Diseases

• GHB and Rohypnol are available in odorless, colorless, and tasteless forms that are frequently combined with alcohol and other beverages. Both drugs have been used to commit sexual assaults (also known as "date rape," "drug rape," "acquaintance rape," or "drug-assisted" assault) due to their ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault.
• GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is typically taken orally in pill form. Recent reports, however, have shown that Rohypnol is being ground up and snorted.
• Both GHB and Rohypnol are also abused for their intoxicating effects, similar to other CNS depressants.
• GHB also has anabolic effects (it stimulates protein synthesis) and has been used by bodybuilders to aid in fat reduction and muscle building.
• Ketamine is usually snorted or injected intramuscularly.

• GHB acts on at least two sites in the brain: the GABAB receptor and a specific GHB binding site. At high doses, GHB's sedative effects may result in sleep, coma, or death.
• Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can produce anterograde amnesia, in which individuals may not remember events they experienced while under the influence of the drug.
• Ketamine is a dissociative anesthetic, so called because it distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Ketamine acts on a type of glutamate receptor (NMDA receptor) to produce its effects, which are similar to those of the drug PCP. Low-dose intoxication results in impaired attention, learning ability, and memory. At higher doses, ketamine can cause dreamlike states and hallucinations; and at higher doses still, ketamine can cause delirium and amnesia.

Monitoring the Future (MTF) Survey* MTF has reported consistently low levels of abuse of these club drugs since they were added to the survey. For GHB and ketamine, this occurred in 2000; for Rohypnol, 1996. According to results of the 2009 MTF survey, 0.7 percent of 8th-grade and 1.1 percent of 12th-grade students reported past-year** use of GHB, a statistically significant decrease from peak-year use of 1.2 percent in 2000 for 8th-graders and 2.0 percent for 12th-graders in 2004. GHB use among 10th-grade students was reported at 1.0 percent, an increase from 2008 (0.5 percent), and statistically unchanged from peak use of 1.4 percent in 2002 and 2003. Past-year use of ketamine was reported by 1.0 percent of 8th-graders, 1.3 percent of 10th-graders, and 1.7 percent of 12th-graders in 2009. These percentages also represent significant decreases from peak years: 2000 for 8th-graders (at 1.6 percent) and 2002 for 10th- and 12th-graders (at 2.2 and 2.6 percent, respectively). For Rohypnol, 0.4 percent of 8th- and 10th-graders, and 1.0 percent of 12th-graders reported past-year use, also down from peak use in 1996 for 8th-graders (1.0 percent), 1997 for 10th-graders (1.3 percent), and 2002 and 2004 for 12th-graders (1.6 percent).

Uncertainties about the sources, chemicals, and possible contaminants used to manufacture many club drugs make it extremely difficult to determine toxicity and associated medical consequences. Nonetheless, we do know that:

• Coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths.
• Rohypnol may be lethal when mixed with alcohol and/or other CNS depressants.
• Ketamine, in high doses, can cause impaired motor function, high blood pressure, and potentially fatal respiratory problems.

There is very little information available in the scientific literature about treatment for persons who abuse or are dependent upon club drugs.

• There are no GHB detection tests for use in emergency rooms, and as many clinicians are unfamiliar with the drug, many GHB incidents likely go undetected. According to case reports, however, patients who abuse GHB appear to present both a mixed picture of severe problems upon admission and a good response to treatment, which often involves residential services.
• Treatment for Rohypnol follows accepted protocols for any benzodiazepine, which may consist of a 3- to 5-day inpatient detoxification program with 24-hour intensive medical monitoring and management of withdrawal symptoms, since withdrawal from benzodiazepines can be life-threatening.
• Patients with a ketamine overdose are managed through supportive care for acute symptoms, with special attention to cardiac and respiratory functions.