DESIGNER DRUGS

OFFICIAL NAMES: 2C-B (4-bromo-2,5 dimethoxyphenethylamine)

STREET NAMES: Nexus, 2C-B, bromo, toonies, performax 2's, spectrum, synergy, venus, Eve, erox, zenith, cloud nine, utopia, cee-beetje, afterburner, bromo mescaline

DRUG CLASSIFICATIONS: Schedule I, synthetic hallucinogen

OFFICIAL NAMES: 3, 4-Methylenedioxymethamphetamine (MDMA)

STREET NAMES: Ecstasy, E, X, XTC, Adam, Eve, hug, beans, love drug

DRUG CLASSIFICATIONS: Schedule I, hallucinogen

OFFICIAL NAMES: Gamma hydroxybutyrate (GHB)

STREET NAMES: Liquid x, Georgia home boy, goop, gammaoh, grievous bodily harm

DRUG CLASSIFICATIONS: Schedule I, hallucinogen OFFICIAL NAMES: Ketamine hydrochloride (brand names include Ketaject, Ketaset and Ketalar)

STREET NAMES: K, ket, quick, lady K, special K, vitamin K

DRUG CLASSIFICATIONS: Schedule III, dissociative anesthetic

OFFICIAL NAMES: Methamphetamine

STREET NAMES: Crystal, speed, meth, chalk, ice, glass

DRUG CLASSIFICATIONS: Schedule II, stimulant

OFFICIAL NAMES: Phencyclidine (PCP)

STREET NAMES: Angel dust, ozone, wack, rocket fuel, embalming fluid, fry, formaldehyde, wet, water, amp, hog

DRUG CLASSIFICATIONS: Schedule II, hallucinogen

OVERVIEW

Illicit drugs that fall under the heading of designer drugs encompass substances originally manufactured to have the same or more potent effects of illegal drugs, but which were chemically distinctive and, thus, not technically illegal. Their creation, traffic, and use were designed to sidestep the Controlled Substances Act (CSA) that banned the illegal sale of narcotics, stimulants, depressants, and hallucinogens.

Before the advent of so-called designer drugs, substances were explicitly banned by law or not technically illegal. The underground chemists knew that, by changing base ingredients or otherwise modulating the chemical structure of drugs, they could create completely new compounds called analogs that are different enough from controlled substances that they would not violate the law, yet close enough to produce many of the same effects.

Finally, in the mid-1980s, the U.S. government added designer drugs to the Drug Enforcement Administration's (DEA) list of controlled substances. The DEA also took exception to the phrase "designer drug," suggesting the use of the technically more precise phrase of "controlled substance analogs" (CsA).

The surge in CsA use in the United States, particularly among teens, is tied by many experts to the growth and influence of "raves" or "trances," large, all-night dance parties that cater to young audiences. Rave society is richly developed with dominant and reinforcing styles of music, dance, cultural mood, and expression. It also supports a social environment that encourages the liberal experimentation of drugs to heighten or deepen the event experience.

It is important to note from the outset that not all "club drugs" or "rave drugs" are designer drugs, although the terms are often used synonymously. Though the use of Rohypnol at raves is well documented, for example, it is a prescription sleeping aid sold overseas, and the cultural histories and usage patterns of drugs such as LSD and mescaline are quite distinct from the designer drug phenomenon.

This overview will therefore focus on the following substances and narrow discussion of their use primarily to the club environments where they are most used and abused. These drugs include: ecstasy (MDMA), gamma hydroxybutyrate (GHB), ketamine (special K), methamphetamine (crystal), 2C-B (nexus), and phencyclidine (PCP).

CHEMICAL/ORGANIC COMPOSITION

The composition of the six controlled substance analogs listed above often stimulate the same areas of the brain, but are chemically quite distinct from one another. MDMA (3, 4-methylenedioxymethamphetamine) is a complex drug that makes simple classification difficult. Its chemical structure is related both to the stimulant methamphetamine and the hallucinogen mescaline. Methamphetamine bears a close resemblance to two powerful chemicals in the body, dopamine and norepinephrine, which regulate mood, memory, and movement.

2C-B (sometimes called bromomescaline) is a hallucinogenic phenethylamine, related structurally to mescaline and the lesser known phenethylamine analogs DOB (2, 5-dimethoxy-4 bromoamphetamine) and DOM (2, 5-dimethoxy-4-methylamphetamine). DOM, also known as STP, gained a considerable following in the 1960s, despite its association with violent behavior. 2-CB is distantly related to MDMA (ecstasy).

GHB is readily manufactured from its precursor, gamma-butyrolactone (also known as 2(3h)-furanone dihydro, or GBL). GHB is relatively easy to synthesize in household laboratories, mixing ingredients such as floor cleaning products, nail polish, and super glue removers with sodium hydroxide in the form of lye. Unintentional poisonings from bad homemade batches are not uncommon.

Phencyclidine (PCP) is a synthetic chemical that can be derived from an essential oil of the sassafras tree and is the best-known representative of the class of drugs collectively known as arylcyclohexylamines. As a chemical, PCP was first synthesized in 1926 and was briefly used in the 1950s as a dissociative anaesthetic. The chemicals needed to manufacture PCP are also readily available and inexpensive, and the production process requires little formal chemical knowledge or laboratory equipment.

Other precursor analogs chemically related to PCP include N-ethyl-1 phenylcyclohexylamine (PCE), 1-(1-phenyl-cyclohexyl)-pyrrolidine (PCP or PHP), and 1-(1-(2 thienyl-cyclohexyl)-piperdine (TPCP or TCP). PCC (1-iperidinocyclohexanecarbonitrile) is particularly

common and particularly dangerous. It appears as a chemical by-product in poorly synthesized batches of PCP, and its ingestion may have serious health consequences.

Another member of the arylcyclohexylamine structural class is ketamine, which is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, meaning it disables certain higher-function signaling mechanisms in the brain (consciousness, memory, perception, and motor activity) from lower functions (breathing and heart rate). Ketamine is manufactured commercially for use as a surgical anesthetic for both humans and animals.

Ketamine is chemically related to other dissociative anesthetics, including dextromethorphan (DXM), found in some over-the-counter cough syrups, and nitrous oxide (often called "whippets"). Ketamine also shares a close chemical kinship to the prescriptives tiletamine and memantine. Tiletamine is used in combination with zolazepam as a veterinary anesthetic under the brand names Zoletic and Telazol.

INGESTION METHODS

Though regular drug users will frequently modify their ingestion methods to hasten the impact of the drug's effects, such as grinding MDMA tablets into powder and snorting it rather than swallowing the pill), this overview will focus on the most common means of delivery and usage.

Of all the designer drugs, ecstasy is by far the most commonly used drug, and is sold and distributed in pressed tablets or capsules and ingested orally. Users have also been known to snort it.

2C-B, or bromomescaline, is also sold and taken in capsules or tablets. There are also reports of Nexus being snorted, although unlike ecstasy, snorting 2C-B is said to be excruciatingly painful.

GHB is sometimes sold as a powder in a bag or capsules, but is most commonly sold and consumed as a liquid in small (30 ml) glass or plastic bottles, enough for three moderate doses. Dosing of GHB is extremely variable. Quantities used with ecstasy or other stimulants to modulate the highs of both drugs.

PCP is available in the form of tablets, capsules, liquid, and powder. In its base form, PCP is a white crystalline powder that is snorted, pressed into tablets, or mixed together with water or alcohol. More commonly, it is sprayed in its liquid form on leafy material such as oregano, mint, or marijuana, and sold to end users in the form of joints to be smoked.

THERAPEUTIC USE

Research into the benefits of drug therapy in clinical settings for the treatment of psychosis, schizophrenia, and other mental ailments was in large part responsible for the widespread use of MDMA during its introduction. The empathic properties associated with MDMA, giving users a sense of heightened emotional attachment and connectedness, made its use very intriguing for psychotherapists.

Studies are currently underway in Spain and Israel to assess MDMA's effectiveness in the treatment of post traumatic stress disorder (PTSD). On November 2, 2001, the Food and Drug Administration (FDA) approved the first clinical trial of MDMA as a treatment for PTSD in the United States. The study is currently awaiting approval from the research review board at the Medical University of South Carolina.

Following the drug scheduling of MDMA in the mid-1980s, 2C-B was marketed as a legal substitute for use by American psychotherapists. In clinical settings, it was used as a mood-altering agent, capable of creating a warm, empathetic bond between doctors and patients. Also, the drug's action was said to dissolve the patient's ego-defenses and inner resistances, thus enabling the person to get in touch with suppressed emotions and repressed memories.

Ketamine, like MDMA, was once thought to hold great promise for use in the field of experimental psychotherapy, although its use has been sidelined for this purpose in the United States.

In the early years following the introduction of ketamine and other antagonists into clinical settings, doctors and researchers thought they held great promise. They were not only considered excellent anesthetics, they appeared to assist brain function and recovery after damage from strokes, head injuries, hypoxia, polio, and a variety of other conditions. Evidence of brain damage where NMDA antagonists are most active did not surface until later.

PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Use of PCP in humans was discontinued in 1965, because it was found that patients often became agitated, delusional, and irrational while recovering from its anesthetic effects. Commercial production of PCP ended in 1978.

GHB (gamma hydroxybutyrate) was originally developed as an anesthetic, but was withdrawn due to unwanted side effects. GHB holds several U.S. patents for use in the treatment of sleep disorders such as narcolepsy and insomnia, and as a muscle relaxant. GHB is used as a fast-acting anesthetic in small animals. The compounds and compositions made from GHB are useful in the treatment of Parkinson's disease, schizophrenia, and other dopamine-related disorders.

Amphetamine attracted a widespread audience in 1932, when it was marketed as the nasal inhaler Benzedrine by the pharmaceutical company Smith Kline & French. Amphetamine is still widely used as a bronchio dilator, allowing asthmatics to breathe more freely.

Methamphetamines are still legally produced in the United States for attention-deficit disorder (ADD) under the trade names Desoxyn or Ritalin (methylphenidate). As the street name "speed" suggests, amphetamines elevate mood, heighten endurance, and eliminate fatigue.

USAGE TRENDS

Designer drug use is most common among young adults and is most commonly associated with large-scale dance events, nightclubs, and raves. The 1999 National Household Survey on Drug Abuse found an estimated1.5% (3.4 million) of Americans had used MDMA at least once during their lifetime. The heaviest use (5% or1.4 million people) was reported for those between 18 and 25 years old.

During 2000, 4% of the U.S. population (8.8 million people) said they had tried methamphetamine in their lifetime. The age demographic skews slightly older, with highest rate of methamphetamine use reported by adults 26 or older (4.3% of these adults report at least trying methamphetamine in 2000). Of those between the ages of 18 to 25, 4.1% reported lifetime use and, for those between the ages of 12 and 17, 1.3% reported lifetime use of methamphetamine. The number of methamphetamine emergency room treatment admissions in the United States has been climbing steadily and alarmingly, from 14,496 admissions in 1992 to 53,560 in 1997 and 57,834 in 1999.

GHB use appears to be increasing alongside its wider availability, according to the Drug Abuse Warning Network (DAWN). Emergency room admissions tracked by the organization find mentions of GHB have risen dramatically since the mid-1990s from just 56 in 1994 to 4,969 in 2000. Although ketamine use has remained steady over the same period, hospital data collected by the U.S. Department of Health and Human Services suggest the 18–25 age group still accounts for 58% of all ketamine-related incidents.

Use of PCP increased between 1991 and 1996, at which time levels began to drop. Although levels of use remain relatively low, they are higher than in the early 1990s. DAWN estimates 6,510 emergency room visits in 1995 secondary to PCP use (or PCP in combination with another chemical/drug), up from 3,470 in 1991. As of 2000, approximately 5.8 million individuals aged 12 and older had used PCP at least once in their lifetime; most of these users were adults over 18 years of age.

From 1999 to 2000, the use of MDMA among high school-aged teens increased in every measured grade—eighth, tenth, and twelfth. For tenth and twelfth graders, this is the second consecutive year MDMA use has increased. Past year use of MDMA increased among eighth graders from 1.7% in 1999 to 3.1% in 2000; from4.4% to 5.4% among tenth graders; and from 5.6% to8.2% among high school seniors. The perceived availability of MDMA also rose sharply, from 40.1% in 1999 to 51.4% in 2000.

Reports on the use of 2C-B are sporadic, but growing in number, leading law enforcement to believe that it could emerge as a significant drug in rave culture. The DEA reports a number of significant arrests throughout the United States. Information compiled by the National Institute on Drug Abuse indicates that 2C-B has become popular for recreational use in Germany and Switzerland. Clandestine manufacture has been reported in the Netherlands. The drug is reportedly making an appearance at dance clubs in the Washington, D.C. area.

MENTAL EFFECTS

Known to many as the "hug drug" or the "feel good" drug, MDMA reduces inhibitions while enhancing sensitivity to sound, light, and touch. The mixed effects of stimulant and psychedelic peak after approximately two hours and may continue for up to six hours. The drug lowers inhibitions, increases mood sensitivity, and gives club-goers energy to dance well into the morning hours. People say they are friendlier, happier, and "more connected" to music and to other people when on the drug.

Like MDMA, recreational users of 2C-B say the drug greatly heightens their appreciation of and sensitivity to music and say that it greatly enhances the enjoyment of dancing. At higher doses (15–20 mg), recreational users report heightened tactile sensations and profoundly altered states of consciousness.

GHB is another drug reported to have MDMA-like effects. Some people report positive mood changes and an increased appreciation for music, dancing, and talking while on the drug. Slurring of speech, giddiness, and mild incoherency are also common. Some users of GHB report heightened tactile sensitivity, relaxation, and sexual arousal.

Users of ketamine report the immediate effect as a non-localized numbness all over the body, altered vision, muffled hearing, and a floating sensation. Many people, after using the drug once, will not knowingly use it again. At higher doses, ketamine leads to out-of-body experiences with a pronounced hallucinatory state. Users liken the effects to an intense religious experience and an out-of-body sensation. Visions of angels and empathic beings are not uncommon.

Stimulants such as methamphetamine give users an intense sensation, called a rush or flash, that lasts only a few minutes and is described as extremely pleasurable. Oral or intranasal use produces a euphoric high, but not a rush. Some report that they feel "superhuman" after losing a night or two of sleep while binging on the drug. People also report feeling unusually sharp or in control. Wanting to prolong the high and delay the inevitable crash is emblematic of the drug's addictive character.

Individual responses to PCP at low and moderate doses are varied. Many people, after using the drug once, will not knowingly use it again. Others seek it because they claim the drug makes them funnier, more insightful, and gives them feelings of invulnerability. Users generally progress from feeling detached, distant, and removed from their immediate surroundings to a surging sense of power and strength. Others report prominent body-image distortions (enlarged or detached head and limbs) against a background of depersonalizing numbness and a sense of profound isolation.

The mental state considered by many to be the hallmark of PCP intoxication, the recurring delusion of superhuman strength, has prompted people to snap handcuffs and, unarmed, attack large groups of people or the police. The pronounced analgesic effects of the drug have fed delusions of immortality, causing people to jump from windows or cliffs. Such extreme and bizarre behavior is often accompanied by gruesome self-mutilation or violence against innocent bystanders. Hospitals have recorded nonviolent people pulling out teeth and attacking family members in reaction to paranoid delusions.

Recent experiences can have a substantial effect on the mental effect of 2C-B use on the user. Physically or psychologically unsettling events in the days before a "trip" can blossom into more serious distress and trauma while using the drug. Some users have described hallucinations that are debilitating in their intensity and that are looked back upon as the most terrifying drug-related experiences of their lives.

PHYSIOLOGICAL EFFECTS

Many designer drugs share a steep dose-response curve, meaning its effects can triple or quadruple with only minor increases in consumption. A 150 mg dose of MDMA, for example, can produce double the effects of a 120 mg dose. As many of the designer analogs are manufactured in underground laboratories, unknowns about the concentration of active ingredients have the potential to cause life-threatening situations.

Even experienced users of ketamine can miscalculate the dosage and find themselves on the verge of slipping into unconsciousness. In non-clinical settings, this potentially life-threatening state is called a "K-hole" and may be accompanied by convulsions, vomiting, and respiratory depression. Researchers report that while most users recover within 72 hours after ketamine usage, language and some aspects of memory impairment linger. Visual flashbacks have been reported days or weeks after use. Amnesia, aggressive behavior, and paranoid or delusional thinking have been reported after high recreational ingestion of ketamine.

The central nervous system actions that result from taking even small amounts of methamphetamine, on the other hand, include extreme alertness, increased energy, decreased appetite, increased respiration, hyperthermia, and euphoria—generally the effects sought by users. But over time, side effects such as irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness begin to intrude. These symptoms are magnified by lack of sleep. Withdrawal often produces severe depression.

The impact of MDMA use on the body includes muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating. Immediate side effects may include nausea, dizziness, disorientation, anxiety, and panic attacks. 2C-B, a close cousin to MDMA, has a stimulating effect on the central nervous system, usually causing a slight rise in blood pressure and a quickening of the heart rate. As a result, 2C-B could pose a danger to those suffering from diabetes, epilepsy, or cardiac problems.

Because of high demand, ecstasy pills are frequently mixed with fillers and other active substances, most commonly amphetamines (speed), caffeine, and ephedrine (a natural amphetamine-like substance). Some pills have been found to contain DXM (dextromethorphan), a dissociative psychedelic found in some cough medicine, and PMA (paramethoxyamphetamine), a highly toxic hallucinogenic stimulant.

Because 2C-B is clandestinely produced, users are unaware of the dose they are ingesting and may be over-whelmed by the drug's effects. Users seeking MDMA-like effects do not expect or enjoy the unpleasant physical side effects on the body, including acute nausea, diarrhea, cramps, and gas. There are also several reports of allergic-type reactions causing increased mucus production concentrated in the windpipe and lungs.

2C-B is not physically addictive, as is the case with methamphetamine or GHB. However, if used very regularly, there is the possibility that psychological dependence could develop. When used at dance clubs or large indoor events, there are dangers associated with overexertion as a common reaction to drug's stimulatory effect, thereby causing dehydration and possible collapse. Nevertheless, to date, no deaths have been attributed to this drug.

GHB temporarily inhibits the release of dopamine in the brain. This may cause increased dopamine storage, which is followed by increased dopamine release when the GHB influence wears off. This effect could account for the middle-of-the-night awakenings common with use of higher GHB doses, and the general feelings of increased well-being, alertness, and arousal the next day.

There is much debate and considerable conflicting evidence regarding the mechanism of action of PCP. It is thought to stimulate alpha-adrenergic receptors in the brain and to elevate epinephrine, norepinephrine, and serotonin levels. PCP is also thought to inhibit communication along certain central nervous system pathways. Still others think that PCP acts on opiate receptors.

The physical effects of PCP on the user can be as varied and unpredictable as the psychological reactions. At low to moderate doses, PCP produces a slight increase in breathing rate and a more pronounced rise in blood pressure and pulse rate. Respiration becomes shallow, and flushing and profuse sweating occur. Generalized numbness of the extremities and loss of muscular coordination may also occur.

Harmful side effects

Most of the pleasing physical sensations and mental effects of drugs covered in this section come from the forced release of serotonin and dopamine in the brain. Over the medium and long term, repeated abuse has been shown to damage dopamine transporters by shriveling the nerve endings of these crucial cells.

Methamphetamine and MDMA have been shown to cause damage to dopamine transporters. Anecdotally, users of both these drugs refer to the hardships of "coming down" and the "hangover" typified by fatigue and depression that typically lasts several days.

Methamphetamine use causes a sharp spike in blood pressure, dangerously irregular heartbeats, chest pain, shortness of breath, diarrhea, nausea, and vomiting. The drug can increase body temperature to critical levels, provoking cascading failures in vital systems. Brain hemorrhage is perhaps the biggest risk associated with abuse of the drug, which, if not fatal, can cause permanent paralysis and speech loss.

Ketamine toxicity is less of a concern than the accidents caused by the suddenness and duration of the dissociative state. Sudden collapse can lead to accident or injury, and loss of consciousness coupled with vomiting can lead to a blockage of the airway that could cause the user to choke to death.

At high doses, PCP prompts a drop in blood pressure, pulse rate, and respiration. These reactions may be accompanied by nausea, vomiting, blurred vision, uncontrolled eye movement, drooling, loss of balance, an exaggerated gait, seizures, convulsions, coma, and death.

PCC, a common by-product of PCP's illicit manufacture (sometimes accounting for 10–25% of the mixture), causes abdominal cramps, diarrhea, and in sufficient doses, coma. PCC is an unstable compound, degrading to piperidine. Contaminated batches of PCP can sometimes be recognized by a strong fishy odor. When heated, as when it is smoked and inhaled, PCC liberates hydrogen cyanide, so cyanide poisoning in PCP smokers is also a strong possibility.

Long-term health effects

Some of the popularity associated with so-called designer drugs comes from the belief that these drugs are "safe" and not addictive. Both assumptions are wrong.

Methamphetamine is highly addictive. Users trying to abstain from use may suffer withdrawal symptoms that include depression, anxiety, fatigue, paranoia, aggression, and intense drug cravings. Chronic abuse of methamphetamine produces a psychosis similar to schizophrenia and may include violent behavior, anxiety, confusion, and insomnia. Users can also exhibit psychotic behavior, including auditory hallucinations, mood disturbances, delusions, and paranoia, possibly resulting in homicidal or suicidal thoughts.

Methamphetamine can cause brain damage that results in slower motor and cognitive functioning—even in users who take the drug for less than a year—according to two studies published in the March 2001 issue of the American Journal of Psychiatry. Over time, the damage that meth use does to dopamine receptors appears to seriously reduce the overall level of dopamine in the brain. This can result in symptoms like those of Parkinson's disease, Alzheimer's disease, stroke, and epilepsy, characterized by shaking and difficulty with walking, movement, coordination, and memory.

GHB is also addictive. Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms. At four to six average doses per week, people report finding that they need to increase their dose to get the same level of intoxication. Many subsequently report that they need a little GHB just to feel normal. With very heavy use (one or more doses per day), many people report very serious physical addiction. Stopping "cold turkey" results in anxiety, inability to sleep, and feeling like the heart is arrhythmic (irregular).

More people are overdosing on GHB than ecstasy. In 2000, 2,482 GHB users visited the emergency room for an overdose, compared with 1,742 ecstasy users. There also are more deaths from GHB. According to the DEA, 73 people have died from taking GHB since 1995, compared to 27 ecstasy-related deaths from 1994 to 1998.

Although not thought to incite physical dependency, MDMA should not be considered risk-free. Recent studies confirm that MDMA is neurotoxic. A report published in June 1999 by researchers at Johns Hopkins University confirmed that the forced release of serotonin damages serotonin receptors in the brain. The serotonin system plays a direct role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. The study, conducted on primates, showed that exposure to MDMA for four days caused brain damage that was evident six to seven years later. It was the first study to demonstrate MDMA's potential for causing permanent brain damage.

Recent studies suggest all N-methyl-D-aspartate (NMDA) antagonists cause brain damage to the portions of the brain responsible for higher cognitive functions like memory and speech. These are the areas most affected by dissociative anesthetics and include ketamine, dextromethorphan (DXM), phencyclidine (PCP or angel dust), nitrous oxide (whippets), and dizocilpine (MK-801).

The long-term impact of 2C-B use is unknown. The September 1998 Journal of Analytical Toxicology reported that very little data exist about the pharmacological properties, metabolism, and toxicity of 2C-B. The relationship between its use and disease and death are unknown.

Given the similarity of its chemical structure to MDMA and the relatedness of effects on the user, it seems reasonable to infer that 2C-B may possess similar neurotoxic qualities, but more research is needed before any such conclusions can be drawn.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

According to the ONDCP, MDMA is frequently used in combination with other so-called club drugs, greatly increasing risks to the user. These other drugs include LSD, psilocybin mushrooms, GHB, ketamine, and nitrous oxide. MDMA and marijuana is a common combination in the South and West of the United States; MDMA and methamphetamine combinations are found in the West. "Candy flipping," the use of ecstasy and LSD, was mentioned in several areas, including Chicago, Denver, Honolulu, Memphis, Miami, Philadelphia, Washington, D.C., and Los Angeles.

Users of GHB are warned that it should never, under any circumstances, be mixed with alcohol or other nervous system depressants. Combining even a low GHB dose with alcohol can trigger the overdose reaction and a state of unresponsive unconsciousness and depressed breathing. GHB has been linked to 70 deaths in the United States, most often attributed to its ingestion with alcohol. About a third of those deaths have been tied to GHB overdose alone.

Other nervous system depressants that could trigger a GHB overdose reaction are benzodiazepines (mild tranquilizers such as Valium and Xanax), phenothiazines (potent tranquilizers like Thorazine and Stellazine), various painkillers (barbiturates and opiates), anticonvulsants (Dilantin and phenobarbital), and even many over-the-counter allergy and sleep remedies.

GHB taken in combination with ecstasy or methamphetamine can lead to the impression in users that their tolerance for the drug has increased far beyond what it actually has. Individuals who report consuming up to five times the normal dose when on speed or ecstasy acknowledge that their "average" high dose landed them in the hospital when taken alone.

Combining the use of ketamine with drugs that suppress respiratory function, including alcohol, barbiturates, or Valium, is dangerous and potentially life threatening. Users mixing these drugs risk slowing their breathing and heart rates to dangerously low levels that starve the brain of oxygen, which increases risks of permanent brain damage, coma, and death.

Ketamine is almost never taken alone in a club environment. It is frequently mixed with a stimulant like cocaine or methamphetamine and taken simultaneously (commonly called "trail mix"). Because its effects are relatively short-lived compared with drugs like MDMA, it is often used as a "booster," or a secondary substance, that draws out desired pleasurable effects of the primary drug.

Because of its easy synthesis, PCP is frequently used as either an additive in drugs such as MDMA, cocaine, and methamphetamine, or substituted for and sold on the street as THC (active ingredient in marijuana), cannabinol, mescaline, psilocybin, LSD, amphetamine, and other psychedelics.

PCP has a sedative effect on certain systems in the body and interactions with other central nervous system depressants such as alcohol and benzodiazepines may lead to coma or accidental overdose.

The trend of selling marijuana with drug treatments that have been sprayed on marijuana, mint, or oregano leaves is gaining popularity in the United States, and federal, state, and local authorities believe that PCP is playing a major role in the resurgence of a trend originally popular in the 1970s. Hospitals report that the physical effects of highs associated with "wet" or dipsticks (joints presumably dipped in embalming fluid) are nearly identical to those long associated with PCP use.

Anecdotal evidence lends support to these claims. "Embalming fluid" is a common street slang term for PCP. Confusion about the origin of the term is thought by many to have influenced the trend whereby PCP is actually mixed with formaldehyde (or other embalming chemicals) and used as a recreational psychoactive.

The spiked joints are called "squares" and the wet marijuana is called "fry"; adolescents are congregating in "fry houses." A sample joint obtained by Houston law enforcement and submitted to spectral analysis revealed PCP and byproducts of its home-lab manufacture, PCC and PCH.

Health officials describe "burn-out" (also called amotivational syndrome), a state long associated with prolonged abuse of PCP, that results from recreational exposure to fry. These symptoms include memory dysfunction, lethargy, lack of interest or motivation, and decreased spontaneous speech and blank staring.

Because of neurotoxicity and overdose concerns, 2C-B may have potentially dangerous interactions with users taking monoamine oxidase inhibitors (MAOIs). MAOIs are most commonly found in the prescription antidepressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline).

TREATMENT AND REHABILITATION

Generous funding of drug treatment programs is costly and politically challenging but absolutely essential. A 1995 study by the Rand Corporation found that every dollar spent in drug treatment saves society seven dollars in crime, policing, incarceration, and health services.

The National Institute on Drug Abuse (NIDA) confirms that the most successful drug rehabilitation programs are those that tailor treatment to the user, not the other way around. While there is no single treatment program that works successfully in every circumstance, programs that have the highest success rates are those that take into consideration differences in age, nationality, race, sexual orientation, gender, economic status, and education level.

Once these are factored in, therapeutic efforts can target the needs, problems, and pressures unique to that individual's life experience. As any recovering addict will attest, getting over the attachment to the drug is only the beginning of a much longer journey.

People turn to drugs to escape, fit in, feel better about themselves, or just to feel better—ending that dependency often means replacing the place drugs used to occupy with something stronger. The goal of every successful drug treatment program is to identify what that something is, and to give individuals the tools they need to achieve it.

Therapies help users devise their own coping strategies for confronting temptation and opportunity and preventing relapse. Even if relapse does occur, people may be taught how to tap into a network of support that will help them out of that situation as well.

With these difficulties in mind, drug treatment programs do surprisingly well at keeping people on the road to recovery. The NIDA says the treatment of addiction is as successful in 2002 as the treatment of other chronic diseases such as diabetes, hypertension, and asthma.

PERSONAL AND SOCIAL CONSEQUENCES

So-called designer drugs have a particularly glamorous appeal, marketed by dealers as safe, non-addictive, fun drugs that carry minimal risks to the user. This is not now, nor has it ever been, the case.

All drug use has built-in disadvantages that handicap the user. Drugs have a way of reshaping lives to accommodate their use. People who decide they want to experiment or "have a little fun" with any of the drugs covered in this overview may discover somewhere down the line that their relationships, particularly with non-drug users, have changed—some irrevocably. Academic or work-related pursuits may seem less important, and may suffer as a result. Family members may be neglected.

With addictive substances such as methamphetamine, the dangers of use are more pronounced. Even those who claim not to have a problem with recreational, or what might be termed occasional, use of drugs might be kidding themselves. The low that follows a euphoric high can make the rest of the user's life seem dull and depressing when compared to a drug-enhanced state. The allure of recapturing a feeling of euphoria that has suddenly deserted other aspects of their "real" lives may be prove too enticing to pass by, and result in dependence or addiction.

Repeated use of certain drugs brings about dramatic changes in both the structure and function of the brain. The euphoric effect derived from their use is itself a sign that the drug or drugs are changing the chemical wiring in the brain. As it adjusts to the imbalances being inflicted upon it, the user needs more of the drug to recapture the high. In a shorter span of time than many realize, this change becomes more pronounced and indelible, until finally the individual has become addicted to the drug.

The hallucinatory potential of many controlled substance analogs (MDMA, GHB, ketamine, PCP) may trigger traumatic emotional episodes in many users. While there is little evidence to support the claim that drug use can cause long-term psychotic or schizophrenic behaviors, individuals with an underlying mental condition may find their experimentation with so-called designer drugs triggers an outbreak of symptoms associated with mental illness. Anecdotal evidence suggests that psychotic breaks and schizophrenia-like symptoms are far more frequent with heavy or regular dissociative anesthetic use (including ketamine and PCP).

LEGAL CONSEQUENCES

In 1970, amphetamines constituted 14% of all psychoactive drugs prescribed by physicians in the United States. The passage of the Controlled Substances Act (CSA) abruptly changed the availability of amphetamines by imposing severe manufacturing quotas and by establishing strict guidelines for their use.

The passage of the CSA pushed the manufacture of banned substances into illicit laboratories and promoted experimentation with substances that were similar to, but distinct from, controlled substances. The federal government responded by modifying the Controlled Substances Act in 1986, banning all designer drugs and all possible variations of controlled substances.

The amendment states that any new drug that is substantially similar to a controlled substance currently listed under the Code of Federal Regulations (CFR), Schedule I or II, and has either pharmacological properties similar to a Schedule I or II substance or is represented as having those properties, will be considered a controlled substance and duly categorized as Schedule I.

In case there be any doubt about the government's intent to prosecute and jail people charged with drug offenses, it is worth noting that between 1980 and 1997, drug arrests tripled in the United States. In 1997, four out of five drug arrests (79.5%) were for possession.

In the country's largest state, California, the number of people locked up for drug offenses has increased 25-fold since 1980. Nearly half of all drug offenders imprisoned in the state in 2000 were imprisoned on possession charges alone.

See also Ecstasy (MDMA); GHB; Ketamine; Methamphetamine; PCP (phencyclidine); 2C-B

RESOURCES

Books

Holland, Julie, M.D. Ecstasy: The Complete Guide, A Comprehensive Look at the Risks and Benefits of MDMA. Rochester, VT: Inner Traditions. 2001.

Periodicals

De Boer, D., et al. "More Data About the New Psychoactive Drug 2C-B." Journal of Analytical Toxicology 23 (May/June 1999): 227-228.

European Monitoring Center for Drugs and Drug Addiction. Report on the Risk Assessment of Ketamine in the Framework of the Joint Action on New Synthetic Drugs. September 2000.

European Monitoring Center For Drugs And Drug Addiction. Risk-Assessment Report. October 1999.

Groombridge, Christopher. "The Identification of 4 Methylthioamphetamine in a Drug Seizure." Microgram 31 (May 1998): 150-159.

MacKeen, Dawn. "Kicking the PCP Habit." Salon Health & Body Sec. August 24, 1999.

Poortman-van der Meer, Anneke J. "The Identification of 4 Methylthioamphetamine." Microgram 31 (June 1998): 174-179.

U.N. World Health Organization. Guide to Drug Use Epidemiology. March 2000.

U.N. World Health Organization. United Nations International Drug Control Program. Evaluation of Psychoactive Substance Use. February 2000.

U.S. Department of Health and Human Services. 2001 Monitoring the Future, National Results of Adolescent Drug Use. January2002.

U.S. Department of Health and Human Services. Community Epidemiology Work Group. National Institutes of Health Epidemiologic Trends in Drug Abuse, Advance Report. June 2000.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. 2000 National Household Survey on Drug Abuse. October 2001.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network. The DAWN Report: Club Drugs. December2000.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network. Year-End 2000 Emergency Department Data. July 2001.

U.S. Department of Justice. National Drug Intelligence Center. National Drug Threat Assessment 2002. December 2001.

U.S. Office of National Drug Control Policy. Pulse Check: Trends in Drug Abuse. 2000.

Other

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. <http://www.samhsa.gov>.

U.S. Department of Justice. Drug Enforcement Administration. <http://www.usdoj.gov/dea>.U.S. National Institute on Drug Abuse. <http://www.nida.nih.gov>.

U.S. Office of National Drug Control Policy. <http://www.whitehousedrugpolicy.org>.

Christopher V.G. Barillas