Club Drugs
SPECIAL TOPIC: "ECSTASY" AND OTHER CLUB DRUGS
The last issue of Pulse Check addressed "club drugs" as a special topic because of increasing reports that a wide variety of illicit drugs were being used and sold, mostly by white youth from middle to upper SES groups, in nightclub and rave settings. Since then—amid concern about increased consequences and possible spread to other populations and broader settings and contexts— this problem has continued to be monitored by numerous sources, including the Drug Abuse Warning Network (DAWN), the Monitoring the Future (MTF) study, the Community Epidemiology Work Group (CEWG), the Drug Enforcement Administration (DEA), and numerous local law enforcement and public health agencies. The growth of the problem, particularly the proliferation of "ecstasy" (methylenedioxymethamphetamine or MDMA), has warranted further scrutiny by Pulse Check, and so this issue once again devotes a special focus to this broad category of drugs, which includes the following:
- Ecstasy, a synthetic, psychoactive substance with stimulant and mild hallucinogenic properties, is most often used in pill form.
- Gamma hydroxybutyrate (GHB) is a central nervous system depressant usually sold as an odorless, colorless liquid in spring water bottles or as a powder and mixed with beverages. GHB precursors, gamma butyrolatone (GBL) (a chemical used in many industrial cleaners) and 1,4- butanediol (BDL), convert into GHB in the body and have been sold as nutritional supplements in health food stores and over the Internet, often in powder or capsule form.
- Ketamine is a prescription anesthetic with hallucinogenic and dissociative properties and marketed for human use, but primarily for veterinary use. Ketamine can be used in liquid or powder form.
- Rohypnol (flunitrazepam) is a benzodiazepine, no longer marketed in the United States, that is obtained by prescription in Mexico (and sometimes Colombia) and smuggled across the border. It has been involved in numerous drug rapes, but its most common abuse pattern is episodic use by teenagers and young adults as an "alcohol extender" and disinhibitory agent, most often in combination with beer.
- Methamphetamine is a stimulant (discussed in the previous section).
- Nitrous oxide is an inhalant often referred to as laughing gas.
- Lysergic acid diethylamide (LSD) ("acid") is a hallucinogen, most commonly distributed on blotter paper and taken orally.
The club or rave experience typically involves music, dancing, and socializing and usually lasts through the night. Club drugs are commonly combined with one another and with other illicit drugs and alcohol.
For this issue, all four categories of Pulse Check sources were asked about club drug use and activity in their areas. The law enforcement, epidemiologic, and ethnographic sources provided most of the information, whereas treatment sources had little first-hand knowledge of club drug use, suggesting that club drug users have not yet entered the treatment system in large numbers.
Pulse Check discussions suggest that club drug availability and use are increasing, corresponding to reports from the sources listed above. For example, according to DAWN, emergency department mentions for GHB and MDMA increased significantly between 1998 and 1999 (from 1,282 GHB mentions in 1998 to 2,973 in 1999, and from 1,143 MDMA mentions in 1998 to 2,850 in 1999), whereas other club drugs did not increase significantly during this time period. Additionally, emergency department episodes involving club drugs usually involve multiple substances, such as marijuana, cocaine, and other club drugs. Alcohol is a common factor in these episodes.
Similarly, MTF data showed that ecstasy use (both lifetime and past-30-day use) continued to rise sharply between 1999 and 2000 among 8th, 10th, and 12th graders. Furthermore, perceived ecstasy availability among 12th graders (the only grade for which perceived ecstasy availability was reported) also increased markedly during that time period. The other club drugs included in the survey are LSD, Rohypnol, and methamphetamine, use of which declined among 8th, 10th, and 12th graders. GHB, ketamine, nitrous oxide use were not specifically surveyed.
Pulse Check discussions in 2000 further indicate that club drug activity may be expanding from nightclubs and raves to high schools, streets, and open venues; further, they suggest that whites are no longer the exclusive users and sellers, which now include more blacks and Hispanics. Pulse Check sources corroborate the DAWN reports of the continuing practice of combining club drugs with one another, with other illicit drugs, and with alcohol.
ECSTASY AND OTHER CLUB DRUGS: THE PERCEPTION
How serious a problem are club drugs in Pulse Check communities in 2000? Club drugs (including ecstasy) or ecstasy alone were perceived as the emerging drugs in their communities by 27 sources in 18 of the 20 Pulse Check cities (52 percent of 52 responding enforcement, epidemiologic, ethnographic, and treatment sources). Billings and Birmingham were the only two cities where these drugs were not named as an emerging problem. While no sources reported club drugs or ecstasy as their communities' most serious drug problem in 2000, three did report club drugs as the second most serious drug problem: the non-methadone treatment source in Boston, the law enforcement source in Miami, and the law enforcement source in New Orleans.
ECSTASY AND OTHER CLUB
DRUGS:
Availability, Form, Price, and Purity
The most common type of ecstasy available in Pulse Check cities, by far, is the pressed pill (tablet), followed by powder and liquid forms. In Brooklyn, New York, a street gang is reportedly selling a powder form of ecstasy that, like heroin, may be snorted or injected. In Los Angeles, homemade ecstasy is reportedly increasing, albeit not widely available, according to the epidemiologic source.
Has club drug availability changed? (Exhibit 3) More than 80 percent of epidemiologic, ethnographic, and law enforcement respondents report that ecstasy availability increased between 1999 and 2000; only one source (in Portland, Maine) reports that ecstasy availability declined. Ketamine availability increased or remained stable according to most respondents, whereas GHB availability was mixed, with 48 percent of sources from all four U.S. regions reporting increases, and 18 percent reporting declines (in El Paso, Los Angeles, and Miami). Rohypnol availability trends are also mixed, with increases in Denver, El Paso, Los Angeles, Memphis, New Orleans, and St. Louis and declines in Los Angeles and Miami.
How are club drugs and their combinations referred to across the United States? (Exhibit 4) Slang terms for ecstasy are similar across the Nation. It is generally
referred to as "X," although "E," "roll," and "the hug drug" are more recent names. The practice of taking ecstasy is referred to as "rolling."
Ketamine is referred to as "K" or "special K" in most cities, with additional terms by locality. Where available, Rohypnol is referred to by many names, including "roofies," "roches," and "R-2." Slang for other club drug and drug combinations are national or vary by city. The numerous terms for club drug combinations (for example, LSD combined with ecstasy is referred to as "candy flipping" across the Nation) highlight the practice of using club drugs with other club drugs, hallucinogens, heroin, and cocaine, particularly in eastern cities.
What are street-level ecstasy prices across the country and have they changed? (Exhibit 5) Ecstasy ranges from $10 to $45 per pill in Pulse Check cities, according to law enforcement, epidemiologic, and ethnographic sources. Price ranges in the Midwest seem to start at higher levels than elsewhere, while the lowest prices are reported in southern cities. Little information is available on the purity of ecstasy or any club drug.
What adulterants are added to ecstasy across the country? According to law enforcement, epidemiologic, and ethnographic sources, ecstasy may contain many substances other than MDMA, and adulterants include mostly stimulants.
According to a law enforcement source, very weak, home-pressed ecstasy pills were seized in Columbia, South Carolina, where the seller reportedly "sold as many as he wanted to for $25 each."
ECSTASY: THE USERS
Who, Where, How and With What?
Who uses ecstasy? According to all responding epidemiologic and ethnographic sources, ecstasy users are predominantly adolescents and young adults, with many sources mentioning high school and college students (in Boston, Los Angeles, Philadelphia, St. Louis, and Washington, DC). Of 14 epidemiologic and ethnographic respondents, half report that ecstasy users are predominantly male, and half report that they are evenly divided between the genders. Nearly all epidemiologic and ethnographic respondents (87 percent) report that ecstasy users are predominantly whites. In El Paso, however, both Hispanics and whites are reportedly the predominant users, and in Sioux Falls, users represent a cross-section of the general population. Most ecstasy users range from middle to upper socioeconomic status, although in New York, users reportedly fall into all socioeconomic groups. Treatment sources who provided information on club drug use concur that the groups most likely to use ecstasy are adolescents (in Honolulu and Portland) and young adults (in Denver, El Paso, and Los Angeles).
Where do ecstasy users tend to reside? (Exhibit 6) Suburban and urban areas are equally mentioned by Pulse Check epidemiologic and ethnographic sources as areas where ecstasy users reside, with sources in Chicago, St. Louis, and Seattle mentioning both suburbia and the central city as areas where ecstasy users live. Additionally, users tend to reside in affluent areas in Los Angeles and in college apartments and dorms in Philadelphia. In New Orleans, most ecstasy users are young out-of-towners who visit the city.
Where and how is ecstasy used? Ecstasy is used at social settings (mostly nightclubs and dance clubs, raves, and private parties), although it is also reportedly used in private homes, on college campuses (including dorms), and at bars. Ecstasy is almost exclusively taken orally in pill or powder form, although it has also been reportedly used anally in Miami (only one case reported), snorted in Philadelphia, and diluted with water and drunk in St. Louis.
What other drugs do ecstasy users take? According to law enforcement, epidemiologic, ethnographic, and treatment sources, ecstasy— and all club drugs, for that matter— is often used in combination with many other drugs, most commonly alcohol, other club drugs (including GHB and ketamine), marijuana, methamphetamine, psilocybin mushrooms, and LSD. Other combi-nations vary geographically: Rohypnol in El Paso; antidepressants or sildenafil citrate (Viagra ®) in Los Angeles (to gain a "better bump"); powder cocaine in Miami; benzodiazepines in Miami, New York, and Philadelphia; powder heroin or cough syrup in Philadelphia; opiates other than heroin in Portland, Maine; and heroin and diverted pharmaceuticals in Washington, DC.
ECSTASY: THE SELLERS
Who, How, Where, and With What?
Who sells ecstasy? According to law enforcement, epidemiologic, and ethnographic sources, ecstasy sellers, like ecstasy users, are predominantly white, male, middle-class young adults, whose ages range from 14 to 32 years. In Miami, rave operators, nightclub personnel, and security guards at raves also sell ecstasy, and in St. Louis, sellers are predominantly high school and college students. In Birmingham, sellers are often "regular" nightclub patrons who may or may not know the owners of the clubs. Similarly, in Billings, sellers are often nightclub frequenters and rave partygoers. In New York, street gangs and organized crime are becoming involved in ecstasy sales.
Where is ecstasy sold? (Exhibit 7) Similar to ecstasy user settings, Pulse Check law enforcement, epidemiologic, and ethnographic sources overwhelmingly mention nightclubs and raves as the settings for ecstasy sales, with nightclubs or bars mentioned in 17 of 20 Pulse Check cities (by 24 sources), raves in 16 cities (by 19 sources), followed by private parties, private residences, college campuses, streets, and high schools. Other settings for ecstasy sales include dealers' homes in Los Angeles, sex and strip clubs in Miami, shopping malls in New York, and coffee shops in Washington, DC. Law enforcement sources in New York and Philadelphia also report use of the Internet by promoters to advertise nightly raves and by rave goers to locate them.
How is ecstasy sold? According to law enforcement, epidemiologic, and ethnographic sources, the way that ecstasy is sold often depends on the setting. For example, in Birmingham and Chicago nightclubs, buyers are referred to and approach sellers. At Los Angeles raves, buyers may ask users who seem "high" to refer them to an on-site dealer. At Miami raves and nightclubs, "runners" on dance floors are used as liaisons between ecstasy dealers and buyers, and rave operators, security guards, and bar personnel may sell the drug. At raves in Columbia, South Carolina, young, female heroin addicts sell ecstasy and other club drugs for male dealers ("hustling"), so that they can support their heroin habits. In settings other than nightclubs and raves, ecstasy is most often sold hand-to-hand among friends and associates or through introductions and referrals by friends (as reported in Billings, Boston, Columbia, Detroit, and Seattle). In Philadelphia, ecstasy is sold from user to user, and in Washington, DC, it is sold through contacts and beepers.
How is ecstasy packaged and marketed? (Exhibit 8) All law enforcement, epidemiologic, and ethnographic respondents reporting on packaging state that ecstasy is sold as loose pills. Additionally, the pills are packaged in various ways: in small, plastic zipper bags in Honolulu, Los Angeles, Miami, and New Orleans; in plastic pill bottles in Memphis; and in bottles in New Orleans and St. Louis. Liquid ecstasy in New Orleans is packaged in bottles. Most sources report that ecstasy pills are stamped or impressed with a wide variety of designs and logos and that new designs and logos emerge often. Only in Memphis and St. Louis are pills reportedly unlabeled.
OTHER CLUB DRUGS: THE USERS AND SELLERS
Who uses and sells ketamine, GHB, and Rohypnol? (Exhibit 9) Regardless of the specific drug, club drug user and seller characteristics are usually similar with a few key differences. For example, Internet sales are mentioned primarily in conjunction with GHB, veterinary break-ins and pharmacy diversions are mainly associated with ketamine, and Hispanic involvement in use and sales is mentioned only for Rohypnol.
