli et al., 2003, Rusch et al., 2004, Strote et al., 2002). In light of the emerging use of these drugs and associated adverse consequences, we examine the extent, patterns, and correlates of each specific drug use and of multidrug use among American youths aged 16–23.

We focus on a crucial developmental period from mid-adolescence to early adulthood during which time: (a) the onset of use of many drugs occurs (Kandel et al., 1992) and (b) older adolescents make the transition into their young adulthood. This transitional period typically involves major role changes in many domains of life (e.g., leaving high school, going to college or other postsecondary training, starting a career, becoming married, or having children), and it has been suggested to be a heightened risk period for the onset of club drug use and heavy drinking (Chilcoat and Schütz, 1996, Cuomo et al., 1994, Schulenberg and Maggs, 2002, von Sydow et al., 2002). Hence, it provides an illustration of variations in drug use through different developmental stages.

We first determine the prevalence of lifetime (ever) and past year (recent or active) use of each different type of drug use and examine the extent of multidrug use among each subgroup of drug users. Using advanced statistical procedures to adjust for demographic variations, we then examine potential correlates of use of each of the specific drugs and of multidrug use. Findings from theses analyses could help to identify demographic subgroups for targeting prevention programs to reduce the frequency and adverse consequences of this emerging club drug use among adolescents and young adults.