Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths
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.
Section snippets
Data source
Statistical analyses were based on data from the public use file of the 2002 National Survey on Drug Use and Health (NSDUH), an annual survey of the use of licit and illicit substances by noninstitutionalized, household Americans aged 12 or older (OAS, 2003). We used the 2002 public use file because it was the most recent NSDUH available for public use at the time we conducted the analyses. This study was declared exempt from the RTI International institutional review board because it used an
Prevalence of club drug use: methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam
The prevalence of lifetime and past year drug use is summarized in Table 1. Among youths aged 16–23 (N = 19,084), one in five (20%) reported having used at least one club drug in their lifetime. MDMA (14%) and LSD (13%) were more likely to be used than the other drugs (methamphetamine, 5%; ketamine, 0.4%; flunitrazepam, 0.4%; GHB, 0.05%). Lifetime use increased with age and reached a peak at age 21 (28%). Overall, 8% of youths aged 16–23 used at least one of these drugs in the past year (40% of
Discussion
This study provides population-based prevalence estimates and correlates of the use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam in a nationally representative sample of American youths residing in the community. The most salient finding was the relatively high prevalence of lifetime use of these drugs and the excess multidrug use of club drugs among females. Among youths aged 16–23, one in five (20%) had ever used at least one of these drugs. Multidrug use of club drugs
Acknowledgments
This work was supported primarily by the Division of Workplace Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration (contract no. 270-2003-00001). It also was supported in part by the National Institute on Drug Abuse (R21DA015938; L.T. Wu). The Substance Abuse and Mental Health Data Archive and the Inter-university Consortium for Political and Social Research provided the public use data files for the 2002 NSDUH, which is sponsored by the
References (101)
- et al.
Drug use and HIV risk-taking behaviour among injecting drug users not currently in treatment in Sydney, Australia
Drug Alcohol Depend.
(1994) Designer drugs in the general hospital
Psychiatr. Clin. North Am.
(2002)- et al.
Ecstasy use among college undergraduates: gender, race and sexual identity
J. Subst. Abuse Treat.
(2003) - et al.
Impact of parent monitoring on initiation of drug use through late childhood
J. Am. Acad. Child Adolesc. Psychiatry
(1996) - et al.
Age-specific patterns of hallucinogen use in the US population: an analysis using generalized additive models
Drug Alcohol Depend.
(1996) - et al.
Patterns of use and harms associated with non-medical ketamine use
Drug Alcohol Depend.
(2003) - et al.
Solvent use as a precursor to intravenous drug abuse
Compr. Psychiatry
(1991) - et al.
The effects and consequences of selected club drugs
J. Subst. Abuse Treat.
(2002) - et al.
Sexual HIV risk among gay and bisexual male methamphetamine abusers
J. Subst. Abuse Treat.
(1996) - et al.
Predictors of polydrug use among four ethnic groups: a 12-year longitudinal study
Addict. Behav.
(1999)
Prevalence of youth substance use: the impact of methodological differences between two national surveys
Drug Alcohol Depend.
Prevalence and correlates of drug use and DSM-IV drug dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey
J. Subst. Abuse
Inhalants to heroin: a prospective analysis from adolescence to adulthood
Drug Alcohol Depend.
Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population
Drug Alcohol Depend.
Delivering quality care: adolescents’ discussion of health risks with their providers
J. Adolesc. Health
Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls
J. Adolesc. Health
MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City
Drug Alcohol Depend.
MDMA (‘ecstasy’) and other ‘club drugs’. The new epidemic
Pediatr. Clin. North Am.
Profiles of urine samples from participants at rave party in Taiwan: prevalence of ketamine and MDMA abuse
Forensic Sci. Int.
Circuit party attendance, club drug use, and unsafe sex in gay men
J. Subst. Abuse
The reasons why children in their pre and early teenage years do or do not use illegal drugs
Int. J. Drug Policy
Associations between types of maltreatment and substance use during adolescence
Child Abuse Negl.
Hallucinogens
Pharmacol. Ther.
GHB: a new and novel drug of abuse
Drug Alcohol Depend.
Sequences of substance use among American Indian adolescents
J. Am. Acad. Child Adolesc. Psychiatry
Amphetamine derivative related deaths in northern Greece
Forensic Sci. Int.
Patterns of HIV risk and alcohol use among African–American crack abusers
Drug Alcohol Depend.
Prevalence and risk factors for LSD use among young women
J. Pediatr. Adolesc. Gynecol.
The context of sexual risk behavior among heterosexual methamphetamine users
Addict. Behav.
The association of sexual risk behaviors and problem drug behaviors in high school students
J. Adolesc. Health
Alcohol use patterns predict high-risk HIV behaviors among active injection drug users
J. Subst. Abuse Treat.
Increasing MDMA use among college students: results of a national survey
J. Adolesc. Health
Adolescent substance use and sexual risk-taking behavior
J. Adolesc. Health
Comparative epidemiology of initial drug opportunities and transitions to first use: marijuana, cocaine, hallucinogens and heroin
Drug Alcohol Depend.
Differential effects of MDMA, cocaine, and cannabis use severity on distinctive components of the executive functions in polysubstance users: a multiple regression analysis
Addict. Behav.
Use, abuse and dependence of ecstasy and related drugs in adolescents and young adults-a transient phenomenon? Results from a longitudinal community study
Drug Alcohol Depend.
High prevalence of substance use disorders among adolescents who use marijuana and inhalants
Drug Alcohol Depend.
Inhalant abuse and dependence among adolescents in the United States
J. Am. Acad. Child Adolesc. Psychiatry
The relationship between employment and substance use among students aged 12 to 17
J. Adolesc. Health
Relationship between methamphetamine use and risky sexual behavior in adolescents
Kaohsiung J. Med. Sci.
College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement
Drug Alcohol Depend.
Diagnostic and Statistical Manual of Mental Disorders
Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey
Exp. Clin. Psychopharmacol.
Alcohol as a risk factor for HIV transmission among American Indian and Alaska Native drug users
Am. Ind. Alsk. Native Ment. Health Res.
Patterns of simultaneous polysubstance use in Canadian rave attendees
Subst. Use Misuse
Parent influences on adolescent peer orientation and substance use: the interface of parenting practices and values
Child Dev.
Polydrug use at raves by a Western Australian sample
Drug Alcohol Rev.
Consequences of adolescent marijuana use: incompatibility with the assumption of adult roles
Genet. Soc. Gen. Psychol. Monogr.
The role of parents in protecting Colombian adolescents from delinquency and marijuana use
Arch. Pediatr. Adolesc. Med.
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2019, Biosensors and BioelectronicsCitation Excerpt :Flunitrazepam, however, is also illegally found in countries in which its medical use is not approved. In the United States and elsewhere, flunitrazepam is smuggled as illegally produced tablets or legally manufactured preparations and it is used as a recreational drug (Wu et al., 2006). Flunitrazepam is also misused to “drug-facilitated sexual assaults” (DFSA), i.e. to physically and psychologically incapacitate a person, usually women, targeted for sexual assault.