Drug Rehab

Club Drugs: Ecstasy (MDMA), GHB (Grievous Bodily Harm, Liquid X) and Rohypnol

As each generation of youth has their cause and their movements, so too each has its own underground scenes. The latest manifestation of this is the Rave Scene, started in New York, Miami and other major metropolitan cities like Dallas, Los Angeles and Washington DC.

In the late 70s and early 80s, as an offshoot of the disco scene, "Clubbing" or "Club Hopping" became popular. Mostly during that time, people hopped from one drinking establishment and legitimate dance club to the next in all night forays of drinking and dancing. In the early 1980s as Cocaine became passé, new drugs were being introduced to this crowd of revelers. One such drug and one that stuck around was MDA and later an analogue of MDA, MDMA which is the more popular version of this designer drug", usually called Ecstasy, X or XTC.

As the scene evolved and became more and more focused on the use of Ecstasy to heighten the free and communal environment at raves, other drugs started to show themselves. Two of these are GHB and Rohypnol. GHB, sometimes called "Grievous Bodily Harm" or "Liquid X" was originally sold in health stores as a workout supplement, but in higher doses produces the anesthetic qualities of alcohol or benzodiazepines. Rohypnol, usually obtained illegally from pharmacies outside of the US, is a powerful sedative much like valium or klonopin. Together these two drugs, because of their strong sedative and anesthetic properties helped usher in a new term in the drug underworld, "Date Rape Drugs".

Also popular among the "Club Kid" or "Raver" crowd are drugs like LSD, Ketamine, DXM, Magic Mushrooms, Marijuana, Cocaine and Methamphetamine.

MDMA (MDA, Ecstasy, Eve, Adam, X, XTC)

MDMA pillMDMA (3,4-methylenedioxymethamphetamine) is the N-methyl analog of MDA, and shares similarities to both mescaline, a hallucinogen, and methamphetamines, a family of stimulants; but is chemically more closely related to the amphetamine class of drugs than the hallucinogens (1). The common association of MDMA to hallucinogens like LSD, Psilocybin and Mescaline is erroneous and misguided, as the effects differ greatly in the way that most drugs classed as hallucinogens produce drastic distortions in visual, audio and tactile perception, whereas MDMA tends to heighten the senses and provides a more introverted state of consciousness, rather than the "mind-blowing" consciousness expanding effects of hallucinogens.

MDMA Origins and Early History

MDMA and MDA have been around for quite a bit longer than it has been popular in the drug underground. It was first synthesized in 1912 in Germany for obsequious reasons, much debated in entheogenic circles, and later found it's way into clinical trials by psychotherapists in Europe and N. America as an adjunct to behavioral therapy, especially in couples and relationship counseling (2).

From the earliest patent of MDMA to the first trials by Alexander Shulgin for Dow Chemicals in the 1970s, the drug took a time out from experimentation and research, with only one mythos purporting US military applications of the drug as a truth serum in the 1940s and 1950s, however there is no factual evidence to support this claim.

Alexander Shulgin, Father of MDMA

Shulgin, Father of Ecstasy/MDMAAlexander Shulgin, a somewhat controversial figure in the biochemistry field, tested the drug for Dow Chemicals, who had obtained the patent from Merck, Germany. The first tests were conducted on fighting fish and after little success, Shulgin began testing the drug on himself and a close nit group of friends. Shulgin and others in this first "trial group" began to extol the drugs qualities for use in psychotherapy. It was about this time, the drug first made it's way onto the streets. After discovering the drug was being manufactured and distributed illegally in the illicit drug market, Dow Chemicals cancelled all company testing and fired Shulgin (2).

Those years 1977 to 1985 are looked back on as the 'golden age' of Ecstasy or Adam as it was then known. In psychotherapy, its use only appealed to a few experimental therapists since it didn't fit in with the usual 50-minute psychotherapy session, but they did include some of the most dynamic people in the field, including some who claimed that a five hour Adam session was as good as 5 months of therapy (2).

Physical and Psychological Effects

At the lower spectrum of dosage and the usual first time dose of MDMA, users typically report such physical effects as dry mouth ("cottonmouth"), thirst, sweating, eye twitches, tightness in the jaws and teeth clenching. Also associated with the physical effects of ecstasy is a state of relaxation, however many attribute this more to the psychological state induced by ecstasy. At higher dosages users exhibit many of the same effects as those represented by methamphetamine use, fast heart rate, extreme sweating, dizziness, restlessness and anxiety.

More profound than the physical effects are the psychological effects of ecstasy. These are described by terminology created specifically for the effects of MDMA by it's earliest researchers, some argue creating an entirely new class of drugs.

Empathogen or Entactogen - The first term used to describe the effects of ecstasy was Empathogenesis and ecstasy was first labeled an Empathogen by psychotherapist Ralph Metzner, friend and co-author to Timothy Leary, the guru of the psychedelic movement of the 1960s. Later, David Nicholas, Professor of Medicinal Chemistry and Pharmacology in the School of Pharmacy and Pharmaceutical Sciences at Purdue University, insisted on re-labeling the drug an Entactogen, because of the negative association to the roots of the word Empathogen, which is from the greek Pathos, meaning suffering. He made the case that Entactogen better described the drug, as it's roots were the greek En, meaning within, Tactus, meaning touch and Gen meaning produce (4, 5, 6).

The effect of Empathogenesis or Entactogenesis (both are used today nearly interchangeably) is described as a feeling of "everything is alright" and the users interpersonal relationships are more easily established and maintained while on the drug. Those who have used the drug also report that they are able to gain insight into their own beingness and their interpersonal relationships. This is the reason that the drug was very early termed the "hug drug" and is widely studied as an adjunct to Behavioral and Existential Therapy.

Other effects include sensory enhancement and in some users time and spatial distortions, with the most extreme sensory enhancement being of the tactile and auditory type. In this way the drug differs from hallucinogens, as there is no real "hallucinatory" effects, merely exaggerations of things and feelings already existent.

As to the exact Psychopharmacological effects of the drug Beck (1) has this to say:

The MDMA dosage range between effectiveness and toxicity is fairly narrow. It is reported that toxic effects begin to increase sharply over the 200 mg dose level. Effects generally appear within 20 to 60 minutes, when the user experiences a "rush" usually described as mild but euphoric. The "rush" may last from a few minutes to half an hour or not occur at all, depending on the user's mental set and the environment, the dose ingested, and the MDMA's quality. Zinberg (1976) described a similar pattern with MDA in an early field study. After the rush, the high levels off to a plateau, usually lasting from two to three hours, followed by a gradual "coming down" sensation, ending with a feeling of fatigue. Insomnia, however, may persist long after the fatigue stage, depending on the dosage and the user.

MDMA, although milder and shorter-lasting than MDA, still exerts amphetamine-like effects on the body, including dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and overall stimulation. These effects vary depending on dose. In addition, MDMA exerts a strong paradoxical effect of relaxation, which often causes many users to be unaware of the stimulant side effects (Beck, 1986). Most users cite a dramatic drop in defense mechanisms and increased empathy towards others. Combined with the stimulant effect, this generally produces an increase in intimate communication. Although both MDA and MDMA have been labeled "aphrodisiacs," users most often describe a more sensual, rather than sexual, experience (1).

Health Risks and Neurotoxicity

Although widely disputed by those who advocate MDMA, recent studies support to some degree that long-term there is a negative impact seratonin levels in the brain. Seratonin is an important neurological chemical neccessary in regulating mood, memory, sleep and behavior. Ricaurte states in his paper Toxic effects of MDMA on central serotonerginic neurons in the primate . . . (7) that even in single doses, taken weeks apart, the drug still produced a marked reduction in the thalamus and hypothalamus. In multiple oral doses spaced over less time than the above sample, the drug reduces seratonin in the caudate nucleus of the brain by 29% and in the somatosensory cortex by 58% (7).

Aside from short-term and long-term depletion of seratonin, public health authorities have issued a number of warnings associated with the use of MDMA. Beck (1) states that orally ingested doses of MDMA would need to be in the 1100-1780mg range for a 150 lb adult to be at risk of death from overdose (1). A single street dose of MDMA typically contains 80-160mg (3). However, much of the Ecstasy available on the street may contain manufacturing impurities, a combination of other more dangerous drugs or amphetamines, greatly increasing the risk of ingesting a lethal dose. Also apparent with use of the drug are the health risks typical of methamphetamine such as psychological burn-out , paranoia, malnutrition, dehydration, etc.

GHB (Grievous Bodily Harm, Liquid X, Georgia Home Boy)

Gamma hydroxybutyrate (GHB) was first synthesized in the 1920s and by the 1960s was undergoing clinical trials in humans throughout Europe as a possible anesthetic and hypnotic. By 1961 Dr. Henri Laborit of France had developed the drug and deemed that GHB was unsafe due to undesireable side effects. In N. America the drug became available through health food stores and was marketed as a body building supplement in the 1980s (1). By 1990 the US Food and Drug Administration levied a ban on GHB due to consumption of the drug in a recreational environment, in March 2000 GHB became a Schedule I Controlled Substance in the US (2). GHB appears in crystalline powder, clear liquid solutions and is most often taken orally, but can be smoked or snorted.

Prevalance Estimates and Availability

GHB was very quickly recognized as a dangerous drug, however because of the initial availablitly of the drug in retail health stores, it's availability through the internet from foreign sources and the ease at which any novice chemist can synthesise the drug it has made quite a large impact on illicit drug use in the US.

The Drug Abuse Warning Network (DAWN) reports exponential increases in the number of reported Emergency Department mentions from 1994 through 2000 (see table). However in 2001, mentions decreased, probably due to a combination of legislation, media attention and the availability of actual information about the negative side effects of the drug. Since it's growth in popularity through the late 1990s and it's leveling off in 2001, the drug continues to be a source of concern and worry for legislators, public health officials and parents.


Emergency Department Mentions of GHB 1994-2001 (Est.)
1994
1995
1996
1997
1998
1999
2000
2001
56
145
638
762
1,282
3,178
4,969
3,340
Source: Lloyd - Drug Abuse Warning Network (2)

Substance Facilitated Rape and Sexual Assault Associated with GHB

Most media attention focused on GHB, Rohypnol and Ketamine today is due to the high instance of these drugs being used in the perpetration of rape and sexual assault. Although alcohol is probably involved in more sexual assaults and rapes in the US, the use of GHB, Rohypnol and Ketamine in such Substance Facilitated rapes is much more insidious, especially in the case of GHB and Ketamine, which because of their anesthetic properties may keep a victim from remembering details of the attack and may even exhibit symptoms of amnesia associated with the drug and not remember that they were assaulted for days or weeks.

Effects of GHB in Users

GHB is most often taken orally in liquid or powder form. Gamma hydroxybutyrate is a clear, odorless, nearly tastless substance, making it easy to slip into drinks. Dosage level is typically 1 to 5 grams and is sold for $5 to $10 in capful or teaspoon full quantities, and depending on purity, measuring doses in this way is dangerous and risky as a user may take more than appropriate. In measured doses of pure GHB, at 1 to 2 grams the user will feel a loss of coordination, slowed reflexes, loss of inhibition, relaxation and slowed heart rate. The effects are similar to what one would feel if moderately drunk from alcohol. At 2 to 4 grams a marked detriment in the muscle coordination and speech centers of the brain occurs and users may enter a coma-like state, requiring intubation to be aroused (2).

The dangerous effects of GHB can be seen, as the same dose taken to achieve the desired result is very close to the level of dose that can cause serious side-effects and death. This is if GHB is taken alone. In cases where a user might also be consuming alcohol or other CNS depressents, the effect is almost certainly deserving of an Emergency Room visit, if not death. On Lycaeum.org, an informational website with leanings toward responsible use and moderation in opposition to deterence, it is even warned that misuse of GHB and it's chemical anologues can be deadly (4).

It is also noted by Lycaeum, Erowid, and Lloyd that GHB is an addictive drug and Llyod goes on to state that daily use will definitely produce withdrawal, addiction and tolerance, while even sporadic use can cause withdrawal. For those that use GHB throughout the day, Lloyd reports the withdrawal can be quite severe, and include "anxiety, insomnia, tremors, and episodes of tachycardia (abnormally fast heart rates), and may progress to delirium and agitation (2)", mimicing the withdrawal symptoms of a moderate to heavy drinker. And even in light users, because of it's short half life similar symptoms may occur from 1 to 6 hours since the last dose (2).

Rohypnol (Ruffies) Flunitrazepam, Rope, Roach, Roofies, Date Rape, Mexican Valium)

RuffiesLike Valium and Klonopin, two popularly prescribed drugs in the benzodiazapine family, Rohypnol (trade name for Flunitrazepam) is used in the treatment of anxiety and insomnia and is most often prescribed in L. America and Europe (1). Rohypnol has been widely made available on the American illicit drug scene due to it's popularity in Mexico, where it can be easily obtained and smuggled across the border into the United States. Initially, the drug got media attention as it was one of the first drugs to be widely used in drug facilitated rape. More recently the manufacturer of the brand Rohypnol, Hoffmann-LaRoche has added a dye to the drug to make it more easily detectable if slipped into a drink and is available oblong olive color pill in 1 milligram doses with the imprint of the number 542 (2).

Availability, Use and Effects

The drug is currently made available illicitly by drug dealers primarily at raves, but is also available through other illegal means, as well as legitemately by doctor's prescription. The pill is sold illicitly for $2 to $5 per dosage unit, but has been reported to sell for as much as $10 to $30. The effects of the drug are like that of other benzodiazepines, including decreased blood pressure, dizziness, visual disturbances (double vision), drowsiness and confusion, as well as having the effect of anterograde amnesia (not remembering events that occured while under the influence of the drug) (2). While the drug may be used alone, many heroin users may combine the drug with low grade heroin to increase the effects of both drugs and is also used in combination with alcohol, providing a synergistic effect (3).

Dangers Associated With Use

There has been a low reported incidence of overdose and death with the drug, however because of it's use in drug facilitated rape, it has received much media and law enforcement attention. In addition, it produces physical dependence as well as having a high tolerance factor and withdrawal for regular users. For this reason, an increasing number of detox and drug treatment clients are being admitted for dependence to the drug.

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MDMA (MDA, Ecstasy, Eve, Adam, X, XTC) - Bibliography and Resources:

  1. Drug Abuse Series: MDMA, Jerome E. Beck, School of Public Health Berkeley, CA Institute for Scientific Analysis, April 1987, Elizabeth Piper Deschenes ed. (Health and Welfare Agency State of California Clifford L. Allenby, Secretary George Deukmejian, Governor, California DADP contracts # D-0053-5 and # D-0001-7.)
  2. E for Ecstasy, Published by Nicholas Saunders, 14 Neal's Yard, London, WC2H 9DP, UK. ISBN: 0 9501628 8 4. Published May 1993. 320 pages.
  3. MDMA FAQ, Jon M. Taylor, www.lycaeum.org (pub), February 1994, maintained by Brian Behlendorf.
  4. Wikipedia: The Free Encyclopedia, en.wikipedia.org (pub), June 2004.
  5. Erowid Character Vaults, Ralph Metzner, www.erowid.org (pub), March 2004.
  6. Erowid Character Vaults, David Nicholas, www.erowid.org (pub), March 2004.
  7. Toxic effects of MDMA on central serotonergic neurons in the primate: importance of route and frequency of drug administration Ricaurte GA, DeLanney LE, Irwin I, Langston JW Brain Res , 1988; 446(1):165-8

Image Credits:

  1. Photo of Alexander Shulgin, photographer unknown, from Erowid.org

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GHB (Grievous Bodily Harm, Liquid X, Georgia Home Boy) - Bibliography and Resources:

  1. GHB Timeline, Erowid, www.erowid.org (pub), Unknown Date.
  2. Gamma Hydroxybutyrate (GHB), Jennifer Lloyd of ONDCP Drug Policy Information Clearinghouse, www.whitehousedrugpolicy.gov (pub), November 2002
  3. Substance Related Sexual Assault, Erowid, www.erowid.org (pub), May 2000.
  4. GHB-related, www.lycaeum.org (pub), November 2000.

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Rohypnol (Ruffies, Flunitrazepam, Rope, Roach, Roofies, Date Rape, Mexican Valium) - Bibliography and Resources:

  1. InfoFacts - Rohypnol and GHB, The National Institute on Drug Abuse (NIDA), www.nida.gov (pub), July 2003.
  2. Rohypnol (Flunitrazepam), www.dea.gov (pub), date unknown.
  3. Fact Sheet on Rohypnol, PREVLINE www.health.org (pub), date and author unknown.

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