There has long been found a link between increasing HIV infection rates and drug use. Specifically, stimulants, such as crystal meth have been associated with becoming HIV infected. Crystal Meth is considered a party drug, often used on the club circuits as a way to become freer. Free in every meaning of the word, including sexually free. And so, individuals of all different backgrounds, sexual orientations, colors and races utilize this drug, usually in combinations with others, to achieve the high they so desire. Unfortunately, along with this feeling of freedom, often come unsafe behaviors. So, what can be about it? There are the traditional, HIV prevention programs which have been evolving since the start of the HIV epidemic in the early 1980’s, but what about the obvious link between drug use and HIV infection? It is no mystery that certain behaviors are more prevalent among those individuals utilizing crystal meth and other drugs. It is for this reason, that in a recent study, researchers found utilizing the twelve step program as a means of reducing crystal meth use, can also reduce rates of HIV infection.
What is the Twelve Step Program?
These programs are based on the idea that their only purpose is to work on personal recovery. The most famous of the twelve-step programs include Alcoholics Anonymous (the twelve steps for AA are listed below), which is basically a recovery guide from alcoholism. Since the onset of A.A., there have been many different groups that have used the AA principles for recovery. A branch of the said program is Crystal Meth Anonymous, which is the group in question here.
As the name implies, there are twelve steps or principles by which the program is run. They are as follows:
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Why Would This Program Work to Reduce Rates of HIV Infection?
The twelve step programs are effective because individuals with similar experiences are supporting one another. There is the facility of both guidance and respect that comes with having had a certain life occurrence. Recipients of one’s thoughts or advice are often more welcomed and better received because the receiver feels the advice giver has the proper credentials. In effect, the twelve step program is a peer run group. And peer support has been found to be helpful in both drug reduction programs as well as with HIV prevention. Therefore, the combination of the two protocols, should naturally procure a satisfying and efficient result.
What Did the Study Find?
The University of Illinois at Chicago recruited 64 cocaine- and methamphetamine-using MSM (men who have sex with men) at Crystal Meth Anonymous meetings. In addition, participants were recruited at other twelve step meeting, HIV treatment clinics and through public advertising. Data collected from the participants, which was collected in an “open” fashion including questionnaires, indicated a few things: First, the majority of the individuals did not just use crystal meth. Most individuals utilized an array of various drugs with the most popular combination being crystal meth and cocaine or crack cocaine. There were IV drug users included in this number and out of this group of fifteen, thirteen were HIV positive. The data collected indicated that the participant’s risky sexual behavior declined in conjunction with participation in the Crystal Meth Anonymous meetings. Participants acknowledged the relationship between drug use and risky sexual behaviors. For instance, unprotected sexual anal intercourse dropped from seventy percent to twenty four percent. In addition, the number of sexual behaviors dropped from seven to one per month. For the HIV positive participants in the group, the reduction in risky behaviors was even larger. Participants consistently noted complications in sexual relations during recovery and even attributed reducing sexual risk behaviors because of a fear of drug relapse.
A Two for one Deal
In effect, reducing rates of crystal meth can fix two very pressing and current problems. HIV infection rates are consistently on the way up, and as they rise so dose the financial and personal costs to both the individual infected and general population. Though the originators of the twelve step program probably never thought their plan could have as much influence as it indeed does, it proving quite effective. Perhaps the best part of the twelve step program, as noted prior, is that it is peer based. Utilizing peers to transmit the message of a drug free existence as well as HIV safety serves as a reminder to continue positive behaviors both to the teacher and his or her recipient and that is the overall goal of the interaction.
Crystal Meth, which is short for methamphetamine in its crystallized form (as opposed to being either in a powder or rock formation), has become a very popular drug both in the United States and around the world. This drug, which was used almost three times more than crack cocaine in 1999, is not just a new fad. Crystal meth has been in existence close to one hundred years.
In 1893, Methamphetamine or crystal meth, was first developed from ephedrine. A chemist by the name of Nagayoshi Nagai was responsible for this creation. It wasn’t until 1919, that methamphetamine was turned into its crystallized form by Akira Ogata. Ogata was able to do this by reduction of ephedrine using iodine and red phosphorous. Amphetamine, which is a related drug, first came into existence in 1887 by a Lazar Edeleanu in Germany. Methamphetamine manufacturing initially began in the United States in Hawaii in the 1960s.
The “Flyer’s Chocolate”
One of the earliest uses of methamphetamine occurred during World War II. The German military dispensed Pervitin which was methamphetamine. It was freely administered to both tank crews and aircraft personnel. Chocolate was often dosed with methamphetamine and was known as Fliegerschokolade or "flyer's chocolate". Panzerschokolade or "tanker's chocolate" was given to tank crews.
Hitler and Crystal Meth?
For last three years of Hitler’s life, 1942 - 1945, Adolf Hitler received daily IV injections of methamphetamine by his doctor, Theodor Morell. This was done as treatment for depression and fatigue. Historians have speculated that this was done to treat Parkinson’s disease. However, it is unsure as to whether Hitler had Parkinson’s or if the Parkinson like symptoms (pill rolling finger movements, ataxia or unsteady gait) were due to abuse of methamphetamines.
The Advent of Shabu
After World War II, what became known as “Shabu” or amphetamine became largely available in Japan. This occurred because the Japanese military no longer utilized the drug. In 1951 Shabu became prohibited by the Japanese Ministry of Health banned. The banning of the drug is thought to have contributed to the overproduction of methamphetamine in Japan. Even today, crystal meth is strongly associated with the Japanese underworld and has a strong social taboo associated with it.
After the War
In the 1950s methamphetamine became a more commonly prescribed drug. It was often prescribed for the following:
* narcolepsy
* alcoholism
* treatment of obesity
* and post encephalitic Parkinsonism.
By the 1960s there was a more significant use of illegally manufactured methamphetamines by users within their own homes. Since Crystal meth is made from everyday household chemicals and common household components, it makes it easy to manufacture. Today, instructions for making crystal meth can be viewed on websites and until quite recently, Sudafed, a major component of crystal meth can be purchased in bulk without question. An ounce of crystal meth worth up to $1000 can be made with just eighty dollars of products from your local hardware and pharmacy.
In the 1980’s use of methamphetamines peaked. In fact, San Diego, California was considered the methamphetmine capital of the North America by The Economist magazine.
If There Was Any Doubt, Crystal Meth is Illegal
The United States passed laws in 1983 prohibiting possession of equipment and precursors for methamphetamine production. Shortly thereafter, Canada passed a very similar bill. The Controlled Substance Analogue Enforcement Act was passed by the government in an effort to decrease the growing rate of designer drugs, both in use and production. Regardless of said efforts, use of Crystal meth expanded all throughout the United States especially in the South and Midwest. It is in rural places that clandestine labs are often set up. This is because production of crystal meth causes toxic smells that can dispel unnoticed. Since for every pound of crystal meth there is five to six pounds of toxic waste produced, being in a clandestine area is ideal. If there is no one around, wast can be dispersed throughout the yard and surrounding areas. This is also why police officials have become more observant regarding crystal meth production.
There have been five federal laws and many state laws written since 1989 in order to try to curb production of methamphetamine. Pseudoephedrine or ephedrine, sales have been restricted in order to reduce the amount of the main ingredient of methamphetamine available to the general public. The Combat Methamphetamine Epidemic Act of 2005, was written especially to combat the sales of of pseudoephedrine and ephedrine that an individual may purchase in a specified time period. In addition, there are other requirements regarding storage of these products in order to prevent theft.
Is It Going Anywhere, Anytime soon?
Despite efforts by law enforcement, crystal meth use is still alive and raging throughout the United States and the world. It is a serious issue which will take much more work and effort to combat. For this reason, it is quite feasible that in a few more years, crystal meth will have again appeared in the news yet again, creating an even more interesting history for itself than it has now.
Rohypnol (Flunitrazepam) is a benzodiazepine class of drug. It is primarily used as a hypnotic/sedative type of drug in Europe and South America. It is primarily used for sedation for general anesthesia. Flunitrazepam has similar pharmacological effects to other benzodiazepines but is 10 times more potent than valium. Rohypnol is not manufactured nor has it been approved for clinical use in the United States. It has been widely used in Europe and South America for more than a decade.
The majority of Rohypnol in the USA has been smuggled in from Europe, South America and Mexico. Recent seizures indicate that a significant amount of the drug is smuggled and distributed by the Israelis and Russian drug traffickers. Illicit use of Rohypnol originated in Europe in the 1970s and has increased worldwide since then. However, Rohypnol did not appear in the United States until the early 1990s.
Dose
Flunitrazepam is marketed under the trade name Rohypnol. It is available as a 1- and 2-milligram tablet. In Europe, liquid preparations are available for intravenous use. The effects of flunitrazepam appear approximately 15 to 20 minutes after oral administration, and last for approximately four to six hours. Some residual effects can persist up to 12 hours or more after administration.
Rohypnol Abuse
The drug is frequently available at raves, night clubs, all night parties and bars. The drug has been widely used as a “date rape” drug. Most users of Rohypnol also abuse other drugs including methamphetamine, alcohol and heroin. In the United States, Rohypnol is used widely in Texas and Florida where it is popular among high school students. All reports indicate that the population which uses Rohypnol is rapidly growing. Numerous seizures of the illegal drug have been made by the DEA.
Rohypnol is abused by individuals especially high school students and college students. In the US, each tablet costs about 2-4$. It is usually ingested with alcohol and frequently mixed with other drugs (cocaine, marijuana). Individuals who take it with alcohol report a euphoric feeling and lightheadedness.
Date Rape
Flunitrazepam is known to induce antegrade amnesia in sufficient doses; individuals are unable to remember certain events that they experienced while under the influence of the drug. This property of flunitrazepam has been used by males to aid in the commission of a sexual assault. Most victims do not remember or recall sexual assault, the assailant, or the events surrounding the event.
If an individual suspects that he or she has been a victim of a flunitrazepam-facilitated sexual assault, laboratory testing for flunitrazepam should be done as soon as possible. Recent technological advances can detect flunitrazepam and related compounds in urine for up to 5 days after administration of a single dose of Rohypnol and up to a month in hair.
In the United Kingdom, the use of flunitrazepam has been connected to robbery from sedated victims. Many individuals are robbed each year after having their drinks spiked with sedatives, making drug-assisted robbery as common as drug-assisted rape.
Side effects
Flunitrazepam is considered to be one of the most addictive of the benzodiazepines. It can produce several side effects including:
• Drowsiness, Fatigue
• Gait problems
• Dizziness, lethargy
• Lack of motor coordination
• Slurred speech
• Amnesia and forgetfulness
• Confusion
• nausea, vomiting
• Respiratory depression
Overdose with rohypnol can lead to coma, respiratory arrest and death. Although the drug is classified as a depressant, Rohypnol can cause paradoxical reactions in some individuals that may include excitability or aggressive behavior.
Rohypnol Addiction
Both short and long term use can lead to physical dependence on Rohypnol. The addictive features are more pronounced in individuals who use Rohypnol in large doses for a long time. Long-term use of flunitrazepam can result in psychological and physical dependence and the appearance of withdrawal symptoms when the drug is discontinued.
Flunitrazepam impairs cognitive and psychomotor skills, affects reaction time and driving skills. The use of this drug in combination with alcohol potentiates these side effects, and can lead to toxicity.
Legal status
Flunitrazepam is currently a Schedule III drug under the international Convention on Psychotropic Substances of 1971; in the United States, it is on Schedule IV. According to FDA Associate Director for Domestic and International Drug Control
Nicholas Reuter:
Flunitrazepam was "temporarily controlled in Schedule IV pursuant to a treaty obligation under the 1971 Convention on Psychotropic Substances. At the time flunitrazepam was placed temporarily in Schedule IV . . . there was no evidence of abuse or trafficking of the drug in the United States."
Rohypnol is currently under consideration to be rescheduled to Schedule I, and is already considered such in the States of Florida, Idaho, Minnesota, New Hampshire, New Mexico, North Dakota, Oklahoma, and Pennsylvania. Most states have introduced legislation that provide for stiff prison terms for the possession of flunitrazepam; penalties for use or distribution include life in prison, should death or serious injury occur.
The drug must be declared to US Customs upon arrival. If a valid prescription cannot be produced, the drug may be subject to Customs search and seizure, and the traveler may face criminal charges or deportation.
Ketamine has been around for about 30 years and was initially used only in veterinary medicine. Over the past 2 decades, it has become known that ketamine is a general anesthetic with hallucinogenic and analgesic (pain relieving properties). The drug has a unique ability to differentiate perception from sensation. It is currently widely used in pediatric anesthesia. Ketamine is structurally related to PCP, a drug known for its psychedelic effects and vivid hallucinations. The drug has a tendency to produce a feeling of an out-of-body experience.
Pharmacology of Ketamine
When injected ketamine can cause profound analgesia, respiratory depression, cardiovascular stimulation and amnesia. However, despite the anesthesia, the protective reflexes are maintained. It has excellent analgesic activity and useful for control of severe pain.
Ketamine causes an insensate feeling throughout the body. Prolonged use has been associated with physical and psychological addiction. In the majority of individuals who frequently use ketamine, tolerance does develop to these effects, thus requiring the addicts to consume higher doses.
Dosing
In clinical medicine, ketamine is administered either intravenously or intramuscularly. For illicit uses, ketamine is prepared by evaporating the liquid from the legitimate pharmaceutical product and pulverizing the residue into a powder. All of the ketamine abused has been diverted from legal sources. Theft of veterinary/pharmacy clinics is the most frequently reported source of illicit ketamine.
Ketamine is commonly snorted by abusers. Intra-muscular injection is also a widely used method for abuse. Injected Ketamine takes a few seconds to work whereas snorted ketamine takes 5-15 minutes to take effect.
Symptoms of Ketamine Use
Ketamine is known to cause hallucinations, nausea, mental clouding, loss of memory and an amnestic feeling may occur. Numerous individuals report out of body experiences after having undergone anesthesia with ketamine. Physical features of ketamine use include increased heart rate, paralyzed feeling, numbness, impaired attention, delirium, and high blood pressure
Is Ketamine Addictive?
Although ketamine does not give rise to physical dependence like that seen with morphine, heroin or alcohol, it is associated with a powerful psychological addiction- like that seen with cocaine. Because of its ability to produce intense vivid psychedelic effects it is frequently abused. The psychedelic effects and out of body experiences have been primary reasons why the drug is abused.
Ketamine Abuse
The dose of ketamine which is used by drug addicts is only about 10-25% of the therapeutic dose required to induce anesthesia. At these low doses, it behaves more like a stimulant than a sedative and does not affect the breathing or heart rate, although exceptions do occur. At very high doses, ketamine behaves more like other anesthetics and can induce respiratory arrest and increase blood pressure.
Deaths with abuse of ketamine alone are rare. The majority of fatalities occur when ketamine is combined with other CNS depressants like alcohol, benzodiazepines and a mixture of other illicit drugs.
Side Effects
Prolonged use of ketamine can result in amnesia, impaired motor function, delirium, and respiratory problems that can be fatal. Ketamine can cause loss of in consciousness, neuroses or other mental clouding. Other common side effects include confusion, delirium, vivid dreams, hallucinations and feelings of detachment from the body. Some physicians routinely use haloperidol or a benzodiazepine to alleviate these distressing symptoms.
When injected, ketamine can also cause a significant increase in blood pressure, abnormal heart rhythms, respiratory depression, airway obstruction, visual problems, seizures, skin rash and pain at the injected site.
Drug Interactions
Respiratory depression may occur with over dosage or too rapid a rate of administration of ketamine, in which case mechanical ventilation should be available. Mechanical support of respiration is preferred to administration of anti dotes. Prolonged recovery time from respiratory arrest may occur if barbiturates and/or narcotics are used concurrently with ketamine.
Safety
Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of ketamine (up to ten times that usually required) have been followed by prolonged but complete recovery.
Usage in Pregnancy and Elderly
Since the safe use in pregnancy, including obstetrics (either vaginal or abdominal delivery), has not been established, ketamine use is not recommended. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Treatment Options
Ketamine addiction, like all addiction begins with the acceptance of a problem by the individual. Several drug rehabilitation and treatment facilities are available for ketamine treatment. There are no antidotes to ketamine and the majority of therapy is based on psychotherapy and behavior modification.
Gamma-hydroxybutyrate (GHB) is a sedative and classified as a central nervous system depressant. The drug is known to occur naturally in the body and may have a role in inducing sleep. GHB is a controlled drug in the USA and is classified as a schedule I controlled substance.
Gamma hydroxybutyrate (GHB) is an illicit chemical that has become a major cause of drug-related comas in the US. GHB is fast becoming the most common cause of illicit drug induced coma. The drug traffickers also claim that the drug is an antidepressant, can help reduce weight and has anabolic properties- none of which is substantiated by scientific data.
The drug was initially used in anesthesia but because it’s severe toxicity and unreliable clinical affects, the drug is no longer used. However, the drug was highly touted as an anabolic steroid and thus is frequently sold at gyms and exercise parlors. In fact, the majority of abusers clam that is the anabolic properties which first led them to use the drug. Todate, there is no scientific data to suggest that the drug has any body building properties.
Most individuals who abuse GHB are also abusers of other drugs like valium and alcohol. The drug has also been widely used as a date rape drug.
History
GHB was first manufactured in Europe and was planned to be used as an intravenous anesthetic and for use in narcolepsy. However, clinical studies soon revealed that the drug had major side effects and its results were highly unpredictable.
For the past 2 decades the drug has been used for illicit purposes. Over the years, the drug was classified as a club drug and is widely available at parties, raven, bar and night clubs. It’s most recent fame has come from its use as a date rape drug. Restrictions on its manufacture and availability has allowed proliferation of GHB-look-alike drugs which proliferate all over America.
Analogs of GHB
In recent years, various States have passed legislation to control the sale of GHB, thus making it a criminal offence to possess the drug. This forced limitation in the supply of GHB has resulted in a proliferation of related chemicals, like gamma butyrolactone (GBL) and 1, 4-butanediol (BD). These chemicals are converted to GHB in the body. They are widely available at gyms, parties and night clubs across the nation.
Users of GHB
The most frequent users of GHB are college students and young teenagers. The majority of users attend dance clubs, parties, or rave parties. Recent data indicate that body builders, exotic dancers, strippers and some professional athletes are also frequent users of this drug. Recent seizures indicate that professional business men also consume the drug for sleep. In addition, the gay and lesbian population also uses GHB on an increasing basis.
Dosing
GHB is available as a liquid, powder, tablet or capsule forms. It is colorless, odorless and has a salty taste. It is generally swallowed as a pill. The physiological effects of GHB occur within a few minutes after taking it by mouth. The duration of its actions usually last anywhere from 6-8 hours.
Street Names
GHB has the street names Georgia Home Boy, Liquid Ecstasy (though it is not the liquid form of ecstasy), Easy Lay, Gamma-Oh, Salty Water and Scoop.
Side Effects of GHB
In low doses GHB is a CNS depressant and has similar effects like alcohol. It can induce a sense of calm, relieve anxiety and cause generalized relaxation. When combined with alcohol and other CNS depressants, it can cause severe lethargy, mental confusion, coma and even breathing difficulties
Other adverse effects of GHB use include:
Lightheadedness
Vomiting
Weakness
loss of peripheral vision
agitation
hallucinations
unconsciousness and coma.
GHB OVERDOSE
Overdose can and does occur in individuals who consume GHB. At high doses and especially in combination with alcohol, respiratory depression and coma can occur rapidly. A number of deaths have been reported from GHB overdose.
Tolerance and dependence
Even short term use of GHB is associated with the development of dependence. When GHB is abruptly stopped, the individual may develop:
profuse sweating
anxiety attacks
blood pressure increases
fast heart rate
These symptoms persist for a few days and in many cases require a benzodiazepine for relief. The symptoms may subside on their own after two or three days or in response to medication. Unlike other club drugs, GHB withdrawal symptoms also occur on a delayed basis or second phase symptoms. In the delayed phase of withdrawal the individual may have extreme mental clouding, anxiety, confusion and paranoia. The second phase of withdrawal usually lasts another 2-4 days and may required drug treatment.
GHB DETOXIFICATION PROTOCOLS
Treatment of the GHB withdrawal syndrome is empirical and no standard protocols have yet been devised. However, most treatment centers have utilized benzodiazepines, anti seizure medications and sedative to help with the detoxification/withdrawal symptoms. In addition, it is highly recommended that medications to control the blood pressure be available because of the extreme levels of BP that can occur. Most individual studies indicate that detoxification is a lot safer with the use of antipsychotic medications.
It is also recommended that GHB detoxification be done as an inpatient, so that the individual can be carefully monitored. Most detoxification programs ensure that the individual is slowly tapered of GHB to help reduce the symptoms of withdrawal during detoxification. A number of fatalities have occurred when GHB has been abruptly stopped because GHB withdrawal symptoms may be severe and unpredictable. The help of an addiction specialist is highly recommended during the detoxification procedure. The detoxification program usually takes 10-14 days.
Post Detoxification Treatment
GHB withdrawal is comparatively new to the medical field. Withdrawal is often hazardous and even life threatening. Seeking medical attention from an experienced physician is highly recommended. Even after detoxification, multiple relapses are common in the majority of GHB addiction cases. Sleeping difficulties, depression and anxiety usually require some form of medical therapy. Work with a multidisciplinary group is essential to prevent relapses.
MDMA was first synthesized in Europe as a possible appetite suppressant but never caught on because of its side effects. MDMA (3, 4-Methylenedioxymethamphetamine) is a psychoactive synthetic drug possessing stimulant and hallucinogenic properties. The drug is analogous to amphetamine and LSD in terms of its hallucinogenic properties. Ecstasy is a slang or street name for MDMA. The drug has a tendency to alter perception of time and distance.
The drug was introduced in the USA in the 60s and was legally widely used to treat various psychiatric disorders. However, rather than cure any disorder, it made most patients worse and its use as a therapeutic agent was abandoned soon after. The drug became widely known for its psychedelic effects in the 1980s and its use for this purpose has increased over the past 3 decades. Today, it is the number one Club Drug abused among college students.
Effects of Ecstasy
The majority of individuals who take ecstasy tell of a pleasant, relaxant effect of the drug. The drug is known to heighten the senses of kindness, affection and a loving feeling, and it is this property which make its abuse potential high. The drug is also known to decrease appetite and sleep- a combination which is highly sought after by the college students.
However, the ability of this drug to decrease sleep and increase physical activity endurance combined with its ability to decrease to fluid intake has often resulted in dehydration, exhaustion and even death. Various studies have revealed that even recreational users of the drug might be at risk of developing permanent damage that can manifest depression, anxiety, memory loss, and psychotic disorders.
User Statistics
While MDMA abuse currently is not as widespread as that of many other illicit drugs (cocaine, marijuana), it nonetheless has increased significantly over the past 2 decades. Drug Abuse Warning Network (DAWN) estimates reveal that nationwide hospital emergency room admission for MDMD toxicity has increased significantly over the past decade. Seizures by law enforcement agencies indicate that MDMA is the most smuggled club drug. The drug is smuggled in from Europe, Mexico and even China. All these figures are expected to increase in the coming years.
MDMA is commonly used by individuals who frequent night clubs, raves, rock concerts and beach parties. Recent usage patterns indicate that MDMA is the most popular club drug used by teenagers and college students. Almost every town and city in North America has had the Ecstasy craze and the last decade has seen wider usage among high school adults.
Synthesis
MDMA is not a natural chemical but has to be synthesized in a laboratory. Because the use of this drug is illegal, the drug is manufactured illegal in clandestine laboratories all over the country. Because of government regulation, the precursor drugs required for synthesis are difficult to obtain. The manufactured MDMA has a lot of other chemicals added to it during the processing. Many of these chemicals are impure and include caffeine, dextromethorphan (cough syrup), amphetamines, cocaine and even chalk. Because of the lucrative market, a lot of manufacturers in unsophisticated laboratories add many impure chemicals to dilute the product and increase the profits. Thus, buyers of MDMA should always beware.
Like other illegally manufactured drugs, there are no controls on factors such as the strength and sterility of the drug. This increases the chances of a person overdosing, being poisoned or experiencing other adverse reactions after taking the drug. In most cases, when buying ecstasy, there is very little MDMA and lot of deadly junk.
MDMA/Ecstasy Synonyms
- Adam
- Beans
- Cloud 9
- Decadence, Domex
- E, Essence
- hug
- Kleenex
- Love drug, Love trip, lover’s speed
- M&M
- MDM
- Rave energy, Rolling, Running
- Shabu, Speed for lovers
- Ultimate X-phoria, X
- X-TC, X, X-ing
Dosing
Ecstasy is usually taken by mouth in a pill, tablet, or capsule. These pills come in different colors and sizes. They are sometimes inserted into the anus (known as "shafting" or "shelving"). Injecting ecstasy has increased in recent years. A typical dose has an onset of about 20 to 60 minutes. Users feel a euphoric effect that will last about 3 to 5 hour and the effects may last for up to 1-2 days. Prices range from $25 to $40 per pill.
Drug Schedule
MDMA is a Federal Drug Enforcement Administration (DEA) -- Schedule I Substance -- meaning that it has no medical use and high abuse potential. The Federal penalty for manufacturing or selling the drug are severe and long term prison sentences are not uncommon.
Effects of Ecstasy
The effects of ecstasy are not predictable and vary from individual to individual. The symptoms of ecstasy include the following:
Immediate Effects:
• Extreme confidence
• Sense of well being
• feelings of affection
• anxiety
• dilated pupils
• tensing of the facial muscles, jaw clenching, teeth grinding
• increase in heart rate, body temperature and blood pressure
• nausea
• loss of appetite
• sweating, chills
• rapid eye movements
At higher doses, the toxic complications may include:
• convulsions
• nausea & vomiting
• floating sensations
• manic or bizarre behavior
• hallucination
• paranoia
• psychosis
Who is at risk for MDMA TOXICITY?
Individuals with some disorders are at a slightly higher risk for MDMA toxicity. These individuals may have:
- hypertension
- heart disease
- diabetes
- liver disease
- history of seizures
- Individuals with panic attacks
- Psychiatric disorders
Overdose
Overdose from ecstasy can occur. It is usually presents with a very high body temperature and blood pressure, hallucinations and an increased heartbeat. This is especially dangerous for those who have preexisting heart or lung disease and for individuals with psychiatric disorders. Although the exact cause and number of deaths from ecstasy are difficult to determine, hospital admission records indicate that ecstasy is known to cause deaths by inducing :
• bleeding in the brain
• kidney failure
• overheating of the body, dehydration
• excessive increase in blood pressure
Ecstasy is associated with overheating of the body and for users some precautions should be taken. It is highly recommended that to prevent heat exhaustion and overheating, one drink a lot of water continuously. One should wear loose clothing to help reduce the risk of overheating. A number of individuals, who do develop toxicity from MDMA use, require urgent medical attention. Anyone who is unresponsive, has difficulty breathing or is dehydrated should be immediately transported to the closest Emergency room for treatment.
Tolerance and Dependence
MDMA is an addictive drug and can cause both physical and psychological dependence. Besides the side effects, the drug has severe social, behavioral and health consequences. As to who and when someone becomes addicted remains unknown. Even though long term use of MDMA is known to cause addiction, it is very likely that even short term use may cause partial dependence. There is no doubt that when Ecstasy is used for longer duration and in high doses, tolerance does occur over time. Unfortunately the tolerance is only to the pleasant hallucinogenic effects of the drug and not to the unpleasant side effects which increase in severity with an increase in dose.
Ecstasy can rapidly cause dependence and most individuals complain that they have a difficult time stopping the drug. Because the pleasant effects of Ecstasy diminish with time, most users tend not to use it for prolonged period. However, the addictive nature of the drug makes stopping the drug difficult and the vicious cycle of dependence continues.
Treatment Options
A number of drug treatment options are available to treat Ecstasy dependence. While abstinence may be a suitable management plan for those who have only used MDMA for the short term, it is not a valid solution for long term users. Long terms users develop severe withdrawal symptoms and abrupt abstinence is fraught with medical complications. Most treatment programs offer counseling, behaviors modification, and detoxification with the use of sedatives. Both in and outpatient detoxification programs are available. The aim of all programs is to reduce the risks of detoxification over time.
Pregnancy and HIV
The use of MDMA should be curtailed during pregnancy. The majority of illicit drugs can pass both through the placenta and even be found in breast milk. MDMA has been associated with delayed development and subtle abnormalities in the newborn.
Because certain individuals inject the drug using shared needles, the chances of contracting HIV, hepatitis or other sexually transmissible infections is always present.
In 1893, methamphetamine (meth) was first synthesized from ephedrine by Japanese chemist, Nagayoshi Nagai. In 1919, Akira Ogata synthesized crystallized meth by reducing ephedrine using red phosphorous and iodine.1 In the 1950s, Pharmacology and Therapeutics reported legal prescriptions of methamphetamine given to the American public for the treatment of narcolepsy, post-encephalitic Parkinsonism, alcoholism, and obesity.2
Meth is an extremely potent stimulant that works within the central neverous system and affects the bodies neurochemical mechanisms that are responsible for regulating appetite, heart rate, blood pressure, body temperature, blood pressure, attention, mood and automatic responses such as alertness or alarm. Methamphetamine causes the norempinephrine transporter and the dopamine transporter to switch their direction of flow. This switch causes a release of these transmitters from the vesicles to the cytoplasm and from the cytoplasm to the synapse, causing increased stimulation of post-synaptic receptors. In addition, Meth indirecly prevents the reuptake of these neurotransmitters, causing them to remain in the synaptic cleft.3 It is neurotoxic in overdose.4
Because the "high" that methamphetamine gives is intense and can last from eight to 24 hours, it has replaced cocaine, heroin, and marijuana as the drug of choice in many areas. Known on the street as "speed," "meth," "ice," and "crystal," it can be injected, smoked, snorted, or swallowed. During an interview with Dr. David McDowell, M.D.,(medical director of the Substance Treatment and Research Service at Columbia University at the New York State Psychiatric Institute)states, "The timing and intensity of the ‘rush’ are a result of the release of high levels of dopamine in the brain. Methods that cause methamphetamine to pass into the brain more quickly—smoking or injecting—are more reinforcing and more addiction."5
There are several serious physical and psychological risks involved when using crystal meth including: increased blood pressure, rapid heart rate, inflammation of the heart lining, damage to small blood vessels in the brain which can lead to stroke, episodes of violent behavior, anxiety, paranoia, insomnia, and confusion.6 Intravenous users also expose themselves to risks such as human immunodeficiency virus (HIV), hepatitis B and C, blood-borne viruses, scarred and collapsed veins, infections of the heart lining and valves, abscesses, pneumonia, tuberculosis, and liver or kidney disease. After using meth, the addict crashes which can cause feelings of depression and suicide. After discontinuing use, Crystal meth addicts can have continuous psychotic symptoms that persist for months and years.
According to the United States Department of Justice Drug Enforcement Agency (DEA) and under the Controlled Substance Act (CSA), all controlled substances are rated on a five-schedule system. Schedule V, the lowest, for the potential for abuse and dependency and I, the highest. Crystal meth is a Schedule II controlled substance having the following attributes: a high potential for abuse, severe psychological and physical dependence. Other drugs in this category are cocaine and PCP.7
Behavioral intervention is the most effective treatment for crystal meth addiction. These approaches are designed to help modify the patient's thinking, their expectancies, and behaviors, and to increase skills in coping with various life stressors. Meth recovery support groups such as 12-step programs are also effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery. There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs such as methamphetamine.8 There are also numerous treatment obstacles such as: paranoia, decreased social skills, delusions, depression, malnutrition, violence, aggression, permanent psychological problems, kidney and lung disorders, liver damage, hallucinations, and feeling of suicide.9
In conclusion, crystal methamphetamine continues to plague our world and recovery from this hazardous drug proves to be among the most difficult habits to break. Education is a must if society desires to demolish these trends. Education and awareness is key to stopping the crystal meth epidemic today, tomorrow and years to come.
Club drugs have become the drugs of choice at all night dance parties. These dance parties are often referred to as raves or trances and are generally frequented by young adults. These dance parties are held at clubs, bars and hotels. These high energy parties frequently involve loud rock music and flashing neon/laser lights. These all night parties frequented by ravers are almost always associated with the use of club drugs. The use of club drugs has increased significantly over the past 2 decades. The danger of mixing alcohol and club drugs also has the potential to cause serious intoxication and fatalities are not unheard of.
MDMA, GHB, Rohypnol, ketamine, methamphetamine, and LSD are the most common club drugs used at these parties. One reason for their increased use is the easy availability, low cost and their intoxicating effects produced. Because the majority of the club drugs are colorless, tasteless and odorless, they can easily be added inconspicuously to beverages by persons who want to intoxicate or sedate others individuals.
Because of the tendency of club drugs to sedate others, the subject of date rape has become a recent concern. Date rapes have been on the rise and often involve friends and associates. These drugs have the potential to cause retrograde amnesia and thus the victims usually are unable to remember or have any memory of the event. These drugs also have the ability to decrease a person’s inhibition and alter the mental capacity of individuals. These factors make it easy to date rape friends or acquaintances.
Because of the increased demands for these drugs and the potential to make money, many individuals intentionally manufacture them under less than ideal conditions. Thus possible contamination and impurities are always a concern for users.
MDMA (ecstasy)
The most widely used club drug is MDMA (ecstasy). MDMA was developed and marketed in the early 1990s as an appetite suppressant, although it has never been clinically used in humans. The drug bears a strong resemblance to amphetamine like drugs. When ingested, it can produce brain stimulation with a dominance of hallucinogens and psychedelic effects. Over the past decade the use of the drug has slightly declined among older individuals but the use of MDMA is still on the increase by teenagers and college students.
MDMA has dual properties acting as a brain stimulant and also has the ability to generate hallucinogenic effects. Ecstasy is an available as a pill/capsule which is easily concealed. Its duration of action is known to last at least 4-8 hours. In a few people it can cause idiosyncratic reactions like depression, insomnia and severe anxiety for long periods, ranging from a few days to weeks. Other common side effects of ecstasy include panic attacks, syncope, coma, seizures, chills, diaphoresis, muscle cramps and blurred vision. Deaths have been known to occur especially when the drug is combined with alcohol or other club drugs. MDMA is known to cause malignant hyperthermia which is fatal if not treated.
MDMA use enables the individual to be awake for extended periods, but this may lead to dehydration, heart or kidney failure due to lack of appetite and physical over activity. MDMA is neurotoxic agent and its affects to the brain are permanent if used chronically.
Gamma hydroxyl butyrate (GHB)
GHB (liquid ecstasy) is a strong sedative and often used as “date rape” drug. The drug is available as a clear liquid, powder, capsule or pill and is easily dissolved in alcohol or soft drinks. Once ingested, the drug rapidly takes effect and the sedative effects can last up to 4-6 hours. Prolonged loss of consciousness, breathing difficulties, seizures, coma and even death has been reported with the drug.
The drug is used predominantly by adolescents and young adults during all night parties. The drug is often manufactured at home by obtaining ingredients purchased from local food stores, pharmacies and the internet. The drug has the potential to be a strong sedative and also has euphoric effects. Also noticed over the past decade is that GHB can release anabolic hormones which can increase muscle size. Some claim that GHB is also a potent aphrodisiac like chemical.
Because GHB is a central nervous system depressant, it can also lead to increased lethargy, coma and even death. Overdose with GHB are not rare especially when it is ingested with alcohol or other CNS suppressant drugs. The drug is rapidly excreted from the body and often escapes detection in the body when patients are admitted to hospital.
Rohypnol
Rohypnol (flunitrazepam) is also known as rophies. It belongs to the benzodiazepine class of drugs (such as valium) and acts like a sedative. It is not approved for clinical use in the USA, but is approved as a sedative in Europe. Because of its ability to cause antegrade/retrograde amnesia, it is often used in anesthesia.
The drug is tasteless and odorless and is easily dissolved in both non alcoholic and alcoholic beverages, thus making it a popular “date rape” drug. The drug is very potent and has a prolonged action which can last up to 12 hours. When combined with alcohol, it is known to cause mental confusion and lethargy. Drowsiness, dizziness, mental slowing lethargy and constipation can result with the use of rohypnol. Deaths have been reported with the drug when combined with alcohol.
Methamphetamine
Methamphetamine (speed) is a brain stimulant that causes delusions of grandeur, hyperexcitation, irritability, anxiety, and panic. The drug is frequently manufactured in clandestine factories using impure and cheap ingredients. The drug may be ingested, inhaled or even smoked. It is associated with a number of serious side effects which include mental confusion, extreme aggression, paranoia, psychotic ideations and damage to the heart. It has a great potential to be addictive. It is available as a pill, capsule or powder; the drug can be ingested, snorted, injected or smoked. Its actions may last up to 24 hours. When first ingested, it always produces an intense rush and a feeling of extreme confidence and euphoria.
Overdose with the drug can cause extreme agitation, slurred speech, fever, hal¬lucinations, seizures and death. Methamphetamine is known to cause irreversible damage to the heart, kidney, lung and liver. When the drug is injected, the spread of HIV has been known to occur, especially in those sharing needles.
LSD
LSD (acid) is a chemical with hallucinogenic properties and has the ability to generate extra sensory perceptions. The effects of LSD are highly unpredictable. Different individuals experience different perceptions, depending on their pre morbid personality.
LSD is available as a clear liquid, tablet, capsule, or the drug may be leached on to pieces of paper which can be swallowed. The effects of LSD are apparent within 20-40 mins after ingestion and can cause a mild increase in heart rate, blood pressure, diaphoresis and a loss of appetite. Dry mouth and restlessness are also common features.
Overdose can cause dramatic visual flashbacks, psychotic ideations and delusions of grandeur. Extrasensory perceptions such as sound and colors are amplified. Some individuals may experience severe reactions such as frightening vivid imaginations and this is referred to as a “bad trip”. Bad trip reactions can often last from 12-24 hours.
Those who use LSD chronically are prone to developing psychotic ideations and recurrent hallucinations.
Ketamine
Ketamine is a general anesthetic used in clinical medicine. It is widely used in animal medicine also and has properties similar to the hallucinogen, Phencyclidine. The agent has the ability to cause dissociative anesthesia and is available as a liquid or powder.
After anesthesia with ketamine, patients have reported hallucinations and dream like states. Illicit use is common with this agent which can be inhaled, injected or even smoked with marijuana or cigarettes. The drug can increase blood pressure and may even cause difficulty in breathing. Deaths have been reported with this drug.
Prolonged use of ketamine often leads to mental confusion, impaired learning and loss of memory.
Summary
Club drugs are illegal drugs which are widely used at all night parties. Almost all of them have the potential to cause serious health problems and death is always a concern. The drugs have the potential to cause addiction with serious consequences. Club drugs are frequently used as “date rape“drugs and thus all friends acquaintances and associates “ beware”.
