August 2008 Page 1 of 4

Club drugs† are a pharmacologically

heterogeneous group of psychoactive

compounds that tend to be abused by

teens and young adults at a nightclub,

bar, rave, or trance scene. Gamma

hydroxybutyrate (GHB), Rohypnol, and

ketamine are some of the drugs in this

group; so are MDMA (ecstasy) and

methamphetamine, which are featured in

a separate InfoFacts.

• GHB (Xyrem) is a central nervous

system (CNS) depressant that was

approved by the Food and Drug

Administration (FDA) in 2002 for

use in the treatment of narcolepsy

(a sleep disorder). This approval

came with severe restrictions, including its use only for the treatment of

narcolepsy, and the requirement for

a patient registry monitored by the

FDA. GHB is also a metabolite of the

inhibitory neurotransmitter gammaaminobutyric acid (GABA); thus, it

is found naturally in the brain, but

at concentrations much lower than

doses that are abused.

• Rohypnol (flunitrazepam) started

appearing in the United States in the

early 1990s. It is a benzodiazepine

(chemically similar to Valium or

Xanax), but it is not approved for

medical use in this country, and its

importation is banned.

• Ketamine is a dissociative anesthetic,

mostly used in veterinary practice.

How are Club Drugs

Abused?

Raves and trance events are generally

night-long dances, often held in warehouses. Many who attend raves and

trances do not use club drugs, but those

who do may be attracted to their generally low cost and the intoxicating highs

that are said to deepen the rave or

trance experience.

• Rohypnol is usually taken orally,

although there are reports that it can

be ground up and snorted.

• GHB and Rohypnol have both been

used to facilitate date rape (also

known as “drug rape,” “acquaintance rape,” or “drug-assisted”

assault). They can be colorless, tasteless, and odorless, and can be

added to beverages and ingested

unbeknownst to the victim. When

mixed with alcohol, Rohypnol can

incapacitate victims and prevent

them from resisting sexual assault.

• GHB also has anabolic effects (it

stimulates protein synthesis) and has

been sought by bodybuilders to aid

in fat reduction and muscle building.

Club Drugs

(GHB, Ketamine, and Rohypnol)
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• Ketamine is usually snorted or injected intramuscularly.

How do Club Drugs Affect

the Brain?

• GHB acts on at least two sites in the

brain: the GABAB receptor and a

specific GHB binding site. At high

doses, GHB's sedative effects may

result in sleep, coma, or death.

Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can produce anterograde

amnesia, in which individuals may

not remember events they experienced while under the influence of

the drug.

• Ketamine is a dissociative anesthetic,

so called because it distorts perceptions of sight and sound and produces

feelings of detachment from the environment and self. Ketamine acts on a

type of glutamate receptor (NMDA

receptor) to produce its effects, similar

to those of the drug PCP.1 Low-dose

intoxication results in impaired attention, learning ability, and memory.

At higher doses, ketamine can cause

dreamlike states and hallucinations;

and at higher doses still, ketamine

can cause delirium and amnesia.

Addictive Potential

• Repeated use of GHB may lead to

withdrawal effects, including insomnia, anxiety, tremors, and sweating.

Severe withdrawal reactions have

been reported among patients presenting from an overdose of GHB or

related compounds, especially if

other drugs or alcohol are involved.2

• Like other benzodiazepines, chronic

use of Rohypnol can produce tolerance and dependence.

• There have been reports of people

binging on ketamine, a behavior that

is similar to that seen in some

cocaine- or amphetamine-dependent

individuals. Ketamine users can

develop signs of tolerance and cravings for the drug.3

What Other Adverse Effects

do Club Drugs Have on

Health?

Uncertainties about the sources, chemicals, and possible contaminants used to

manufacture many club drugs make it

extremely difficult to determine toxicity

and associated medical consequences.

• Coma and seizures can occur following use of GHB. Combined use with

other drugs such as alcohol can

result in nausea and breathing difficulties. GHB and two of its precursors, gamma butyrolactone (GBL)

and 1,4 butanediol (BD), have been

involved in poisonings, overdoses,

date rapes, and deaths.

• Rohypnol may be lethal when mixed

with alcohol and/or other CNS

depressants.

• Ketamine, in high doses, can cause

impaired motor function, high blood

pressure, and potentially fatal respiratory problems.
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What Treatment Options

Exist?

There is very little information in scientific literature about treatment for persons

who abuse or are dependent upon club

drugs.

• There are no GHB detection tests for

use in emergency rooms, and as

many clinicians are unfamiliar with

the drug, many GHB incidents likely

go undetected. According to case

reports, however, patients who abuse

GHB appear to present both a mixed

picture of severe problems upon

admission and good response to

treatment, which often involves

residential services.2

• Treatment for Rohypnol follows

accepted protocols for any benzodiazepine, which may consist of a

3- to 5-day inpatient detoxification

program with 24-hour intensive medical monitoring and management of

withdrawal symptoms, since withdrawal from benzodiazepines can

be life-threatening.2

• Patients with a ketamine overdose

are managed through supportive

care for acute symptoms, with

special attention to cardiac and

respiratory functions.4

How Widespread is Club

Drug Abuse?

Monitoring the Future (MTF)

Survey††

According to results of the 2007 MTF

survey, 0.7 percent of students in the

8th grade reported past-year††† use of

GHB, as did 0.6 percent and 0.9 percent of students in grades 10 and 12,

respectively. This is consistent with use

reported in 2006.

Past-year use of ketamine did not

change significantly from 2006 to

2007—use was reported by 1.0 percent

of 8th-graders, 0.8 percent of 10thgraders, and 1.3 percent of 12thgraders in 2007.

There was no significant change in the

illicit use of Rohypnol from 2006 to

2007, according to 2007 MTF results,

which report consistently low levels of

Rohypnol use since the drug was added

to the survey in 1996. Annual prevalence of use stands now at around 0.5

percent in all three grades surveyed.
August 2008 Page 4 of 4

† For more information about club drugs, visit www.clubdrugs.gov, www.teens.drugabuse.gov, and

www.backtoschool.drugabuse.gov; or call NIDA at 877-643-2644. For street terms searchable by drug name,

street term, cost and quantities, drug trade, and drug use, visit http://www.whitehousedrugpolicy.gov/

streetterms/default.asp.

†† These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of

Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes

since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at

www.drugabuse.gov.

††† “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past

month” refers to use at least once during the 30 days preceding an individual’s response to the survey. “Lifetime”

refers to use at least once during a respondent’s lifetime.

References

1 Maeng S, Zarate CA Jr. The role of glutamate in mood disorders: Results from the ketamine in major depression

study and the presumed cellular mechanism underlying its antidepressant effects. Curr Psychiatry Rep 9(6):467–474,

2007.

2 Maxwell JC, Spence RT. Profiles of club drug users in treatment. Subst Use Misuse 40(9–10):1409–1426, 2005.

3 Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and dependence. J Psychoactive Drugs 33(2):151–158, 2001.

4 Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and g–hydroxybutyrate. Am J Health-Syst Pharm 59(11):1067–1076, 2002.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.